Pre-diabetes and LADA

I just joined today. Wow! What a warm welcome! I joined specifically because I wanted to ask this question: For those of you who have been diagnosed with LADA, were you diagnosed with pre-diabetes first, or did you go directly to a Type 2 diagnosis (or even directly to LADA)?

In case you want a little context for the question, read on:

I'm a 40-year old mother of three. I had gestational diabetes with the two most recent pregnancies. With the third child, I developed GD within 6 weeks of pregnancy. Both times that I had GD, I was able to control it with diet. The diabetes went away after each child was born. I kept my meter just in case, and it's clear that I'm still having wacky blood sugars. .

I have fasting numbers over 100 a couple times a week, and the occasional post-meal number over 200 if I eat way too many carbs. My A1c is checked annually by the endocrinologist, but so far it has stayed in the mid-5s. My blood sugar sometimes spikes an hour after eating. When it does spike, it almost always gets back down below 140 within two hours after eating. There is the occasional two-hour over 140 (once even over 200), but only if I am really irresponsible with the carbs.

Two members of my immediate family have autoimmune disorders (celiac and hashimoto's), but there is no family history of diabetes. I am quite thin. The endrocrinologist suspects that I could be developing LADA. She did a GAD test about a year ago, but it was negative. At this point it's just wait and see. Sadly, I am not a patient who has much patience. I find it very frustrating to be waiting for a poorly understood disease to attack. I try to behave as though I already have it, even though I may never develop full-blown diabetes (fingers crossed).

I'd like to hear from others who have LADA. What kind of experience did you have prior to diagnosis? Did you go through a pre-diabetic phase, and if so, how long did it last? Did you have weird highs only at the one-hour mark before you developed full-blown diabetes, and if so, how long were you able to stay in that phase? Or was the diagnosis a complete surprise?

There seems to be so little information about LADA. If you have links to any articles about how LADA develops BEFORE it's diagnosed as Type 2, please include them.

Welcome to TU nicoline!

If you have A1C’s in the mid 5’s you have an average blood sugar well into the 100’s. A normal blood sugar would be below 100 in the 70-100 range. I am a follower of Dr Bernstein and he would treat you now as diabetic since you do not have a normal fasting BG. He is more aggressive than most Endos and the ADA. Most MD’s though would say that 70-100 fasting is a normal blood sugar and you are now above that. Mine does.

It sounds like you are insulin deficient and addicted to carbs. Has your Endo done a C-PEP and the full anti body tests to determine if you are LADA? You mention GAD but did he do the the other tests?

You mention that you are thin which is tell tale of LADA. Since you had GD you really need to stay on top of this and you need to get the carbs under control. Everytime you spike like you have been you are stressing the beta cells you have left.

Based on what you write you are insulin sensitive and need some help. Insulin now would get you into the normal range and is the normal course of treatment for LADA.

The important thing now is that you normalize your blood sugars no matter what type you are.

Hi Nicoline: Pauly has given you some good advice, and there is a large group of adult-onset Type 1s/LADAs here on TuD. Welcome! I had rapid onset Type 1 diabetes at age 35, so can’t personally answer many of your questions. However, there are quite a few women here on TuD who had gestational diabetes who went on to develop Type 1 diabetes (according to the latest studies, about 10% of Caucasian women with gestational diabetes have autoimmune gestational diabetes and go on to full blown Type 1). LADA is just a term for slow-onset Type 1 diabetes, it is not Type 2 diabetes (although most people with LADA are misdiagnosed as having Type 2 based on age, but they have been misdiagnosed). Best of luck to you, take good care of yourself!

Hello Pauly and Melitta,

It sounds like I’m not off base in being worried, even though my endocrinologist isn’t willing to do anything yet. She said that she would not be concerned until the A1c goes over 6, unless she sees something in the 2-hour fasting glucose test. I’m sure there’s something to see at one hour, but she isn’t interested in anything but the fasting and the two hour. When I asked her what the one-hour highs meant, she said that it can be typical of someone in the early stages of developing diabetes. Then she basically told me to stop testing at an hour because those numbers aren’t significant. She only did the GAD test, and that was only after I basically begged her to do it.

Pauly, after your response, I’m thinking I need to find a new endocrinologist who will take my concerns seriously instead of making me feel like a hypochondriac.

I actually am pretty good about my carb intake, as I developed the habit of counting them when I had GD. The one two-hour that I’ve caught over 200 was after I ate an entire box of mac & cheese by myself (125 carbs!)–which I have never done before, and I assure you I will never do again. Pauly’s point about the highs stressing out my beta cells is motivation enough to continue to try to keep my numbers as low as possible.

Thanks again for the support!

And if there’s anyone out there who has been diagnosed with LADA but went through a prediabetic phase, I’d still love to hear from you!