Pre-diabetes? really?

ok, it doesn’t make sense…my daughter is type 1 and now i’m pre diabetic? i eat well, balanced carbs to proten…at a good weight, never been over weight…i exercise…type 2 doesn’t sound right…and what the heck with the pre-diabetes thing…since if have testers here, i’ve been checking my #'s…i’m 107-130 in the am…i know i’ve had lows and highs over the past few years…this was the first time i was check at the office and they tell me i’m pre diabetic?? are there different symptoms for 1.5? what should i ask the dr…and what do i do now at this stage of the game?

LADA or 1.5 is Type 1. There is no difference other than the age at onset. You should ask for antibody testing: GAD65, ICA, and 1A-2.

Actually, just to clarify, the most important difference between LADA and regular Type 1 isn’t age of onset, but rate of onset. LADA comes on much slower, and that is why many LADAs are misdiagnosed as Type 2 because they can do well on oral meds from between a few months to a few years. Adult onset type 1’s can be either LADA or regular type 1 where the onset is very sudden, including DKA.

There are not necessarily differences in symptoms between LADA and regular Type 1 or even Type 2, Tara. Pre-diabetes is diagnosed when there is an A1C between 5.7 and 6.4. LADA can be determined by antibody tests, and c-peptide. Contrasted with regular Type 1’s, LADAs can manage without insulin for a period of time, but generally a much shorter period of time than type 2’s which can be measured in a decade or more. Also LADAs, like other Type 1’s often are thin and have other autoimmune disorders. That is the greatest difference between Type 1 (including LADA) and Type 2. Type 1 is an autoimmune disorder.

I’m a newish LADA. Insist on the antibody testing. My Endo swore that I wasn’t diabetic and swore I wasn’t LADA, but he did the testing to get me off of his back. Guess what? I had high GAD antibodies and the gene the links LADA to Celiac. From what I’ve read, Oral meds aren’t good for LADAs, so a correct dx is important.

LADA can be slow but it isn’t always. You’ll find many here who got walloped all at once even as an adult. But I do agree that generally the remaining beta cells are destroyed more quickly in children and babies than in adults.

Oral medication may work for awhile as the remaining beta cells are destroyed. But ultimately you will need insulin. Practitioners differ in opinion as to how soon you should start insulin. Many believe that insulin should be started while there is still insulin being produced in the pancreas rather than wait until there is no production at all. Unfortunately, too often LADA is not even diagnosed properly until there is no longer any insulin production. Good for you for pushing for the right tests to be performed. That kind of diligence is going to serve you well as you learn to manage your diabetes. There is a celiacs group on the site too that you might be interested in.

I’ve heard that oral meds can put additional stress on the pancreas causing it to burn out earlier. I went uber low carb right away and am still doing ok with diet and exercise, though my diet is rough, and I exercise a lot. I’m happy to hold on to whatever potential to produce insulin as long as I can. My Endo is of the Insulin only faction. I’m not disputing that oral meds will work, just that they may not be a good choice for LADA. If I didn’t exercise as much as I do, I would probably be on Insulin now.

Hi Tara: “Pre-diabetes” can refer to either pre-Type 1 diabetes or pre-Type 2 diabetes. Since you are more likely pre-Type 1 diabetes, it would be helpful to get antibody testing (GAD, ICA, IA-2), and c-peptide testing would also be useful to see how much insulin you are producing. If you are in the early stages of Type 1 diabetes, even low doses of exogenous insulin will help preserve your remaining (sputtering) beta cells. Best of luck, and let us know how it goes with your doctor.

i have an appointment set for next week…my family dr said i should recheck in a year…yeah right…

it it possible that by eating lower carb and higher proten can delay lada, or is it going to happen no matter what you do?
I already eat 40-30-30 meals - 40% carbs 30%proten-30%fat -

Yes, like Melitta. (who I should probably let speak for herself, because she does it so well!) She doesn’t identify as LADA, though, but as “Adult onset Type 1”. By definition LADA is slower onset: "Latent Autoimmune Diabetes in Adults. I’m not trying to be argumentative, Donna, honest!

LADA is typically defined as having (1) the presence of auto-antibodies in the blood, (2) adult age at onset, and (3) no need for insulin treatment in the first six months after diagnosis. That definition excludes people like me who had rapid onset in adulthood and required insulin immediately to stay alive; that’s why I say I have Type 1 diabetes, not LADA. [Things of course get complicated, because many children don’t require insulin in the first 6 months to stay alive.] LADA is just slower onset Type 1 autoimmune diabetes.

I have read a lot of studies, and I have never seen one that indicates that low carb/high protein can delay progression to autoimmune diabetes (of course they may exist, I just haven’t seen any). But it would make sense that not stressing the beta cells with high carb would have positive benefits. What has been shown to truly work (documented in multiple studies) is to use exogenous insulin, even at low doses–this preserves the remaining beta cells, provides better metabolic control, and results in better health outcomes. But it is important to not put the “cart before the horse.” Best that you get appropriate testing (fasting blood glucose, A1c, antibody testing (GAD, ICA, IA-2), and c-peptide and see where you are.

Hi Tara: You are very smart to take care of this, be your own best advocate, and be proactive!

Melitta, I’m interested in the insulin to preserve function, but last A1c I was still 5.5. I’m following Dr. Bernstein and my carbs are coming from seeds, nuts, and low carb vegetables like daikon radish. I thought I read a journal article last year that said that early insulin didn’t work, but I don’t remember the details, and I realize that it was only one study. Do you know which article I’m thinking about? I just lost all my Favorites a couple of days ago when my laptop died…

Hi Sheila: The only “early insulin doesn’t work” studies I have seen were the clinical trials that showed that low-dose insulin did not prevent the onset of Type 1 diabetes in people who were at risk (had close relatives with T1, etc.). That was in people who did not yet have diabetes. However, there are a number of studies that show that low-dose insulin early in LADA preserves beta cells and contributes to better metabolic control. There are human studies that demonstrate that exogenous insulin preserves beta cell function in people with Type 1/LADA–the best summary of results that I have is “Beta Cell Protection and Therapy for LADA” (Cernea, Buzzetti, and Pozzilli, Diabetes Care, Nov 2009). Kobayashi et al (2002 and 2006) are direct human studies that indicate that exogenous insulin preserves beta cell function in people with LADA, and those studies demonstrate that sulfonylureas hasten beta cell destruction. Zhou et al (Diabetes 2004) is a direct study that indicates that insulin combined with Rosiglitazone (Avandia) is most effective for preserving beta cell function in LADAs (but of course the use of Avandia is now restricted). Bruce Buckingham MD at Stanford is doing clinical studies where he initiates really, really intensive insulin therapy in newly-diagnosed Type 1s (mostly young people), and he has had tremendous success with beta cell preservation and better health outcomes. So the evidence for doing low-dose insulin to preserve beta cells is overwhelming, in my opinion. BUT for someone like you, with an A1c of 5.5, insulin even at low doses might produce hypos. Lil MaMa is a member here on TuD who has slow-onset Type 1, and went for awhile without using insulin (she got great results with low carb and exercise). Just recently, her numbers started increasing, and she started using 2 units a day of Levemir (that’s the last I read). Maybe you should contact her? You are doing so well, just keep testing to see if your numbers increase at all. Hope this is not too much information overload, and best of luck!

to much is never to enough for me…seeing that i’ve been doing a low carb diet for over 5 yrs, that may have been enough to “ward it away” for this long…i can’t wait to find out what my a1c is…

Thanks so much for the reply. I appreciate your efforts. I go to the Endo every month because I have multiple endo issues including Hashimoto’s and post-Cushing’s (adrenal), possible parathyroid…So, he knows me, and knows that I’m a balancing act to regulate. At the very beginning, I told the Endo that I wanted to do Dr. Bernstein and asked if he had a problem with that. He said he understood what I wanted to do, and all he cared about were the numbers. He, obviously, never had run into a LADA in the early stages, because initially he said I could not be LADA because I didn’t have numbers in the 700’s in the ER. As he walked out the door after my dx, he said that if I rested my pancreas, I could keep going indefinitely. So far, it has been two years. Make no mistake, this isn’t easy to keep up, but neither is insulin. Lil MaMa is in some of my other groups. I know that she was jumping on the exercise bike to burn off carbs. I’m really careful about what I eat, and usually make myself a separate meal like tonight because I made vegetable soup for the family. I added onions and tomatoes, and I can’t do those things without compromising my bg. The thing is that I cannot skip more than a day of exercise, anymore.

Hi Sheila: At some point, just as Lil MaMa did, you might want to go on insulin just so you don’t have to work so dang hard to keep control. Most people with LADA say that the best thing they ever did was go on insulin–their feeling of well-being increased dramatically. You and Tara, you two are awesome! By that I mean that you are willing to face this and not be in denial.

I did a quick test today…i normally don’t eat pancakes, due to no protein and hig carbs…I had 2 small pancakes, very little light syrp…pre meal #107, post meal… about 1 hr+ i was at #200. …about 2hr + i was at #145…I would have to say something is going on…because if i’m correct, a non-diabetic would not go over 140ish, correct?