Treatment for Early LADA

I visited a new endo yesterday that was suggested by a nurse from a study I contacted. I did some research on him before the visit. He was a professor at University of Penn for 30 years, published several articles, consulted on research studies and lectures nationally/internationally. After looking over my records he explained that I should be on treatment in order to preserve beta cells. I was expecting to be placed on Metformin, but he suggested Victoza instead. He told me that it can delay or prevent diabetes in those who are headed toward type 2, but doesn't have the risk for hypoglycemia that insulin does. Because I am antibody positive he said they don't know if the results will be the same as for those with prediabetes, but it will delay the need for insulin. He taught me to inject .6 mg before I left. I had terrible nausea all night, but woke up feeling a little better. I was excited to see that my fasting BS was 94- the first time it's been under 100 in over a year! He wants me to use 1.2mg then come back in 6 weeks. He also took me off Armour thyroid and changed it to Synthroid. The lab A1c was much lower than my meter readings and the home A1C test. So,he ordered a Fructosamine test and thyroid labs for when I return. I am hopeful that this will help and happy that I found someone willing to treat me with numbers that are not yet in the Diabetic range. Thank you all for your advice and support..I truly appreciate it and will keep you updated!

Studies by DeFronzo on T2 diabetics seem to show that GLP-1s like Byetta and Victoza lead to preserving (and perhaps some healing) of beta cells. Whether the effect translates to LADA is not clear, but it probably is a reasonable choice. If you move to insulin prematurely when you still have a fair amount of natural insulin production you may find yourself experiencing too many lows. My believe is that as long as you can maintain tight blood sugar control (A1c < 6%) you have avoided hurting your beta cells with high blood sugars (glucotoxicity). This likely gives you the best chances of preserving your beta cells.

Thanks Brian and yes I agree that my A1C is not high enough, so it would not warrant insulin use right now. This endo is a Type 2 for 15 years and is on 3 different medications, but well controlled with an A1C of 5.4. I respect that he didn't suggest something he wouldn't try himself. One advantage is that I will get used to injecting--at least with a pen in the event I move to insulin. Right now, I have a fair amount of nausea, but he thinks it may be due either to the glass of wine I had last night with dinner or an unrelated virus. He told me to stay on .6 mg and just have liquids for 24 hours. I still have the symptoms today, so I am thinking it's a side effect. I'm going to try and wait it because I read in the Victoza Group that it may go away. Someone mentioned trying you know if that helps?

I took both Byetta and Victoza for a total of more than a year. I do think it is good practice for injecting. And yes, nausea is a well known side effect. The protocol is to start with the smallest dose (0.6mg) and then adjust. The nausea goes away for most people within days/weeks.

Hi bjm, I hope this will help you. I hope the nausea goes away soon, I had nausea with symlin at first and it got better after 2 weeks or so but I ended up stopping it because of other issues, I only ever took the lowest dose. I would read as much as you can about any drug you take. I have read that this type of drug which stimulates the pancreas to create more insulin may not be good, especially for type 1, because it can increase stress on beta cells.

Thanks Meee, I feel a little better today and could actually eat 2 small meals,but had to run to the bathroom this morning. The doctor wasn't sure if it would prevent me from going on insulin, but he felt it would actually help the Beta cells. I did some searching and found an old post in which Brian gave a great explanation.

Update...It's been exactly 1 month since starting Victoza. I am relatively nausea free; although eating much smaller portions and I'm really not hungry so I have to remind myself to eat. I'm still not on the 1.2 recommended dose because my endo suggested that I increase the .6 beginning dose to only 5 more clicks, which is about .9 and stay at that does until I see him again. My 30 day meter average has dropped from 124 to about 112, which is great but my fasting readings are still over 100 now after initially being under 100 for about 1 week. It seems like I have great results the first week after starting the med and then increasing the dose, but get used to it after the adjustment and my readings start to increase again. I'm thinking that I may just be peaking later then 2 hours since Victoza slows digestion, which would explain the still elevated fasting readings. I return to the endo in 2 weeks so I am hoping he will increase the dose to 1.2 which is a standard maintenance dose. Any thoughts or experience on why my fasting readings are initially good, but then start to increase again and on my theory of peaking later postmeal? I appreciate any input or help :)

Ok, what I didn't tell you before is that my experience with both Byetta and Victoza was that they restored normal blood sugars for a few weeks but then stopped working. This was a consistent pattern I observed with a whole range of diabetes medications. Bernstein notes this in his practice and actually has his patients rotate between Byetta, Victoza and Bydureon.

Frankly, when I was on Byetta and Victoza if I had fastings of 100 mg/dl I would have been doing a happy dance.

Thanks..I hope that isn't the case with me and that when I get on the full maintenance dose in a few weeks it will keep my fasting and before meal readings under 100. When I say over 100 I mean a range from 105 to 114 the past two weeks, which is creeping up closely to what I had before taking the meds. Before Victoza I was averaging between 110 to 121. Would a higher fasting point to having spikes later post meal that I may be missing at my 2 hr post meal readings ?

I was diagnosed as LADA almost three years ago and am a patient of Bernstein. I've had tremendous results with Victoza, Byetta, Symlin and now I'm trying Trulicity - which is a once weekly injection. I write about my initial experience here:

I discontinued it for about a year because of concerns around side effects, but decided to re-start using Incretin Mimetics after seeing that there wasn't any further data supporting their risks other than the UCLA study that had a very small sample size.

if i have to go on medication, i am starting on metformin only first.

Thanks Christopher. The possibility of it causing cancer is concerning to me. Victoza specifically was found to cause tumors or cancer of the thyroid in mice and has the warning listed in the drug information. It also discusses incretins as linked to a higher risk of pancreatitis. I've never heard of Trulicity; although my endo asked if I wanted to try the weekly injectible med and I just assumed it was Bydureon. I'm not sure what to do and if it's worth the risk. My endo is well versed in research on diabetes; having consulted for a few in the Philadelphia area. He has a lot of experience and I am sure will have opinions on the limited research that was cited. I've read what Jenny Ruhl had posted a few years ago and I don't believe that everything reported on that site is 100% proven to be true, but then I tend to not commit myself to one person's philosophies. I like to keep a more open mind and can become skeptical when a conclusion is drawn that X causes Y, without irrefutable statiscally significant evidence. I'm curious to why you have decided to try Trulicity with all the discussion about incretins and their side effects?

The FDA required Amylin to undertake follow-up studies of Byetta to gain a better understanding of the side effects which may include pancreatitis, kidney issues and thyroid cancer. These studies in a addition to the post market surveillance program are aimed at identifying any problems. If there had been any significant rate problems we would expect that to show up quickly, but millions of patient years of experience have now been observed. It may still be revealed that there is a connection but it doesn't appear to be major.

"..The FDA and the EMA have not reached a final conclusion at this time regarding such a causal relationship. Although the totality of the data that have been reviewed provides reassurance, pancreatitis will continue to be considered a risk associated with these drugs until more data are available; both agencies continue to investigate this safety signal."

How does the benefit of Victoza over metformin justify taking Victoza when “…pancreatitis will continue to be considered a risk…”? Is Victoza that much better at preserving beta cells?

Thanks, after reading this article I feel a bit reassured. I'll still be asking questions of my doctor when I see him in a few weeks though. To answer your question you may want to read this article and draw your own conclusions.

If it were me in your situation I would have gone for metformin first probably, I guess they don't want to put you on insulin yet when you still have significant insulin production? Metformin hasn't been shown to cause any major problems as far as I know except for digestive problems which would probably have ruled it out for me, I'm not sure.

He didn't offer it and not sure why except that he said it will help with inflammation. I just assumed because I am not insulin resistant. I'll be asking lots of questions on the 13th when I see him again. Both my parents are on Metformin. It worked for my Dad, but not for my mom (she's also on another drug and still has high blood sugars and neuropathy).

has your mom been tested for antibodies? maybe she is slow developing LADA and she needs insulin.

Good point v/pred,

@bjm2363 I guess it's worth a try. That's too bad it doesn't work at all for your mom. Maybe ask him to try metformin and then insulin if that doesn't work out for you? Let us know what happens.

She was on insulin in the hospital..she had a seizure from a low blood sugar episode. They discharged her on Metformin and Glipizide. She still has higher blood sugar than I would like and experiences lows (likely from the SU drug) but her A1C is 6.5 and her primary doctor thinks that's fine. I thought she may have LADA but she has diabetes for about 15 years or more and would think she would be fully insulin dependent by now if she had antibodies.