Gestational diabetes that did not go away vs. LADA- please advise

Hi, here is a short summary of my diabetic struggles and since I’m totally new here I’ll appreciate some advice.

Female, 36 years old, thin (110 lb), diagnosed with Rheumatoid Artthrisis 7 years ago, currently in full remission.

First pregnancy 2011, gestational diabetes went away immediately after giving birth
Second pregnancy 2015, GD again, now 3 months postpartum oral glucose test 194 and A1c 6.1 so basically diabetic.

Tested myself just before 2nd pregnancy and all numbers were perfect so this is not undetected T2.

My PCP suspects LADA but tests results will come in few weeks. Do you think that this might be LADA?If so how come it went away after first pregnancy?I understand that having another autoimmune disease makes me prone to LADA?Someone has similar experiences?


It is certainly possible that this is LADA or Type 1, particularly with your history of already having one autoimmune disease. I had a coworker approach me because she knew I’m diabetic (she saw my alert bracelet). She had the exact situation you described. Gestational with baby 1 that went away, Gestational with baby 2 that did not. Her ‘wonderful’ doctor informed her that since she was 28, she was “too old” for type 1, and that she must be being non-complaint with her diet, even though she had lost significant weight and was underweight with BGs in the low 200’s. She asked me whether it was possible to be type 1, and then demanded the antibody tests from her doc. Turns out, she was a type 1 and is much healthier now that she is getting the insulin that she needed.

Regardless of the answer, I hope you get appropriate treatment and feel better! Good Luck!

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I always find the term LADA misleading because it is just a slower developing form of T1 diabetes. Most likely all T1 have some chance of working against the attacks of the immune system. In my impression the battle is lost when the immune system starts to attack the bood vessels supporting the beta cells (the cells producing the insulin). Up to this point the beta cells can sort of cope by growing new cells. Still their mass already declines - albeit slowly.

Pregnancy is a big challenge for the beta cells. The weight gain and the hormones are reducing the effectiveness of insulin. If you are already developing T1 this can be the tipping point. If the remaining mass of beta cells has to produce at their maximum then these cells will suffer damage. Their high workload prevents that they can divide and grow new cells at a rate sufficient to keep the current mass. This is refered to as glucotoxitity (=stress on the cells related to workload). It can then be treated as gestational diabetes. Here the chances are good that the exogenous insulin will relief the beta cells from the burden of covering all insulin needs. Thus the beta cells mass can regrow again. However the immune system is getting better and better at attacking the beta cells. So it just takes time or a second pregnancy to tipp this over and fully develop T1.

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Pat, your story is incredibly common. About 10% of women with gestational diabetes will have autoantibodies indicating autoimmune GDM, or Type 1 diabetes that develops/becomes “overt” during pregnancy. So yes, there is a good chance that you have LADA or slowly progressive Type 1.

It is quite common, and likely is autoimmune type diabetes. This type of diabetes can be very slowly progressive… with insulin to control sugar levels, maybe it will not progress very much…

I was diagnosed with diabetes very early in my first pregnancy. After delivery, things went back to pretty low dosing because I insisted I wanted excellent blood sugar and also because I was planning for baby no. 2 as soon as possible, so insulin was the treatment of choice (though it was low dose). Baby no. 2 did not happen as soon as planned… but 3 years later she was on the way and I was on very high doses of insulin during that pregnancy. After her delivery things did not go back down as much as the previous and I have continued insulin since then on a slightly higher dose, but combined with low carb eating (mostly). With insulin I can keep my hba1c around 5.0. I currently use about 25 units of insulin a day…

No family history of diabetes that I know of. I haven’t been tested for antibodies (except GAD, which was negative). I am also hypothyroid, asthma, allergies… so good history of autoimmune. My current Dr still calls me Type 2, which I don’t agree with, but I don’t really care enough to push the issue at this point as long as I get the treatment needed (and there’s no insurance company interfering here).

Oh my I did not realize that. I actually moved to United States because of much better RA treatment options as I had a really bad flare after first pregnancy. I’m in remission with RA after biological treatment and I end up with another auto-immune illness that I know nothing about yet. If this diagnosis confirms should I ask my doctor to put me on insulin immediately or should I wait as I still can control it with diet? I know that insulin is a matter of time but I’ve read that its better not to delay insulin?

Hi Pat: I am glad that your PCP is testing you to see if you have Type 1 diabetes. Good to keep working with your healthcare provider to get the appropriate diagnosis and treatment. If indeed you have slowly progressive Type 1 diabetes, IMO there is substantial evidence that early insulin therapy is the best way to preserve remnant beta cell mass and basically have better health outcomes. For example, The Type 1 Diabetes Sourcebook (ADA/JDRF 2013) says, “for those with early Type 1 diabetes, expert opinion recommends either low doses of basal insulin to prevent diabetic ketoacidosis (DKA) or prandial insulin to prevent postprandial hyperglycemia.” Dr. Richard Bernstein, author of The Diabetes Solution, believes the honeymoon can be prolonged indefinitely. He says (page 104): “Based upon my experience with the fair number of type 1 diabetics I’ve treated from the time of diagnosis, I’m convinced that the honeymoon period can be prolonged indefinitely. The trick is to assist the pancreas and keep it as quiescent as possible. With the meticulous use of small doses of injected insulin and with the essential use of a very low carbohydrate diet, the remaining capacity of the pancreas, I believe, can be preserved.”

Finally, I wrote a blog on autoimmune gestational diabetes that you may find useful. And yes, it can be overwhelming, but you are doing all the right things!

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I had a dear friend who had had GD and then later was diagnosed as T2. Now I’m wondering if she might have been LADA and not getting the right treatment. I have to say, though, that she was very unwilling to modify her diet, probably didn’t take whatever meds she was on regularly, was under a huge amount of stress, smoked a lot, and didn’t exercise. She had a heart attack and eventually passed away from congestive heart failure. I still miss her…

Thank you so much for all the insight. No one has ever mentioned Type 1 when I had GD neither in USA nor in Europe where I had my first baby. When I come to think of it my late grandpa was diagnosed at 45 and extremely thin and always treated for type 2 but on oral meds for very long time. They completely failed to work on him and he ended up on insulin when having many diabetic complications so too late. I now think he must have had Type 1/lada.

I had gestational with both pregnancies. 5 years later…diagnosed with type one. I feel my pregnancies contributed to this but don’t know. I know it took awhile but I think my body was moving towards type one after my second was born. Like others…diabetes went away after my first. Then a1c crept up after number 2. Not sure though. Other factors were involved im sure but my body def felt different after my second was born.

My second pregnancy was very different also. Very fatigued but no bloodwork done. I had a midwife during that time. She did not do bloodwork of any kind. Eighteen months after the baby came, the type 1 diagnosis on my 27th bday. My health continued to better after insulin. Today, I am 52 yrs old with Type 1 for 25 yrs. Doing very well with no complications. Take care of yourself.

I was initially diagnosed with GD at 20 (with BG’s over 400), then labeled T2 when it didn’t “go away” after delivery despite no family history and no risk factors (I was NOT overweight at the time, in fact I was well under my pre-pregnancy weight by 6 weeks PP and had a BMI of about 20). There really was no time for me where things returned to “normal” - I wasn’t ever able to go off insulin without my #'s shooting up really really high… and I still had to fight the moron doctors (my OB and the internist they referred me to) who I saw initially who dismissed the possibility i could really have T1, and find a new doctor (an endo) willing to do the right testing and diagnose me properly.

The worst part was that during this, the first doctor (internist) kept telling me to STOP taking insulin and encouraged me to stop breastfeeding so I could try “more” oral meds - my relationship wth her ended with me screaming at her in the office and walking out because I was so frustrated with the whole situation… and I was never billed for that last appointment. All I really wanted at the time was access “better” insulin (I was using R and N, Lantus had just hit the market, but what I really wanted was Humalog for better meal coverage) and she kept denying me and chastising me for “not following her orders”… what “Type” I was really didn’t matter to me at the time, and I don’t know why she had such a hangup about “letting” me use insulin.

You’re right! Controlling your BS is most important thing you can do.

Your experience demonstrates a willfully ignorant stance taken by some doctors. You did the right thing. I get that medicine is a huge body of knowledge exploding by the minute and no human being, doctors included, can know everything.

Your doctor’s attitude at the time (I hope your interaction caused some productive self-doubt.) reeks of the philosophy of “doctor as god” that still exists, to some extent, today. It’s highly paternalistic and treats the patient as a child.

In this day and age of better access to solid medical data as well as forums like this one that spreads pertinent knowledge well beyond the typical sphere of many clinicians, times have changed. Doctoring is a tough business and practitioners with big egos are slowly learning about things they don’t know. It has to be hard on this personality type. Your story underlines the idea that it’s the patient who is ultimately in charge, providing s/he has the power to hire and fire. This is all good, good for both the patient and the doctor.

So just wanted to share that my GADA test came back positive so indeed I see my case was a classic one. I now have LADA and Rheumatoid Arthrisis and still cant believe how this sucks big time. Next week I have an appointment with endo. Should I demand insulin right away? My sugars are spiking whenever I have anything thats over 15/20 grams of carbs. By spiking I mean 150/160 as Im not taking a chance of eating a high carb meal and watch the spike over 200;)fasting glucose still perfect. What treatment is used at this stage?

Sorry I see that Mellita already posted some useful information to my question earlier. I’m just a bit overwhelmed at the moment. Egh…

Hi there. It sucks. It truly does. I have been on this roller coaster a second compared to others. But…I promise you that you will feel better. I would 100 percent get insulin. You won’t need much now. But I thought it was a weird sensation when I first used it. =) and it took a while for my body (and mind) to get used to it. It was allllllll I thought about the first month. I’m getting better now. All I wanted you to the emotions you are feeling are completely normal. But you will feel better once you learn how and take insulin. Good luck to you.

Sorry to have to welcome you to the club that no one wants to belong to.

I think you should ideally discuss with your doctor about using fasting acting insulin for meals. This is probably a small dose but will mean you can avoid highs. This most important thing to avoiding complications is keeping blood sugars normal or very close to it.

What they know is that by preventing highs they may be able to dramatically slow the progression of diabetes.

I do recommend reading Bernstein Diabetes Solutions, if you haven’t already. I’ve found him an excellent resource, even though I don’t follow everything he teaches.