LADA thoughts? I was originally diagnosed gestational (she’s almost 18 now) and put immediately on insulin. I then failed the follow-up test so went on a pump for the next 6 years (and 2 more pregnancies, both from metformin). After the last, I lost some weight and got too sensitive so dropped the pump. I then tried several meds that didn’t work and eventually tried the pump again for a year. I found out about functional medicine, which drastically reduced inflammation once I healed my gut, dropped the pump again. My previous endo tested for GAD and ICA 3-4 years ago, both negative. He suggested MODY, but 2 genetic tests proved negative. I also have PCOS (diagnosed at 17, low BMI), but cycles have become normal, although there could be some lingering insulin resistance, maybe?
I do have Hashimotos and am C/T for DQ8, which is associated with type-1. I just had my new integrative med family doctor test for GAD, ICA, ZnT8, all negative. IA-2 is 1.5H (<0.8 (U/mL)) and Insulin AutoAntibody is 42.3H (<0.4 (U/mL)). Could these confirm LADA? I have not used insulin for ~5 years, so could the IAA be from previous usage, or am I actually producing antibodies to my own?
A1C has been consistent 6.1-6.4 for the past several years, fasting is now ~135-140, rarely go above 300 and it drops quickly once it gets high, so I know I am still producing insulin. Non-fasting after small low carb breakfast C-Peptide (0.80-3.85 (ng/mL)) is 1.60, which looks to be lowish.
I have done what I can with diet and exercise (mostly AIP), so I know I need to work on getting some sort of treatment, especially since MODY2 wasn’t found. Meds, including metformin, had negligible effect on A1C and FBG, so insulin is likely going to be it again.
I feel I am a lot closer to finally identifying my diabetes and dropping the type-2 label (normal/low BMI, not type-2 phenotype), but don’t know if I am there yet.

Your experience and knowledge of your health status easily exceeds mine, but perhaps @Melitta could respond to you. She has written extensively on the misdiagnosis of T1D-LADA as T2D. There are other members here experienced with gestational diabetes.

@SusanA1, there is also something called “idiopathic diabetes,” or “Type 1b,” which is largely genetic, presents very much like LADA, but doesn’t have any antibodies associated with it. I only learned about this because my doctor suspects that is my diagnosis, although I’m not on insulin yet. I’m also not Type-2 phenotype, have low insulin-resistance, low insulin production, and am insulin sensitive.

On a couple of side notes, I would not want to be running a consistent A1c above 6.0, and fasting at 140 would have me very, very concerned (about developing complications). Also, insulin antibodies themselves are not considered diagnostic if the patient has ever used exogenous insulin, to my understanding. So I think that could be from previous usage.

I’m a plant doctor, and a fairly newbie diabetic myself, but… do you take any other meds to control your diabetes or are you only eating low-carb? PCOS and gestational are definitely correlated with Type 2, so is it possible that you’ve had Type 2 for many, many years and don’t match the “phenotype” because of lifestyle changes you’ve made? If so, you may just have beta cells that are becoming fatigued and less-useful over time. For reference, I haven’t found any peer-reviewed literature on LADA suggesting that sufficient endogenous insulin response lasts more than six years post-diagnosis, so 18 years seems unlikely on that front.

Again, I don’t know, just trying to spitball some ideas. I too am really trying to figure out what my “proper” diagnosis is, so I’ve been reading up on all the non-typical presentations and rarer types of diabetes :slight_smile:

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what is LADA?

Latent Autoimmune Diabetes in Adults. a usually slow progressing type 1.

Formerly known as type 2 diabetes in thin adults. (Kidding, sorta)

ugh, that’s where I am diagnosed now

Could it possibly be that I am only just now actually showing antibodies, the first being IA-2 and insulin, as it looks to happen with much earlier diagnosed type-1’s? Perhaps I have had symptoms for many years, but am only now starting to develop the antibodies so these are the initial to show? I plan on continuing to run labs to see if/when it starts progressing further.

Was your glucose level tested at the same time as your c peptide level? It’s essentially meaningless without the simultaneous glucose level…

It sounds to me that you’re nearer the type 1 end of the spectrum than the type 2 end. (I’ll catch a bunch of flack for phrasing it that way)

Ultimately what they call it doesn’t matter as long as you’re getting treatment appropriate to keep it controlled within your abilities and goals— it sounds like you’ve already used insulin and a pump— that’s really the end of the treatment progression, so now that you’re at that point, it’s pretty much all just words…

No, it wasn’t by the lab, but my test was 140. The conundrum I am in is that I am officially type-2 since my endo’s test showed no antibodies and he was pretty much at a loss as to what is causing it. I have used insulin and the pump, but that has been several years ago. No treatment now other than diet and exercise.
Since MODY has been ruled out, and my thyroid issues have since been determined to be hashi’s, I want to verify that my diabetes may or may not be AI as well. My FBG has been creeping up slowly, and I am showing these antibodies, it is time to find another endo to see where to go from here.

You might find this post by @melitta to be helpful

our community was founded by @askmanny, himself a LADA originally misdiagnosed as T2D

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Hi Susan: You are IA-2 positive, and being positive for any one autoantibody means you have Type 1 autoimmune diabetes. You most certainly are not antibody negative!! Please get your doctor to change your chart on that basis (if you need references for a correct diagnosis, I can provide those). About 10% of women with gestational diabetes are autoantibody positive, and have autoimmune gestational diabetes. I know a woman who had GDM, and she went 30 years before being diagnosed with Type 1/LADA! And of course Hashimoto’s is closely linked with Type 1, especially in women. Let me know if you have questions, and welcome.

Thanks Melitta, yes could you send those references? Next step is to find an endo who gets integrative medicine. The last one humored me when I asked to finally confirm my AI thyroid.

Here is a link to my blog on autoimmune GDM

Thank you!
As far as the insulin antibodies, would you know whether that is likely a current issue against my own insulin or could it be historical against the insulin I took years ago? I think it has been about 5 years since I have used exo insulin.

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And Susan, below is a link to a blog I wrote that includes the reference I was referring to, from the Expert Committee on the Diagnosis and Treatment of Diabetes Mellitus. See the section on “inclusion in appropriate statistics.” According to the Expert Committee, autoantibodies are never present in Type 2 diabetes, and Type 1 diabetes is caused by immune-mediated destruction of the beta cells, and the autoantibodies are evidence of the autoimmune attack.

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My understanding is that, once you have used exogenous insulin, the insulin autoantibody test is not valid for you. But again, you are IA-2 positive. By definition, if you have been diagnosed with diabetes and are positive for any one autoantibody, you have Type 1 diabetes.

Are the insulin and IA-2 autoantibody tests the same thing? If so wouldn’t that mean she’s only positive on a test that is “no longer valid for you” per your own definition?

IA-2 is Islet Antigen antibody test, which is different from an insulin antibody test. IA-2, along with GAD, and now ZnT8, are considered diagnostic for Type 1 when above the reference range (which I believe can differ by lab). The Insulin Antibody test only works if you haven’t ever taken exogenous insulin.

If the person tested is positive for both IA-2 and insulin antibodies, the former can still be diagnostic (if above reference) while the second is no longer valid.

*edit: the insulin antibody tests are known as IgG and IgM.