Question about autoantibody results

Type 1 and LADA
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I am very new here, and glad to have found this resource.

I am 48, and was recently diagnosed with Pre-Diabetes (A1c was 5.7). My endo tested me further for C-Peptides and autoantibodies: C-Peptide was normal, but I did test positive for Ia-2 autoantibodies. GADA, IA, and ZNT8 tests were normal.

I only received notification of the results of my tests, not what they mean for me, so I feel rather adrift.

I do have a Libre CGM, and my glucose numbers are a bit off, but I do not really know what I am supposed to be looking for. I feel a bit as though I were handed the keys to a fancy car, without being taught how to drive it!

Does this mean I have T1 or LADA? Or that I will get T1 in the future?

UPDATE: I spoke to my endocrinologist today, after he’d had time to review all my labs and history. He diagnosed me with LADA, and told me that whilst I do not yet require insulin, he did suggest going on Metformin for now.

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If I had to guess you are type 1 LADA. Often when someone develops autoimmune diabetes mellitus as an adult the destruction of the Beta cells is slow compared those who contracted in childhood.

Type 1 is an autoimmune disease whether developed in childhood or adulthood. At some point as you lose more insulin secreting Beta cells you will need exogenous insulin. That can be scary but you will learn the ins and outs to keep you alive and healthy.

I am no kind of T1DM, I’m a T2DM on an insulin pump. My journey took about 30 years to me needing insulin. I suspect yours will be shorter.

This earlier thread on books might be helpful.

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That positive means your body has started attacking your beta cells and the 5.7 backs that up. But it’s very early as 5.7 is just above normal. The C-peptide normal means you are still producing enough insulin for now. Low or low normal is a sign of type 1 as we lose the ability to make insulin, high or high normal is a sign of type 2 as a type 2 produces extra insulin to try to make up for being insulin resistant.

In an Type 1/LADA, we slowly lose the ability to make insulin as our body attacks the cells that make it. This can take years, 8 years plus until we don’t make enough. It is usual to need insulin within 3 years of diagnosis, but it really depends on how early it is caught. Some people believe taking insulin early helps protect what cells you have longer.

At onset we call it the Honeymoon phase. Your body can be erratic in how much insulin it makes as the cells are attacked. It causes fluctuations that can drive you a little nutty. One day your numbers can be great and the next high all day or in some people you can start dropping too low. Some people do have problems with low blood sugar in the Honeymoon phase so you probably should carry a quick sugar source with you just in case like Smarties or Skittles.

It’s great you already have a Libre, a Dexcom is better but you are not on insulin yet I’m assuming? so a Libre will tell you what your blood sugars are doing.

I got Type 1/LADA at the age of 46. I was misdiagnosed for over 8 years and am happy to hear you got tested early in the process, it’s still a problem for many Type 1’s to get diagnosed right. It can be a huge learning curve at the beginning, but you have time to learn since it was caught early. Start looking at carbs and learning to calculate what carbs you are eating. Regular exercise and how it helps.

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Thank you so much for taking the time to answer. I am very grateful to you!

For more context: I am not on insulin, and the Libre 3 is what they gave me when I asked how I was supposed to know what I could and couldn’t eat, lol. I am unsure whether this brand is what my insurance covers, or if it’s just what the office uses regularly.

I went this afternoon to the diabetes educator attached to my endo’s office, where I was told that no one had yet reviewed my labs as my doctor had been out of office until today. Consequently, they didn’t even realize I’d had a positive antibodies test.

The educator told me that with only one positive result, it was likely not LADA. She did caution that this information was her telling me this rather than anything from my doctor who had not yet reviewed my charts.

She did tell me that if it is T1 that it could take years before my pancreas gave out.

She also gave me some guidelines to follow for carb amounts per meal which I did find helpful, because until today I’d had no idea.

She suggested, too, keeping my numbers under 140 two hours after a meal. Most of the time my numbers are under that all day, and I’ve yet to see them go over 250, although I just started wearing the CGM a little over a month ago.

I have some other health issues that may or may not be autoimmune; Castleman’s Disease and Hyperparathyroidism-both of which I have undergone resection for.

I was also ill with Flu B in 2017, which seems to have kickstarted my Ehler’s-Danlos, which appears to be causing my patchy small fiber neuropathy and autonomic neuropathy- which cause my POTS.

I’ve no idea if any of these issues might exacerbate/cause or have no effect whatsoever on my antibodies tests or even my glucose levels in general.

I was tested back in 2017-2018 with some sort of glucose drink that came back normal from what I can recall. No one had tested my A1c though until this year, so I do not know how long this issue has been ongoing.

It was completely by luck that I had it tested a few months ago by my PCP because I was have new neuropathy issues with my arm (feels as though I have a ball in my armpit even though there’s nothing there) and she requested thorough lab work. At that point, I was just happy someone was taking me seriously.

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Unfortunately, IA-2 doesn’t mean a lot for distinguishing between T1 and T2. That’s the one that’s been really surprising in studies and turning up in the T2 population, too. It’s more prevalent in young T2 diagnoses and also linked to a specific gene variant.

The more we learn about diabetes, the more complicated and confusing things get. It’s not as black and white as it used to be. The stereotypes and classification criteria are getting blown out of the water.

You certainly can develop T1 with just one auto antibody, but it’s not very common. 1 is gray area. You MIGHT develop diabetes, but you might not. And given your particular positive autoantibody, it might not even be considered T1 if you DO develop diabetes. Once 2 autoantibodies have been discovered, though, T1 onset is considered imminent. It’s just a waiting game.

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Thank you!

This seems in line with what the diabetes educator said to me earlier this afternoon, although she didn’t specifically mention the Ia-2 as such, just the fact that I had only one type present.

Not getting diabetes in any form is definitely my aim, I’m still just not entirely sure how to do that. I’m hopeful my endo will have reviewed my labs by the end of the week, and be able to shed more light on what (if anything) I need to do next.

At the very least I do appear to have Pre-Diabetes, so keeping an eye on my diet and exercise regime gives me a little feeling of control! :blush:

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https://endocrinology.testcatalog.org/show/IA2

Type 1’s commonly have, or get other autoimmune diseases. Probably once we have one autoimmune disease it means we are more prone to any. They’ve identified some of the genes responsible that you inherit, some are related to the immune system and then a virus(es) is the most likely culprit to set off the attack, but not always.

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Is this treatment only for children and only available in clinical trials?

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@HighHopes You have to have certain markers for it to work. And if you do, while it might prevent, it might only delay it.

The biggest hurdle is the huge cost.

From what I gather in these articles, at $193,000, it would have to drop below $48,000 to make it cost effective.

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A great website for deciphering medical tests: https://www.testing.com

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I thought it was for all ages and might help the person writing on.