Prediabetes or LADA after GD?

Hello! I need your opinion on my case…!
Sorry for the long post…!
28 years old with a BMI of 19, do a lot of sports and eat healthy (no sodas, added sugars etc)
I was diagnosed with GD at 24 weeks when pregnant with my daughter. OGTT 1h was over 200 (12) and 1 hour was around 180 (9.8) It came as a shock to me as I did not have any of the risk factors and don’t have any family history. Eating mainly low carb I controlled my gestational diabetes with diet and exercice alone (but I was pretty strict on the low carb). I worried a lot during the remaining of my pregnancy that this was a permanent condition, even if all my doctors were telling me not to worry. Post partum I checked my numbers still and I saw some bad ones to around 170. When I did my post partum OGTT 3 months after delivery I had a 2hr value of 178 so diagnosed as a pre diabetic.
I had lost more than 15 lbs since delivery and was already below my pre- pregnancy weight and I exercised like crazy with my baby (more than 4 hours a week plus daily walks). I saw an endo and had some labs done:
A1c 4.9
C peptide 1.0 (reference range 1.1 to 4.4)
Fasting Glucose of 81 (4.5)
AntiGAD negative (<5)
Fasting insulin 23 (lowest of reference range was 21)
The endo told me to just stick to low carb and continue what I was doing and told me it might be hormones still that caused my blood sugars to go up like this…
Well I am 7 months post partum.
Blood sugars go up to 210 with about 35g of carbs in a meal but I go down after (I can be back to 100 at 2 hours after a meal). I feel nauseous with the fast change sometimes and I had some reactive hypoglycemia.
I’ve lost more weight and am now at 100 lbs for a little less than 5ft2.
I feel like it is not typical prediabetes because I have done everything to prevent its progression to diabetes (short of intermittent fasting which i’ve read could help but since I am breastfeeding I can’t)… could I have some sort of LADA without anti-GAD…?
I have auto-immune disease in my family (father has vitiligo)
Is there anything else I should be asking for the doctors to test…?

Can you elaborate on this and perhaps provide the units of measure for this number along with the complete lab reference range as provided on the testing results?

There is a larger panel of T1D testing which can be done (as opposed to only the GAD).

Perhaps request for a complete T1D panel of antibody testing?

Unit for insulin is pmol/L the reference range was 21-154.
The endocrinologist I saw said if no GAD then it is likely not type 1?

An additional suggestion (in addition to the previous one for a full T1D panel) would be to consider a different Endo.

I personally am not comfortable with diagnosis of “not likely” until exhaustive testing has been completed. I have had to accept such with non-D situations but I do not accept that initially nor easily.

According to one US National diagnostic lab, positive rate in new-onset Type 1 diabetes patients are 68% positive for GAD-65 antibody.

People who get gestational diabetes have long been considered to be at higher risk for getting Type 2 diabetes. At the same time there are people with Type 1 and LADA where pregnancy was the final factor that pushed their declining pancreas into full blown diabetes. There are other antibodies than GAD that can be tested. Or there is idiopathic Type 1 with no discernible antibodies. And there are people with Type 2 who are not overweight.

I guess that you need to keep documenting what is going on and educating yourself and working with the endo to find the best way to control your BG numbers. Over time I suspect the way will become more clear. And maybe you’ll be lucky and your hormones will subside and it will all go away,

All of us with diabetes wish that it would all go away…


My first endo said I wasn’t type 1 even though it ran in my family. He never even bothered to test me. My point is some are definitely better than others!

Are those tests from the last few weeks or months ago? Do you have a recent A1C?

These tests are from 4 months ago. I have to go back to do some blood work soon. I guess my A1c will look the same as I eat very low carb and sometimes my BS gets low. But definitely when I have more carbs I go up to 200 which is not normal…!

Yes I have read about thin type 2 but it seems to be related to family history of type 2 or the skinny fat phenotype were even if slim, people have more fat than muscles in their body. I don’t think I fit either as I don’t have family history and I work out a lot so I am fairly « muscular ». Also my fasting insulin being on the low end of normal shows I am not very insulin resistant according to the endo. I guess it could still be the breastfeeding hormones but everywhere I see that lactating gets the blood glucose to be lower… also my OGTT results when non pregnant was the same as when pregnant and I know that pregnancy increases insulin resistance so I do the math and wonder if I am less insulin resistant than before, well my insulin production is probably lower than it was when pregnant.
Obviously there is this tiny hope that it will go away and I know I would be lucky but I am less and less convinced.

Hi: Although you are GAD negative, as others say, you should get the full suite of autoantibody tests to be certain. Here is a good Diabetes Forecast article on the subject. For some women, pregnancy is “the straw that broke the camel’s back” and pushes a woman over into overt Type 1 diabetes. I write about autoimmune gestational diabetes in this blog. I hope you find this useful, and best of luck to you! You are right to question and seek answers.

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I would personally push to get the tests redone as your symptoms and home BG tests have changed. If you can convince your Dr. to green light some sort of CGM like the Libre even for a couple of weeks you will have a much more accurate picture of what your BG’s are doing. Some Dr.s have a blinded version where you just wear it for 2 weeks and then come back and have the Dr.s office download it and review the results.

Going over 200 isn’t normal but it’s good that your BG’s are still going back down after 2 hours. Your A1C might not have changed much because it takes several hours of being at a certain level for the glucose to “stick” to your hemoglobin and thereby change the result. If you aren’t diabetic then you should be able to eat what you want without consequences to your BG. My mom is perfectly healthy yet she eats massive amounts of sugar on a daily basis, if I did that I’d never see a normal BG reading.