My name is Jasmine and I’m 23 years old. I live in North Carolina and I am a graduate student and nanny. I recently went to the endocrinologist with a complaint of recurrent low blood sugar. Some of my low blood sugars were fasting but many of them were 2-4 hours after meals. While checking my blood sugar sugars before visiting the endocrinologist to try and discern a pattern, I discovered that my blood sugars reached the 170’s-180’s post high carb meals. I also spike to at least 140 even briefly no matter what I eat. My endocrinologist tested for insulin antibodies, IA-2 antibodies, ZNT8 antibodies and Anti GAD 65 antibodies. I only tested positive for the Anti GAD 65 antibodies. My c-peptide level was 2.6 with a lab reference range of 1.1 to 4.4. My blood sugar was 76 and I was fasting, although I don’t believe that actually has any impact on c-peptide based on what I’ve read. My A1C was 5 which is up from 4.5 when my primary care doctor checked it during my physical exam 4 months ago. My endocrinologist explained that she believes the hypoglycemia is attributed to abnormal insulin release patterns as part of the early stages of Type 1 based on my positive antibody test, c-peptide level and higher than normal post prandial readings. She referred me to a nutritionist who explained the importance of eating low carb, eliminating processed food and excess sugar (all of which are important, diabetes or not). Right now, we’re just watching and waiting and I’m doing what I can to eat low carb to try and preserve beta cell function for as long as possible. I’m going back to see the endocrinologist in 3 months to recheck c-peptide and A1C. I just wanted to see if anyone here had a similar experience or can provide me with more insight into what these results and numbers mean for my life. Thanks for any help you guys can offer!!
This sounds like classic LADA, and you will find many discussions. Use the search feature.
@melitta has written posts about this, including the testing and results, and challenges with slow onset LADA, that varies from person to person.
I’m classic Type1, diagnosed as a child, 53 years ago. I was fortunate to learn about diabetes gradually, as much of what is used and talked about today was not known back then. You may feel overwhelmed, but this is a great place to get help.
Hi Jasmine and welcome. As MM1 mentions, I write a lot about adult-onset Type 1 diabetes; you can find my blog here. You are very fortunate to have discovered this early, and also to have such a knowledgeable endocrinologist–really great advice there. Going low carb should really help. Online, I have met quite a few people who had reactive hypoglycemia due to a sputtering pancreas. Because you are autoantibody positive, there is a likelihood that you will progress to overt Type 1, but with care and attention (and low carb) you probably will do quite well. All my best!
It’s just a matter of waiting till your pancreas burns out and you need full insulin. Being T1 I wouldn’t be OCD about very low carb. To preserve beta cell, I would be asking for a basal to cover a lot of the base load.
Thank you for the welcomes everyone! My endocrinologist hasn’t mentioned LADA but my nutritionist did. She said that, in her medical opinion, differentiating between LADA and T1 wasn’t imperative since the treatment (insulin) will be the same for both types over time. As far as eating low carb and insulin goes, my endocrinologist thinks we’re not at the point of insulin yet but we’ve only touched on that topic briefly. It would be nice if I could just use a long acting insulin and not have to be so strict on carb counting. I wouldn’t go crazy with eating all the carbs I want by any means but it would be nice to not feel so restricted with my dietary choices. I just think that it would be better over the long term to avoid those spikes to 140-180 after meals if possible even though they do come down relatively quickly in most cases. I’ll bring that up to her at my next appointment and see if she’s willing to give it a try.
Welcome to TuDiabetes, Jasmine! Your story of appropriate and timely medical advice from your doctors impresses me. We often read about poor advice when someone of your profile presents their slow-onset diabetes symptoms as an adult.
I was 30 years old when I was diagnosed as a type 1 diabetic. We didn’t use the LADA label back in 1984. During the year before my diagnosis, I experienced several “reactive-hypoglycemia” episodes that match your descriptions. They usually occurred a few hours after a high-carb slurry of breakfast cereal, milk, and fruit. The crisis was solved when I quickly ate something sweet.
If I were you, I would try to place a reasonable limit on carbohydrates. My thinking is that the more gently your treat your glucose metabolism, the longer it will take to fail. Of course, this is simplistic thinking in that the autoimmunity dimension is more complicated.
In any case, avoiding blood glucose excursions over 140 mg/dL is desirable. Spiking to over 140 and then quickly falling back to baseline is nothing to be worried about. Spiking to the 180s, especially if it lingers there for a few hours, is not good.
I was watching a YouTube video recently of a doctor in North Carolina who was helping people with type 2 diabetes get off of their meds using a low-carb, high-fat diet. He was experiencing excellent success with this program. There seems to be pockets of diabetes enlightenment going on in North Carolina!
Good luck with these unwanted and new health discoveries. I think people who access and participate with their diabetes peers online do well in coping with diabetes.
For your nutritionist, differentiating between LADA and T1 isn’t important, but it should be for your endocrinologist. For example, for LADAs, there is no good way to determine a reliable I:C ratio or correction factor. (Please, please, please, correct me if I am wrong on this.) Because you still have endogenous insulin, if you bolus for a meal, your pancreas plus the bolus will often get your BG back to “normal” before the bolus insulin is out of your system, so you need to test and adjust to that, ie. eat more carbs to satisfy the remaining bolus. This is inherent to early LADAs and does not mean you are doing anything wrong, though my diabetes team made me feel that way.
You are right to want to get the medicines necessary so that you can eat a more normal diet, and thus live a more normal life. You will need insulin eventually, so getting started now, at least in order to learn, has some great benefits. I would recommend getting a basal insulin (probably lantus or tressiba), plus a fast acting insulin for bolusing higher carb meals. Syringes with half-unit markings are a benefit for those taking small doses. It would also be useful to do LOTS of bg testing (many fingersticks or a CGM) to see how various meals affect you, and how many carbs your body can handle without bolusing, and how much insulin you need for meals above that.
I was misdiagnosed T2 at age 57 4 years ago, and re-diagnosed LADA two years ago when I requested the antibody tests (and GAD65 was positive). I currently take 6 units of Lantus per day. For meals, I don’t need to bolus for anything up to about 30g carbs, and then take 1U/30g above that 30g threshold, but Your Diabetes May Vary (YDMV), hence the recommendation for lots of bg testing to determine what works for you.
