Help With Treatment Options for Another Newbie?

Hi. I’ve just found this forum after a recent diagnosis of LADA. I will begin reviewing all of the material on this site - it looks like there’s a wealth of it!! If you don’t mind, I have a couple of questions I’d like to pose. Some of them might be answered elsewhere on the site but in case not… any input would be greatly appreciated.

I’ll begin with a recap of my situation in case that helps…

I’m in my mid forties and have been treated for Hashimotos for about 8 years. I have a long line of auto-immune illnesses in my immediate family. Interestingly enough auto-immune diabetes is not one of them - this really came out of the blue for me. I’m still having a hard time believing this is actually happening.

A year ago my fasting bg level was 111 and hba1c was 5.7. My doctor wasn’t too concerned but I bought a glucometer anyway to get a better handle. Despite cutting back on carbs, increasing protein and joining a gym I saw post-meal numbers of 180 - 260. Not all the time, just enough to know something was wrong. This years labs showed a fasting bg of 126 and an hba1c of 6.1. At this same time my normally well controlled TSH had jumped and so far hasn’t responded to a bump in meds.

My doctor referred me to an endo in December. Thats where the fun really began - it’s been a terribly frustrating experience. Endo #1 was very dismissive of me, but at least ordered the tests I needed. My Gad65 came back positive, my insulin was 4 (range = 1 - 21) and my c-peptide was 1.6 (range = 1 - 5.2). My oral glucose tolerance 2-hour reading was over 260. That office called me with the results and had me scheduled to return in three months. Needless to say I didn’t return there.

I scheduled a consultation with a reknowned out of state medical research and treatment facility thinking they would do a better auto-immune work up. That was a big let down. This endo had nothing to add, just said I was T1 diabetic and could start on insulin if I wanted to – it was up to me. He had me meet with a nurse-educator and nutrionist and both of them were visibly scratching their heads – couldn’t figure out why I was being prescribed insulin and said I didn’t fit the profile of any diabetic they’d ever met. I wasn’t comfortable starting insulin on my own so I didn’t fill the script.

Last week I met with a local endo and thank goodness really liked him - at least he had a decent personality. His told me I’m not Type 1 and I’m not Type 2 – I’m something in between. Translation: Type 1.5/LADA. By this time I was mentally prepared to start insulin and was convinced it was the prudent path. I was really surprised when he told me I didn’t need insulin and should start with oral medications. He first mentioned Metformin. I had read there was concern that Metformin could accelerate beta cell decline. He said there’s no evidence of that, but prescribed Onglyza instead. I’m supposed to try that and see him again in 6 weeks. After researching Onglyza I became concerned with that treatment plan, so called back and had them prescribe Metformin instead. The plan now is for me to try that for six weeks and go from there.

Even though it’s been 4 months of untreated time now since my first endo visit, I feel like I’ve caught this fairly early. I’d like to take advantage of that if early intervention can help with the outcome, so I want to get this right from the start.

My questions at this point are:

  • Has anyone experienced issues with they TSH/hypothyroidism when developing diabetes (if one ‘develops’ diabetes)? Is this typical? It’s bothering me that the endo’s are only focused on the diabetes and no one is talking about my thyroid.

  • Is Type 1.5/LADA diabetes simply the early stages of Type 1 diabetes or is it actually a blend of Type 1 and Type 2 diabetes (ie: both a lack of insulin and insulin resistance?) It seems like I see both definitions. If it’s the former, does anything other than insulin address the problem? Why would a doctor prescribe Type 2 meds? If it’s the latter, are oral meds the right first step?

  • Has anyone else seen literature on the effects of Metformin and beta cell decline? Does anyone have experience using Metformin for LADA? Positive/Negative results?

  • Similar questions regarding Onglyza. I’ve read it’s been very effective helping T2 diabetics control glucose numbers, but also read there is concern about the fact that it’s in essence a permanent inhibitor of Dpp-4. Dpp-4 also has cancer-fighting capabilities, so do you put yourself at risk by using it? It’s only been approved for 18-months (Januvia since 2006) so has there been enough time to understand the long-term effects? The auto-immune system is so delicate and intertwined that I hate the thought of tinkering with it any more unless I absolutely need to. The more I think about it the more comfortable I get with the idea of insulin – more of a direct replacement for something my body’s not producing (much like Synthroid) as opposed to using medications that often come with side-effects – known and unknown.

  • Does anyone know how to interpret the insulin and c-peptide test results? I don’t know what those numbers should be in a ‘normal’ person so I’m not sure what they mean.

Feel free to tell me if I’m obsessing too much on these med choices. I’m just afraid of making a bad situation worse don’t want to regret someday that I didn’t do my homework.

Hi Dazed and Confuzed–you are in the early stages of Type 1 diabetes, and T1 is very closely linked with hashimotos. I was diagnosed with both at the same time. Check out my blogs that I have written on adult-onset Type 1 diabetes, and hopefully you will find some answers there. The basic answer I would give is that all people with Type 1 diabetes, whether rapid onset or slow onset, should be on exogenous insulin. It is the proven method to preserve the few remaining beta cells you have. You have to go about it wisely, as you probably will not need much insulin to start with. I hope this helps, and I hope others chime in to help! Good luck, and go with a doctor who you feel treats you with respect and is truly concerned for your well-being.

Not that I can help you, but welcome to this board! I am also a new LADA diagnosis and your questions are normal not obsessive! Everyone wants more knowledge as knowledge is power! I can tell you that my c-peptide was 1.4 and according to the endo I am making some insulin. Melitta is the expert and there are many others including BSC I am sure he will find his way to this post! I’m glad you are here and insulin is truly the best! I’m knew to that as well. Since I have been on it I have felt so much better. The pills never really controlled my diabetes, but insulin is so much better. You will find that if you start insulin your energy level soars and you just feel normal again! Glad to have you on the board! =)

Dazed and Confused! What a perfect screen name for where you are. I’m also new to D and just now beginning to feel like I can manage my disease. I won’t pretend to be an authority on any of this, especially the oral meds. But I can tell you that you are probably in the best place to get your questions answered and learn what you need through all the great folks and the many experiences they share. I take some time each day to review the blog and forum pages and always find something to further my understanding of D and how to manage it. Welcome and best wishes.

Hi - I am another that has both Hashimotos and Type 1. This is a common pairing. LADA is Type 1 diabetes. The LADA distinction is only to say when you go it – as an adult rather than as a child. Because of remnant insulin in your pancreas, there is a bit of a delay while all of the insulin producing beta cells to be destroyed. This is true of all Type 1 diabetics. It just typically goes a little faster for children than for adults. So there will be a ramping up where oral medications could be helpful. But ultimately you will have to be on insulin. Many physicians will start you on insulin right away. As for your test results a Type 1 will usually have C peptide less than 0.5. Mine was less than 0.5 at diagnosis. A Type 2 will typically have an elevated C-peptide. The other tests are GAD 65 and IA-2. These are antibody tests.

Thank you all for the responses. I really appreciate the input. I’m sure like many I’m finding this a little overwhelming in the early stages – especially when doctors aren’t consistent with their advice. It’s wonderful to have this community to turn to and help sort it all out. I’m slowly making my way through all of the information available here – there just aren’t enough hours in the day!!