What are the Chances I have LADA?

Type 1 and LADA
#1

I was diagnosed last December with diabetes. Type has never really been discussed, but I'm being treated as Type 2: diet, exercise, metformin. I was slightly overweight at diagnosis, 5'3 and 152lbs. Have since lost 30lbs and am now normal weight. My initial HbA1c was 12.5. At 6 months it was 6.5. Just had another yesterday which I suspect will be a little lower judging from increasingly better FBG numbers. So the treatment is apparently working.

However, never having been obese and having absolutely no history of type 2 (or type 1, for that matter) on either side of my family, I'm thinking now that I'm probably not type 2 at all. On the other hand, there is a strong history of autoimmune disorders in my family. My mother has rheumatoid arthritis as did my grandfather. My identical twin sister died from complications of Scleroderma, also an autoimmune disease. That seems to strongly suggest I have LADA.

So the questions are, is the success of the current treatment a "honeymoon"? As long as the numbers are good and trending down would the doctor be inclined to start insulin treatment if tests confirmed LADA or just stick with the current treatment until and unless it stops working?

#2

It could very well be LADA, but you need the antibody tests to know for sure. If the doctor doesn't want to do them, insist on it or switch doctors.

The consensus is that it's best for people with LADA to start on insulin as soon as possible. However, I kept my numbers in line without insulin for 13 years.

#3

i would get the antibody tests. i was diagnosed at 36 and they did them right away and i started on insulin immediately. ditto what badlands said about insisting or switching docs. well with the weight loss and good numbers!

#4

There is also some consensus that the best treatment, even for persons with type 2, is insulin (low dose as required) to normalize blood sugars.

Definitely push for the antibody testing. I assume you are hardly eating... and insulin would definitely give you more eatimg flexibility - though still requires attention.

#5

I don't think my doctor will be resistant to testing, I just don't know how eager I am to have the answer. I haven't really found the new diet that difficult or restrictive. In fact it feels like I'm eating more. Certainly more often. It wouldn't be a hardship for me to eat healthy, exercise and take a couple of pills for the rest of my life if that was sufficient. However, as I understand it, they are much closer to a cure for type 1 and that cure may be dependent on remaining beta cell function and insulin is the best, if not only way, to preserve that. So the sooner the better, yes? (Or is the talk of any cure way too premature? And if one were discovered and implemented would older type 1s be at the back of the line?) I would think insulin might be problematic for me, since I live by myself and have a needle phobia to overcome. And on a much more shallow note I've really been pleased by the weight loss and would hate to see it reversed by insulin use. Just having difficulty taking that step.

#6

Hi Teresa: Yes, there is a decent chance that you have LADA, and the way to tell if you have LADA/Type 1 autoimmune diabetes is via autoantibody testing. I wrote a blog about autoantibody testing that you may find useful. I also wrote a position paper about adult-onset Type 1 diabetes that may be useful. If you have slowly progressive Type 1 diabetes, the earlier you get on insulin the better the outcome. The more remnant beta cells you have functioning, the better your diabetes life. I know that it is tempting to put your head in the sand, but you did post here so obviously you are actually being proactive. I am glad that you found TuDiabetes! It's a great resource.

#7

Yes, I've already read everything you've written on this and it's thanks to you and TuDiabetes I've been able to figure most of this out. I almost made a request for the antibody tests at the latest appointment, but couldn't quite bring myself to do it. Thought I'd get the latest results before taking that step. I get the feeling my doctor already suspects and senses my reluctance (perhaps because I explicitly told her one of my goals was to avoid insulin therapy before I thought it might be type 1) and she's taking a wait and see attitude. Well, yes, I thought I was being proactive, but I feel like I was preparing for a game of chess and now I'm playing Russian roulette.

#8

In the end, all that really matters is that you are able to get good and appropriate treatment. If you find that you test negative for antibodies or are found to still be producing insulin that is not a basis for denying you appropriate treatment. And just because you have T2 (which really only means "diabetes of unknown cause") that is not a reason for the health system to deny you treatment to properly manage your diabetes.