I have type 1 and my sister was just diagnosed with diabetes. But they put her on a anti-diabetic pill and it normalized. She went off the pill after a week or so and with a low carb diet she has decent control with no meds.
I think she might have LADA considering all the elements. Finding a good endo for this has been challenging because she wants to preserve her beta cell functionality and most endos just want to start her on insulin right away.
Can anyone recommend an endo that specializes in this in the DC area?
Many, many endos believe that starting a person with LADA on insulin immediately WILL preserve beta cell function. Not all agree with this and like to push off insulin because of the lows, but if she's looking to preserve her beta cells, getting her started on insulin will protect them rather than tax them like other drugs.
There are some who believe that starting a person with LADA on insulin early won't do much. There is evidence to support both claims, but there is no evidence that starting a person on insulin will decline beta cell function. Therefore, there is possible benefit to the beta cells and no risk to the beta cells for starting insulin.
Thanks Guitarnut. I only can speak of my own experiences. I was diagnosed with T1 through intense ketacidosis so most likely I did not have LADA. However, when they put me on Novolog and Lantus- I noticed that I did get some beta cell function back. In fact, I could go days without taking Lantus.
I sometimes wish that I had only taking the rapid acting insulin. Maybe it could of preserved my beta cell function better.
I really don't think any endo "specializes" in LADA. What you really want is an astute endo and one who will listen and work with you. If find one and your sister asks for the proper tests then you will get a proper diagnosis. I am in the DC area and if you send me a private message, I will give you the info for my endo in the area.
First question: if she has good control, why do they want to start her on insulin? If her A1C is too high, she stopped takingthe meds... Anyway
He has not gotten the best reviews here, but I use Northern Virginia Endocrinolgists in Fairfax, and see Dr. Ross. They are rated well, and I only use my endo for pump and cgm supplies. He is a bit gruff, but his advice is generally very good and I called yesterday for an appointment and got one for Monday.
There are other docs in the practice, but I choose him based on the reviews. I would call and ask about the beta cell protection angle.
George Washintion hospital has a fantastic endo department and is easy access from Falls Church. They do tons of research and are always up to date. My wonderful endo left the area, and I no longer needed that kind of care, but they were great, but hard to get an appointment... I am sure they would love to see an LADA whose goal is the protect beta cells. It has research written all over it!
Spock, I am a type 1 myself and actually Dr Ross is my endo too. I like him and would give him good reviews.
I like him better then my endo is Europe (where i am living now) But, we could not get her an appointment with him because he was not available. She met with Langley I believe.
The Doctors are little clueless on her case because of she restored her normal blood sugars with a pill and a low carb diet. The only problem is that she is loosing too much weight eating that way. She has lost 20lbs or so and she was lean to begin with..
It is actually quite reasonable to restore normalized blood sugars with LADA. But that doesn't make you ok. It simply means that you can control things temporarily. I have seen Dr. Ross as well, and agree he is gruff but competent. He helped me with my endocrine problems related to over medication from the cardiologist, but basically threw me out on my diabetes, having no interest in helping my diabetes problem unless it was "really bad."
Your sister is one of those in the outlying arenas. Her goals are great and wonderful, but not on the radar of the typical endo. I am not surprised they seem clueless.
When I visit endo offices, I just see a lot unhappy and unhealthy people. I find it a very sad place to be. I think endos work with those people a lot, not so much those of us who care and accept diabetes.
Brian, how did you handle his lack of interest? He looks at my reports and charts and acts like I am stupid. Last time I saw him, he said my glucose levels are way too low, I was having too many lows, etc. My A1C was 5.6, but I commented it had been 5.1 for several years. He had three responses: --If you have A1Cs of 5.1, I won't see you anymore.
--These low glucose levels will kill you way before the high ones will cause damage. Lows will impact your heart and your brain, so...
--A normal A1C is 7 or below. With an A1C of 5.6, you have a lot of room to play, so loosen up on yourself.
I go back on Monday. I have loosened up a LOT, but still have many lows. He is very gruff with me, and took all my reports and paperwork and threw them in a cabinet. I called back later to make sure the important paperwork was OK. It was a new office and I was told that the cabinet should have had a trash can. OMG so glad I called as they saved the medical reports/requests from my PCP. Not impresssed with his attitude.
When I lived in Falls Church I went to see Dr. Christine Go in Arlington. Not too far. I liked her (but I like my endo here in Colorado better - in fact I like him better than the endos I saw at the Joslin Center in Boston).
Yeah he can be that way sometimes. But he has also been very helpful to me when I needed him. The first three years after I was diagnosed, I was having a lot of lows and my A1Cs ranged from 4.5-5.5 max. (I was going to the gym before and after every meal).
He didn't go so far as to say that he would stop seeing me but he did look at my low to normal (and high) carb ratio and recommended that I try and get it up.
The last few years I went to him it was probably within the 6-7 A1C range and he seemed more comfortable with those numbers - but of course my lows were much better.
I have had a few doctors in my life who have been passive which led to some problems so i appreciate DR Ross's gruff style in a way.
Well, this was nearly 7 years ago and I saw him primarily because of the statin problems. At the time, through the Bernstein diet and medication I had gotten my A1c down to 5.9 shortly after diagnosis. When I asked him to take me on as a patient, he refused, basically saying that he had lots of patients in much worse shape who needed him.
After my debacle with my previous endo I looked for a new endo. I specifically wanted one who would "listen to me." Not a characteristic I remembered from Dr. Gruff. I also wanted an endo who could accept my desire for "normal" blood sugars and my low carb lifestyle. And since I had started insulin, I wanted a Dr. who would accept and work with me on an insulin regime as a T2.
So, given all the discussion, I'll tell you who I chose. I now see Nahrain Al-Zubaidi who works out of Fairfax Corner. She is also on the faculty at Georgetown. She listens and really works with me. And although she struggles with running late, she will spend time with patients if they need it. I always felt shuttled out the door after only a few minutes of Dr. dominated conversation, but not so with her. She is a fan of low carb diets and although we discuss the risk of hypos, she has worked with me over the last two years as my A1c has ranged from 5.3 to 5.6% and not gotten all over my case about hypos.
I had one doctor who was gruff and sort of rude and I didn't bother seeing him for very long. I'm perhaps more confident now at 45 than I was when I was 20 something and probably rather wild but I'd find a way to complain about the guy or at least get the word out that he's not pleasant.
My doctor initially expressed alarm about hypos, was ok for a while, got appropriately alarmed after one of the hypos caught me but hasn't belabored the point and, *knocks on wood*, lets me run the show and is very supportive and complimentary of my efforts. If she sees a pattern that looks off, she'll ask me about it and we discuss things. My next appointment will be interesting as it seems as if my CGM has run off the rails a bit lately. The BG is ok but the sensor data will be more off than usual I think, which may give us less to talk about. Perhaps I'll bring my meter and see if she wants to d/l that to compare?
Hello! I am the sister and finally got on tudiabetes. The docs dont know how to diagnose met yet. Technically my glucose tolerance test came up as impaired glucose tolerance as opposed to diabetes but when this all started I had an A1C of 8.6. My first antibody tests came up negative, the second time I was "mildly positive" for the GAD antibody. At first I was taking Amaryl, which brought me down from my initial bsl of 303 mg/dl to super lows, such that I gradually came off it within a week. Since then I have been controlling it with a low carb diet. My last A1c was 4.5 and that was 3 months after that first blood sugar test without any medication of any sort (except for 5 days on amaryl). I had heard about the use of insulin preserving beta cells, but the fact that I had lost 10 lbs when I was already thin was reason enough to give me small doses of insulin so I could up my carb amounts. Two weeks ago I started taking a couple units of levemir in the morning, but I haven't found that it really does anything that I can tell. Maybe brings me lower between meals, but it doesn't affect how my blood sugar reacts to carbs. Right now I eat between 80 and 120 g of carbohydrates a day and eating lots of fats and protein, though still not gaining. I currently live abroad and will be moving to the DC area soon, which is why my brother is trying to help me find an endo there. Thanks for your support and information everyone! It sounds like people have some good (and not so good) endos :)
