Early LADA vs T2

How important is the difference in a diagnosis of T2 vs LADA in the really early stages? I was diagnosed really early when I failed a GTT during pregnancy and then continued to monitor afterwards so I could show that I was having high blood sugars despite a normal A1C and insist on continued monitoring, and sure enough my numbers and A1C increased. I thought they had ruled out LADA because I am negative for autoantibodies, but at my recent appointment my Endo mentioned that it’s still a possibility. I’m diet controlled when not pregnant, on fast-acting insulin for pregnancy.

The antibodies don’t always present early on.

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@Hammer is right. Not all Lada’s present with antibodies. The diagnosis is only pertinent when you need/want DME. T2s fight for everything as the Insurance company will outright deny on multiple occasions until you go to a review board so they can save a few $. T1s generally, but not always, have an easier time obtaining DME.

Regardless of diagnosis, your treatment should be what works best for you as an individual, not your diagnosis type. Many early Lada’s are not insulin dependant yet, and many T2s are. In my opinion, forget about the diagnosis and focus on the treatment and how it affects you both short term and long term.

I was diagnosed Type 2, then re-diagnosed LADA after further testing. However, it hasn’t much changed my treatment at this point. With one major exception: for someone with a very controlled A1c (consistently between 4.5-5.2% over the last 18 months), I test a lot more frequently with both glucometer and regular labwork than a well-controlled Type 2 might. Both of my doctors (metabolic specialist and family doctor) want me to keep up both regular bloodwork (every 3 months) and test more than is recommended typically for most T2s. And the one time I got to have an appointment with an endocrinologist, after telling me I was wasting her time (hah) by being in such good control, she insisted I keep testing regularly and eat carbs before and during exercise.

For me, that means my treatment is pretty mainstream for Type 2: 2,000mg Metformin ER (seems to help with DP); low-carb diet; lots of exercise. It works, for the most part, except a persistently iffy fasting glucose reading.

My labwork (and other clues) is what consistently shows that I’m not Type 2:

  • very low to below normal insulin production since diagnosis (fasting insulin and c-peptide tests)
  • borderline high to high antibody tests (Anti-GAD); incidentally, my first test was below the threshold (negative for antibodies)
  • insulin sensitivity causes some weird issues with exercise for a non-insulin dependent diabetic…I have the typical “weightlifting spike” with intense exercise (40-80 mg/dL jump that doesn’t come back down til I eat something after exercising), and I have real, (mild) clinical lows if I don’t consume carbs during endurance exercise (like cycling or running for more than 60 minutes at a time)

So, annoyingly enough, I apparently produce enough insulin to cause exercise issues, but not enough to eat “normally” or keep my BG steady through the course of the day without treatment. My doctors think that the autoimmune attack, in my case, is causing an inability for my pancreas to respond to serum/blood glucose levels in addition to lowering my overall capacity for insulin production. So, while I can produce some amount of insulin regularly, my pancreas doesn’t always know when to produce that insulin.

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Also, did they do a C-Peptide test? This will tell you how much insulin your body is producing. This, to me at least, is far more important that whether you have any verifiable antibodies.
IF your body isn’t producing enough insulin, for WHATEVER reason, you need to start on insulin. Or at least be prepared to start on insulin. Some people have a long honeymoon period, and others don’t.

The exercise and stress issues are why I have named my pancreas Lazy and Stupid. Lazy doesn’t respond to slow steady rises, but Stupid will pour out the insulin with a sharp rise and then I plummet into the 30’s or 40’s. BTW, I spike with any exercise or stress. Going to ask the Endo about metformin at my appt. next month. Hope it will lessen the liver dumps and stop all the stress spikes.

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They did a c-peptide (non-fasting) a couple years ago and it was on the lower end of the normal range. My recent fasting insulin was below the reference range, I’m insulin sensitive, thin, eat healthy, active, and have 3 relatives including my father who were diagnosed as T1 around my age. I was told low fasting insulin doesn’t necessarily mean anything though since my fasting blood sugar was normal (82). At this point I just have a deficient first-phase insulin response so I will spike high if I eat any carbs and then come back down quickly, but my fasting numbers are still good.

Insurance covers nothing normally because I’m diet-controlled so I buy strips out of pocket. Right now they will cover stuff because I’m pregnant so I don’t have to worry about that again until January.

This was basically me when I was first diagnosed. I ate a low carb, then a ZERO carb diet for a while. But exercise would drop me like a rock.
Took a while before my honeymoon phase progressed into needing insulin.
Given the pregnancy, anything is possible. No experience there :wink:
But if things start taking a progressive decline in responsiveness, I will get checked out ASAP.
Taking notes on what your BGs are will help this out. It will help see a trend before it gets too bad.

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