New LADA, question about treatment if BG is well controlled

Hi - please forgive me if I am posting in the incorrect place.

A quick re-cap - 46 yo female, diagnosed 10 months ago with A1C of 10.7, BG of around 250+. I have responded very well to Metformin 500 mg 2x/day, and watch my carbs, test a lot, exercise, etc. A1C has done well - 10.7 to 6.7 to 5.6, most recently 6.0. FBG ranges around 110.

I got confirmation this week after GAD test that I do have LADA. (My mother has adult on set T1 since her late 40's and my uncle on paternal side had T1 as well.)

This was only my second visit with endo (PCP did not encourage me, as I was responding well, but I had a gut feeling the more I research I did and found this endo through word of mouth.) I am feeling confident in him, but know I need to be my own best advocate and really do my homework.

My question is: He has indicated that insulin is of course in my future, but will keep me on my current course for now. 3 month follow up, but call if any changes noted. Does this seem prudent? I have found some info that earlier insulin may preserve remaining beta cells, but am not sure at what point that is advised. I will review with him at my next visit - and will make an appointment sooner if advisable. I have found information that some classes of drugs (I won';t attempt to spell, but Glipizide, etc.)are not appropriate for LADAs but that doesn't seem to be the case with Metformin.

I thank you in advance for any insight!


Hi Marty, welcome to the community. Please read some of Melitta's blogs. She's our unofficial expert on LADA here. here's one of my favorites:

Thank you, will do. and now I realized I should have posted this in the LADA forum....sorry! I tried to move it, but now sure I can.

I was diagnosed as LADA last summer in DKA with a1C of 15!! The C-peptide test showed really low function and the doc started me with Metformin, basal insulin Lantus, and Humolog on a sliding scale when I was released from hospital. I didn’t need the sliding scale doses very long but by keeping a detailed log, I realized that my BG was spiking after meals and so I talked with my CDE about pre-meal bolus Humolog. I’m doing much better now!

So…I recommend doing random pre-and-post-meal BG checks to help you track how much insulin you are producing. And also reading Think Like a Pancreas by Gary Scheiner so you’ll have good information about using insulin before you get to that stage.

Wow, sorry to hear about your DKA, and glad you are doing better! I am reading Think Like a Pancreas right now (I've had it for a few months, but didn't read it, thinking "I'm T2, I don't need that" :)) It is very helpful and I've been getting a grasp of the basics, but want to do all my homework. I do test like crazy, and have a good idea of how different foods/things affect me. I don't typically see highs after meals over 160 (either 1.5 or 2 hours), but do eat low carb - 20-30 per meals plus three snacks of 15-25. Seems to work for me. Thanks for the response. Are you still taking Metformin?

You’re doing great! Yes, I am still on Metformin but there are ptos and cons. I lost weight I really didn’t need to lose but I take less basal insulin. I do have to watch that I get enough carbs when I am very active.

Hi Marty50: Welcome to the adult-onset Type 1 club! It's not a very exclusive club, because there are a lot of us. There is good evidence that early insulin treatment helps preserve beta cells, and The Type 1 Diabetes Sourcebook (ADA/JDRF 2013) recommends starting insulin as soon as possible in adult-onset Type 1. That said, you are achieving good results in your honeymoon, so you would want to approach insulin use cautiously. Some TuD members have started on as little as 3 units of long-acting insulin to begin with. Welcome and best of luck!


I too have heard the advice that you're better off starting on insulin therapy sooner rather than later. I believe Gliclazide is a sulfonylurea and (from memory) it stimulates your pancreas to produce insulin (happy to be corrected on this). Your poor old pancreas is already doing it's best and doesn't need this, so LADA's are put on insulin earlier to try and preserve what pancreatic function they have.

The trouble is most LADAs are misdiagnosed as Type 2 (I was for 8 years).

It sounds like your Metformin is helping (it's a good drug but many need the slow release version or lots of reading material). The difficulty you might face given that your numbers are good is getting a low enough dose of insulin. I managed for around 4 years on basal only (and low carb) but have to bolus now as well. The longer you can delay this (with good numbers) the easier life will be, but dont do it at the expense of beating up your pancreas.


No worries posting here. Some of the sub-forums aren’t viewed by as many people. Welcome to TuD!

Good for you for being aware of the direct relationship between carbohydrate consumption and the blood glucose levels it drives. Carb limits are a rational tactic to limit post-meal BG.

Marty - Be aware that there are some in your situation that dilute insulin to help accurate delivery of small doses. Most insulin is produced in U100 concentration. Diluting to U50 halves the concentration and allows you to deliver twice the quantity. It’s easier to accurately deliver 1 unit of U50 than it is 1/2 unit of U100.

TuD member, 2hobbit1, successfully uses U50 insulin. Her case is similar to yours.

Thank you so much Melitta! your posts have been so helpful to me. I am very cautious about insulin, having seen my mother as a newly diagnosed type 1 about 30 years ago experience some very scary lows. But I am also optimistic and so thankful to have guidance. Thanks again.

Thank you Swim. I am reading like mad and trying to get myself up to date before talking to my endo about starting basal. My gut feeling is he will want me to prolong the wait a bit, but I am trying to find the balance. Thank you so much, this forum is a life-saver!

Hi Terry - Thank you - I have just read about U50. i will look into it more, thanks for the tip!!

Be aware that U50 is not commercially sold. It must be diluted from U100. 2hobbit1’s description of the process makes it seem relatively straight forward. I would expect the average doctor to be skittish about this, simply do to inexperience. Doctors are sometimes more driven by legal fears than by good patient outcomes.

Hi Marty: The insulins of today are thankfully so much better than the insulins of 30 years ago, and they actually decrease the likelihood of hypos. I was on "the old stuff" (R and NPH) and saw a significant decrease in hypos when I switched to Humalog when it first came out. And Terry has also given some good advice regarding U50.

Dumb question time but I assume this is not when using pre-filled pens. I use Novorapid in an already loaded pen.