May 12, 2008

The LADA Epidemic. What's Going on Here?

A surprising number of people who are joining the online diabetes community after recent diagnoses are people who have been diagnosed with a new form of diabetes which is called LADA, which stands for Latent Autoimmune Diabetes of Adults. It is neither Type 1 or Type 2, but is often called "Type 1.5."

Typically, a person with LADA goes to the doctor sometime after the age of 35 and is told they have type 2 diabetes. They are put on oral drugs like metformin or Avandia and almost nothing happens. If they read up online and cut their carbs their blood sugars do improve, but even so, over time they continue to rise.

Within an average of four years, they have no insulin production left at all. At this point they must go on insulin. But the Lantus-only regimens most doctors prescribe--the ones that work well for many people with Type 2 diabetes--do not stop the inexorable rise in their blood sugars, and eventually they end up needing the full basal/bolus treatment that Type 1s use.

That's because LADA is really a slow-developing form of Type 1. The body mounts an immune attack on the pancreas and wipes out the insulin producing cells. The difference between LADA and classic Type 1 is the speed with which this happens. In young Type 1s a person can go from normal to completely whacked in a week. People with LADA may take up to a decade to lose all their insulin-secreting capacity.

People with LADA are often thin, so if you are thin and are told you have Type 2 diabetes, you should demand the antibody tests that are used to diagnose LADA. The antibodies tested for are: GAD antibodies, Islet cell antibodies, and more rarely, tyrosine phosphatase antibodies.

But not all people with LADA are slim. People with defective autoimmune genes are also prone to get thyroid disease and rheumatoid arthritis both of which can promote obesity, the first because incorrectly treated thyroid disease will make you fat and the latter because it limits mobility and hence the ability to exercise and because it is often treated with steroids that promote weight gain.

People with LADA benefit from being put onto full basal/bolus insulin regimens as soon as possible. There's some evidence that injecting insulin may turn off the immune attack on the beta cells and preserve them.

But because overweight people with LADA are universally diagnosed as having Type 2 they are almost always denied insulin treatment until they have spent years with extremely high blood sugars. This isn't because they are overweight, it's because that's the treatment given to ALL people diagnosed with Type 2 whose doctors allow them to maintain criminally high blood sugars for years out of a misguided belief that insulin will worsen, not better, their insulin resistance.

Genetic testing recently revealed that people with LADA have similar immunity-related genetic errors to people with juvenile onset Type 1 diabetes but that they also have defects in a gene, TCF7L2, that are frequently found in people with Type 2. Since just about every LADA I've ever met is thin, this suggests to me that there are probably a lot more people out there who are carrying Type 2 diagnoses who have LADA than we realize who are not getting diagnosed correctly because of their weight and because that TCF7L2 gene may cause enough insulin resistance to make them look like a classic Type 2.

I have to wonder though, WHY we are seeing so many people developing what was an extremely rare syndrome just a few decades ago. Is it better diagnosis, or is it the same thing that is driving the huge increase in the number of kids getting autoimmune diabetes? My guess is the latter, and though there is officially no explanation for this, my guess is that it has a lot to do with the environmental pollutants that saturate our bodies. Plastics, industrial chemical residues, pesticides, PCBs, etc.

Many genetic flaw--for instance those that lead to cancer--do not manifest in overt disease until the borderline-defective gene takes a hit from some environmental exposure. Chemicals, radiation, and viruses can all cause cancer in people with defective genes, and probably they cause autoimmune diabetes in people with defects in their autoimmune genes.

This is likely because even among identical twins who share genes, it is possible for one twin to develop autoimmune diabetes while the other remains normal. So my guess is that many of us have carried slight abnormalities in our autoimmune genes that did not get those extra hits until we started filling our world with plastics and the other toxic chemicals that are now found in our blood, tissues and even, as I blogged earlier, in mothers' milk.

The Warning Signs YOU May Have LADA

1. You are diagnosed with Type 2 diabetes while at a normal weight.

2. Whatever your weight, either you or a member of your family has some other autoimmune disease such as thyroid disease, rheumatoid arthritis, lupus, or multiple sclerosis.

3. You lower your carbohydrate intake shortly after diagnosis to no more than 15 grams a meal and still have a fasting blood sugar over 110 mg/dl and blood sugars that rise 40 mg/dl or more after each meal.

4. No matter what your weight, you do not see a dramatic drop in your blood sugar when you take metformin, Avandia, Actos, Januvia or Byetta in combination with a lowered carbohydrate intake.

5. Your blood sugar deteriorates significantly over the period of a year despite treatment with oral drugs and carbohydrate restriction.

What To Do To Get A LADA Diagnosis

If you think you have LADA ask your doctor for:

1. A fasting C-peptide test. If the value is low, it is suggestive of LADA.

2. GAD and Islets antibody tests. High levels of these antibodies are diagnostic of LADA especially in combination with lowered C-peptide.

The Next Step

Many doctors assume patients will do anything to avoid shots and delay giving people insulin. If you have LADA you want to go on a full-fledged Type 1 insulin regimen as fast as possible.

The sooner you start insulin the easier it will be to control your blood sugar with insulin for many years to come. And by injecting insulin you may be able to stop the attack on your beta cells completely. This is essential because technologies are emerging that might be able to stop the immune attack permanently and even regrow your beta cells. But for these treatments to work you need to have living beta cells. The longer you delay insulin, the fewer beta cells you will have left.

Insulin shots are painless and if you have been running high blood sugars for a while, you will feel much, much better once you start using insulin to get normal blood sugars.

Get Support From Others with LADA

There are lots of people with LADA active on all the online discussion boards that provide diabetes support. If you have LADA be sure to seek out others because their personal experiences will be extremely helpful to you once you start working on adjusting your insulin doses and diet.

You can find people with LADA at Tudiabetes.com, Diabetes Daily Forums, and Diabetesforums.com. LADA is usually discussed in the "Type 1.5" area.

46 comments:

islandinthenet.com said...

Hi Jenny,
I did not notice that LADA was rising? Not cool. I also did not have other autoimmue challenges ( allergies ) until I moved to North America from the Caribbean.

Lili said...

So true!

Rates of LADA and Type 1 are strangely high here in Seattle. Maybe LADA has the same Vitamin D/sunlight connection that they've found regular Type 1 has.

Anonymous said...

Jenny,

I have a question for you. All persons in my immediate family have Type 2 (and are obese or overweight). I am thin and have not been diagnosed as diabetic because of my normal readings, although since my early 20s I've had complications affecting my skin (i.e., a host of infections, boils, etc.) that I contribute to high blood sugar. So I closely adhere to what is talked about on your websites, especially diet and meter testing.

Here's my question: I recently went to see an endocrinologist who suggested I have a GTT to determine how strong my beta cells are, particularly considering my family history. I'm afraid the onslaught of sugars will immediately bring on complications. In your opinion, should I have this test to get an offical diagnosis OR continue with my diet and meter regime and forgo the test?

Thank you!!

Jenny said...

Anonymous,

It takes literally a decade or more for high blood sugars to cause complications. So don't fear the OGTT.

Since research shows abnormalities of insulin resistance in lean relatives of people with Type 2, you may well have some IR, but it sounds like you are doing what you need to do to slow down or perhaps prevent it from advancing.

Anonymous said...

While 'environmental' toxins may play a part why not consider vaccines also. When we were kids we got vaccinated against all the scary 'kill you dead' stuff. Now they vaccinate against EVERYTHING starting at ONE DAY OLD. Kids immune systems are literally carpet bombed with the combo vaccines. I'm not against vaccines but have always wondered about the link between 'overuse' of them and autoimmune disease in people with genetic predisposition. Any questioning of the 'vaccinate everyone against everything always' dogma results in nasty accusations of luddism. A nice non biased study would be great but is unlikely. Some people might actually be BETTER off getting the disease instead of the vaccine if a particular vaccine activates a genetically predisposition.

I also think vitamin d intake during gestation and infancy plays a large part.

Anonymous said...

Jenny,
I'm 39 and very slim. I don't have access to antibody or insulin tests but I'm thinking of using insulin because my FBG is around 110 and post pandrials around 130 while low carbing and I intend to achieve normal blood sugars.
My Dr. won't give me nsulin 'cause my last HbA1c was 5.7.
From what I've read, I'm thinking of using 1-3 units Humalog after meals to start.
Do you think it's a good starting strategy?
If not, what would you do instead?

Jenny said...

Anonymous,

Your blood sugars sound a lot like mine were a couple years ago. I didn't start insulin until the numbers went up another 10 mg/dl. My doctor gave me all the oral drugs and they didn't do anything and then he finally gave me insulin when I was over 140 after meals with an LC diet.

But it takes a lot of effort to make insulin work and with marginal blood sugars it can be harder because you will end up with that counterregulatory problem I wrote about where you go up, not down, because you are using too much insulin.

If you have LADA your blood sugars will rise and then ideally you can find a decent endo to work with you. Meanwhile, study Bernstein and get the hang of how you'd use insulin before you start fooling with it.

Anonymous said...

Concerned,

Hello Jenny. I went through your website and this blog. I have a concern. My FGB (12 hr fast) 2 1/2 years ago was 99 mg/dl (one reading only). Right now it is between 97 (after 13.5 hrs - 1st reading) & 101 (after 11 hrs - 2nd reading). I took an oral test and came with 108 mg/dl. A random blood test from my medical files 7 years ago had a reading of 88.5. My doc gave me a clean bill of health and told me to go home and enjoy life. I'm 34, thin and have no family history of diabetes.

Am I at the every early stages of LADA or even type 2? If so then how many years do I have? Looking forward to your answer

Jenny said...

Anonymous,

I really hope you weren't serious about asking me to diagnose you via anonymous comment posted on a blog.

Your fasting blood sugar is borderline normal. Unless you are spending many hours a day above 140 mg/dl and have a family history or personal history of diagnosed autoimmune disease, it is very unlikely you have LADA.

If it is likely, you should be asking this question to a doctor you trust who has access to your medical records and can run tests.

eadm said...

Hi

I liked your article...

My identical twin (both of us are not overweight) have been diagnosed as type2 diabetes two years ago (she was 22) and started to take Metformins.
Her results last week shows that she is running out of insulin then she observed that she have LADA and will start taking insulin.

Last month I've noted that I have diabetes (I am 24) and started to take metformins. My doctor still didn't make antibodies test yet but I think I am having LADA too.

I've just wanted to make note about what you've said about identical twins.

19921993 said...

Contrary to normal beliefs, people with Latent Autoimmune do often have Type 2 Diabetes' Family History. The problem: not many diabetes specialists really know of Latent Autoimmune--those that do always misinform persons who have diabetes, saying "most with Type 2 Diabetes will eventually need to inject insulin"--which is very questionable. Evidence is now showing Latent Autoimmune and Type Two have strongly equal levels of insulin resistance. I'm plus-sized (slightly overweight to minimally obese) and the doctors diagnosed me Type 2, three years ago. But I've recently heard abot LADA beginning in August 2008, and I really more likely have Latent Autoimmune than Type 2, which certain people in my family do have. Latent Autoimmune, according to some evidence, is genetic, like Type II.

Jenny said...

19921993,

Slightly less than 10% of people diagnosed with Type 2 also show antibodies suggestive of autoimmune diabetes. But most people diagnosed with LADAs are insulin sensitive.

LADA has features of both kinds of diabetes, but those features are genetic, and the genes associated with Type 2 are largely those that cause insulin deficiency, not insulin resistance.

19921993 said...

Well, my friend, Happy Holidays, although the Holiday Season will not prevent me from having inquiries about LADA or MODY. The unfortunate realities about LADA is the plus sized individuals having LADA (Latent Autoimmune Diabetes of Adults) but are diagnosed with Type Two (incorrectly) are extremely too often denied insulin treatments and put under special diets. Iowa City, Iowa is my location, and unfortunately most people around here, particularly medical doctors and diabetes specialists around here in east central Iowa never heard of Latent Autoimmune Diabetes of Adults. I happen being plus sized myself with what is extremely likely LADA even though I was diagnosed as a Type Two. On the 1JPW Division at the Univ of Iowa Hospitals where I sometimes go for depression, autism, anxiety and panic attacks, there's a plus sized brunette nursing assistant diagnosed with Type Two but has autoimmunity involved, meaning she could be carrying Latent Autoimmune, only not really knowing it-that is one of my favorite and most helpful nurses (she is nice to me). I'm female myself and plus sized-you said yourself overweight people (me for example) are always denied insulin treatment. I was denied that, Jenny!

Ian G said...

Ian,
I have just been told I have type 2 diabetes. I have Ankylosing spondilitis and Type 1 has been passed down to my daughter even though up to now I have not had it. My mother was type 1. I have also been on Humira which I beleive compromises the immune system further. I am slightly overweight at 5'10"/85kg. Would I be a candidate for LADA?

Jenny said...

Ian G,

With a personal and family history of autoimmune disease, LADA is a possibility. If your sugars continue to get worse and don't respond to drugs used for Type 2, hou should ask your doctor to test you for the antibodies characteristic of Type 1.

Weight isn't predictive.

Caitlin said...

Hi There Jenny -

My older (by 4yrs) brother was just diagnosed with LADA at the age of 32. I know our granddad had Type 2 (at least that's what they diagnosed him w/ in the 60s!)... and sometimes wonder if I experience mild symptoms ... I've heard of siblings both having Type 1 and am wondering if you know/have heard if this can also be true with LADA. I'm uninsured, so check ups are expensive for me, but I'm looking for a little unofficial guidance as to whether or not I should head in to get checked out.
My family/social hx is otherwise completely non-contributory, so I don't have much other health concern.

PS: I'm asking a stranger as opposed to asking him to ask his MD as I don't want him to think that I'm concerned for anyone other than him right now!

Jenny said...

Caitlin,

The simplest and cheapest way to check this out would be to buy yourself an $8.88 Walmart blood sugar meter and one container of strips. Test your blood sugar when you wake up, once. Then test it 1 and 2 hours after you eat a meal. The Walmart meters aren't extremely accurate, the one I just tested read about 25 points high, so I would caution you not to overreact if you see numbers over normal (140 mg/dl after meals and 100 fasting) but if you see numbers that are significantly higher than those numbers, time after time, it would suggest you might be developing diabetes.

If you do see high numbers, as long as they are under 250 mg/dl you can use the strategy you'll find at http://bloodsugar101.com/how.php to lower them. If they still continue to rise you MUST see a doctor and make him aware of your brother's diagnosis because LADA, unlike Type 2, is almost always progressive. If your sugars stay over 200 mg/dl for long periods you will be damaging your body. If you can keep them under 140 mg/dl you can get by until you have access to better health care.

And be sure to vote for candidates that aren't pledging to undo the Obama health reform. Living in Massachusetts where I have access to affordable health care despite a diabets diagnosis (and where people with little money get help paying for comprehensive insurance) I am disgusted at the lies being told by venal politicians about this kind of plan. People in Massachusetts are VERY satisfied with our health care and people with diabetes here don't have to choose between food and insulin.

Caitlin said...

Thanks Jenny - that was extremely helpful! And I'm certainly on the same page as you with Healthcare - lets hope we can keep positive changes in effect and successfully work for even better changes towards the future to get this sick healthcare system up to par with with rest of the world!

AD said...

I was diagnosed as a Type 2 diabetic when I was 17. I wasn't overweight, but we have a long family history with the disease, and even some deaths from it. I was on oral meds for a number of years, and then slowly found that they weren't keeping my sugars low (I like to keep them in a tight 80-110 range). I went on insulin, and over the course of the next 6 years, became obese. I do have a thyroid issue that doesn't really respond well to medication. I live in Seattle and take plenty of Vitamin D to make up for it.

Nearly a year ago, I had Lap-band surgery. I was hoping that dramatic weight loss would help me find a happier place, medication-wise. I went on a very strict, high-protein diet, and am only taking Metformin. I lost 80 pounds and am no longer considered overweight, but my blood sugars are slowly, but surely, getting worse. After exercising, my sugars are over 200. Fasting sugars are in the 160-200 range. I don't eat more than 10g of carbs at a meal, and usually not that much. I take chromium and other supplements, but I can feel things getting out of control. Exercising with a blood sugar of over 200 is difficult - there's just so little energy to draw from.

I want very badly to be a happy, healthy adult. I really even wanted to have children. But I don't think I can now. It's just too unpredictable.

Jenny said...

AD,

Is your thyroid problem autoimmune? If so, it is more likely that your diabetes is autoimmune too.

Are you using fast acting insulin with meals, with a calculated insulin-carb ratio? If you are only taking Lantus or Levemir, your blood sugars won't be controllable unless you use fast acting. With fast acting you should be able to get normal sugars without weight gain.

If you are using fast acting, try a different brand. They all are a bit different Some people do better with Novolog or Apidra than Humalog.

AD said...

Hi, Jenny,

My thyroid is autoimmune. The more I think about it, the most LADA makes sense.

I'm not on insulin at all right now - it had caused such terrible weight gain (over 100 pounds) that I had absolutely resolved to never use it again. The worst part is that, now that I am thinner, my sugars are worse. The more I exercise, the worse it gets.

I had to call my doctor and demand a C-peptide test because they were just sort of shrugging their shoulders when I told them about the high morning sugars.

Jenny said...

AD,

Insulin prescribed properly should NOT pack weight on you. But the combination of a slow thyroid and hunger will. Insulin not matched to your carb content very carefully WILL make you hungry.

Read books like "Using Insulin" by John Walsh, and Dr. Bernstein's Diabetes Solution to understand how insulin should be prescribed. Most family doctors do NOT understand it and give generic doses.

Trust me, if you can learn how to use insulin you can use it without weight gain, especially if you've gotten your thyroid treated properly.

AD said...

Well, until I find for certain that I really need it, I'm going to stick to the low carb diet and Metformin and see if I can't keep the numbers down. The morning fasting ones tick me off, but if I can get around insulin, that would be great. I had new labs (INSA, GAD) run today, along with my A1C (which turned out to be amazingly good), so I will keep you updated! Like you need to know. ;) Thanks for the book reqs; I will check those out tonight.

Jim Burrill said...

Hi, New to this blog.
I was diagnosed as Type 2 about 10 years ago at 47. Retired Navy and was holding a steady Navy weight of 200 on my 6' frame.

Metaformin , avandia and other pills seemed to reduce the blood sugars, but even makign a concerted effort to diat and exercise, the numbers stayed int he 200's.

Stumbled across word of LADA and asked my Endo. He grudgingly admitted he had "heard of it". Later, I said there were specific tests for it, and he said "Why bother?? you are already on insulin now. Waste of the testing as it won't make any difference to your treatment".

(sigh) I don't think this is a question for you, as much as me venting frustration that it took almost 10 years to get on insulin, and I am still on Metaformin as well as two types of insulin - a 20 unit x2 "daily" shot and 20-30 units per meal.

Other than the knowledge I have Diabetes, I do not suffer from any other related conditions - yet.

I just wonder if the research on LADA will produce something available for treatment before I do.

All the best,
Jim in Phily

Ed said...

Hello,

I just found your blog and was just personally diagnosed with LADA a little over 3 months ago. I'm now sticking myself to test my blood every morning and injecting myself with insulin every night after not having to go to the doctor much less get blood drawn or shots for nearly 50 years. Up until this diagnosis, I have been what I would consider to be a very healthy male with a healthy lifestyle (hiking, biking, kayaking, soccer, etc.), vegetarian for 17 years (now vegan), not overweight, etc. I'm still somewhat in shock and not adjusting well at all to this 'reality'.

I noticed that in your original post you stated the following:

"The sooner you start insulin the easier it will be to control your blood sugar with insulin for many years to come. And by injecting insulin you may be able to stop the attack on your beta cells completely. This is essential because technologies are emerging that might be able to stop the immune attack permanently and even regrow your beta cells. But for these treatments to work you need to have living beta cells. The longer you delay insulin, the fewer beta cells you will have left."

It's been nearly five years since your original post. Why haven't we seen (or heard from our doctors) more information about beta-cell therapy (rebuild or replacement)? They are genetically growing food and whole animal body parts, what is the hold-up? I don't want to inject myself with anything for the rest of my life as your original post suggests.

It feels to me like there is way too much discussion and action on SYMPTOM treatment as opposed to CAUSE treatment.

Sorry for venting, but everywhere I turn, the only thing I am seeing is 'shut up, take your shots and just be thankful it's not worse yet.' That just doesn't seem right in this day an age.

- Ed

Jenny said...

Ed,

Unfortunately, since that post was made, research into whether early injections could stop the autoimmune attack have found that they won't.

Because of the nature of LADA it is likely that you will need to inject insulin. There is no alternative approach that can avoid this, and, sadly, a lot of shysters selling questionable products who pretend there is.

Over time as the beta cells stop functioning you will have to use insulin or will end up in the ER with a possibly fatal condition, diabetic ketoacidosis.

Short term, lowering your carb intake can help, but that is very hard to do on the vegan diet which is heavy in starch. In addition, most vegan diets are high in soy, gluten, and bean proteins. These leak into the bloodstream and provoke antibodies when eaten with soy that contains chemicals that damage the gut lining and cause "leaky gut syndrome."

I have heard from one person with very early LADA who was able to calm it down by eliminating all beans from her diet. However, I have never heard of anyone who could reverse LADA.

My suggestion would be to study up on how to use insulin properly and accept it as part of life. It can be managed and with a limited carb intake insulin is a lot less scary because the margin of error shrinks.

If you haven't read Dr. Bernstein's book, Dr. Bernstein's Diabetes Solution, I'd advise reading it, as it is filled with useful information even if you don't eat a diet as stringent as he suggests.

hurricaneangela said...

Hey Miss Jenny - My cousin Samantha in Iowa City has a diagnosis for Type 2 Diabetes, but I'm suspicious of that, because Miss Samantha has told me she takes Glyburide and she eats right. The problem, however, is her blood sugars keep going into the 208-304 range despite her attempts to control her blood sugar. She is 5'9 and almost 190 pounds - she has never gone over 194 whatsoever. Sammie got the diagnosis on July 27, 2010. She and I really worry because of the fact she may have LADA, Latent Autoimmune Diabetes of Adults. I am also diabetic, and I'm worried I may have the LADA myself - my so called type 2 diagnosis was near September 22, 2010. I have similar problems to my dear cousin and best friend Samantha - me and her take Glyburide, exercise and try eating right. In regard to footwear, Sammie and I prefer ballet flats, moccasins, espadrilles and Keds Canvas Sneakers rather than tennis shoes. Somehow, the real subject I'm speaking of is the University of Iowa Hospitals and Clinics have skewed research about Latent Autoimmune Diabetes of Adults: they always confuse it with regular Type 1 Diabetes, and LADA is really different from Type 1 because some people may be overweight or obese when having the LADA.

Jenny said...

Hurricaneangela,

There are tests that can determine if you or your cousin have LADA. You should demand that they be done to satisfy your concerns. Testing for GAD/Islet antibodies will go a long way towards settling the question,

Whatever the diagnosis, your cousin's blood sugars are dangerously high and she should insist that she be treated with insulin, ideally a combination of fasting insulin and fast acting insulin at meals, prescribed by an endocrinologist. That is the safest treatment for blood sugars that high.

hurricaneangela said...

Hey Jenny! Recently I created a blog on Latent Autoimmune Diabetes of Adults and put some serious facts in there. The fact is, numerous studies are linking the Latent Autoimmune Diabetes with Insulin Resistance, which is also connected with Type 2 Diabetes. Please look at my blog and you will discover what I'm really talking about. Me and my cousin Samantha will most certainly look into using insulin injections. Samantha (birthdate Dec 8, 1976) and I (birthdate Feb 7, 1983) began discussing the use of injected insulin not long after you answered my last post, and she began to quietly sob when I began discussing that - Samantha hates the fact that she may have to use insulin injection for the rest of her life. She hates poking herself using syringes, and there's gotta be better ways to use injected insulin rather than syringes. Are there pens similar to Lantus, but used at meals? And another thing - most doctors working at the University of Iowa Hospitals and Clinics really have no knowledge of what Latent Autoimmune Diabetes is. I'm really scared for me and for my dear cousin. Please help me.

Jenny said...

Insulin needles don't hurt. They aren't like the needles used for giving shots. They are extremely thin and used properly you don't feel them.

LADA is not connected with insulin resistance. By definition it is an autoimmune condition where the immune system attacks and kills the cells that produce insulin, though people who have it may share some genes also found in Type 2 diabetes.

If a person has it, they eventually must use insulin because eventually all the insulin producing beta cells are dead, and without insulin the person will end up in the Emergency Room, very sick, and over time without insulin they will die.

If a person has LADA it takes about 5 years to get to that point, because LADA is a slow form of autoimmune diabetes.

The doctors at your clinic do know about Type 1 diabetes, and if they see your cousin's blood sugars continuing high with treatment, asking for the tests for Type 1 diabetes will identify LADA. Just call it Type 1 instead of LADA.

Hana Kamoun said...

Hi!



Iamwondering if children of parents with lada should consider getting genetic testing to see if they are at increased risk? Does this type of testing even exist?


Thanks!

Jenny said...

Hana,

I don't think you can get genetic testing for LADA, but children of parents with LADA should probably have a glucose tolerance test every few years to see how their blood sugar is holding up.

hurricaneangela said...

Hey Miss Jenny! On April 30, 2013, at the University of Iowa Hospitals and Clinics, Samantha was told by her physician, Doctor Angela Farrell, that she is being prescribed Lantus (aka Insulin Glargine) because of her blood sugar being too high despite using Glyburide. Farrell requested Samantha continue to use the Glyburide and the Lantus at the same time, and there will be tests for GAD Antibodies and certain islet cell issues, which then determines what type of diabetes Samantha has. My appointment is May 8 and my physician is Ashley Stillwell - I am also being warned I may have to use Lantus myself, and in upcoming weeks, officials will inspect ME for GAD Antibodies and find out which diabetes I really have. The results of Sammie's April 30 2013 appointment showed that her blood sugar was around 384; I informed Sammie about the results, she began sobbing and said that she really felt like a failure - she followed a proper exercise routine, ate in moderation, but somehow, it was not enough. Sammie felt as though this would be the actual end of the world for her, so I consoled her and said "Please don't mention that, Sammie." and kissed her. If it turns out that we carry Latent Autoimmune Diabetes, hopefully, our two female doctors may understand. My height is 5'11" and I weigh 188 pounds (I have never passed the 197 pound stage) - we are both plus sized, but we are very comfortable. Samantha and I know about the Latent Autoimmune Diabetes of Adults and are always reading about it and on Types 1 and 2, and have been doing so since around Oct 27 2010. Our doctors informed us both to always be on guard about our feet and that we can continue wearing ballet flats, moccasins, espadrilles and the penny loafers plus the Keds Canvas sneakers, and that we don't necessarily need tennis shoes for exercising. We asked if LADA had the same links to heart disease, stroke and heart attack as Type 2 Diabetes; our doctors said yes. Farrell and Stillwell told us to continue eating proper and eat fried food only sparingly. Me and Samantha usually eat chicken, fish, cheese pizzas, vegetables, fruits, milk, eggs and flavored water. We have not eaten any other meats since next to August 2002. If it turns out that Samantha and I both carry the Latent Autoimmune, at least neither of us are alone. I certainly ain't alone in this battle.

hurricaneangela said...

Hello Jenny. Samantha's medical test results showed her C Peptide was rather low, though there are more testings pending. Right now they are still calling her condition T2DM even though her C Peptides were low, and it is far more likely she has LADA. My test results will be back May 20th, although the news is not really good. I was informed my C Peptides' levels were quite low, and that I'm in serious danger of needing Insulin Lispro in addition to needing Lantus. Me and my cousin are so worried, lovely Jenny. We mentioned Type One instead of the LADA, but they still think we have Type 2. Any advice for us, Jenny?

Jenny said...

Hurricaneangela,

It doesn't really matter what the diagnosis is. Low C-Peptide means you need insulin. Once you start using it, the dose will give a pretty good idea of which type you have. Under about 20 units a day and it's usually Type 1. More than that usually Type 2. It doesn't really matter what kind you have because in both cases you need to get your blood sugar back to a safe level. Insulin is a very good way to do this. My advice is to ask your doctor to provide you with instruction on how to use insulin at meals to control your blood sugars. You will get used to it and you will end up in better health when you learn to use the insulin properly.

hurricaneangela said...

Hey Jenny. Alas, Samantha's doctor confirmed that she DOES carry Latent Autoimmune Diabetes. Her units of Lantus are between 10 and 17 units. Mine are between 12 ans 17. My results are coming back in one week, though my doctor, Ashley Stillwell, says it's likely I have LADA. A few additional tests are pending, though, Jenny. Recently, Sammie and I have become used to injecting insulin by syringes. Here in Southeastern Iowa, our coverage area may actually be different than for Massachusetts. Our Univ of Iowa Hospitals and Clinic doctors have informed us about family history of diabetes. My now deceased dad had diabetes, and he died on August 25, 2008. All we know is LADA is very serious, Jenny.

Jenny said...

Hurricaneangela,

It's good are getting a diagnosis, as that will make it possible for doctors to treat your condition. The very good news is that treatment for autoimmune diabetes has advanced greatly since the day when your father was diagnosed. Back then, doctors did not understand how important it was to keep blood sugars as close to normal as possible. Patients with autoimmune diabetes were allowed to keep their A1cs very high--over 10% was considered normal. So naturally, they developed complications and heart disease very young.

That is no longer the case. Now doctors understand it is important to keep blood sugars much lower--as low as it is possible to do without risking very low blood sugar attacks.

I hope your doctor will send you to Diabetes Education classes where you can learn more about the way to control your LADA. A combination of using insulin properly plus eating a modest amount of carbs rather than the usual boatload of starch and sugars most people eat will go a long way towards controlling your blood sugar and keeping you alive and healthy for a long time.

You might get some help from visiting one of the Diabetes Discussion boards and talking to other people with LADA. Diabetes Forums is one, and the ADA Type 1 discussion forum are places you will find some people who can help answer some of your questions.



So this means that you don't have to suffer his sad fate.

Unknown said...

Hi Jenny

I am not asking for a diagnosis, just an opinion. I am a 60yr old female, BMI 19, very active. My HbA1c have been 6.2, 6.2, 6.3, 6.2 for the past year inspite of being on a LC diet. My normal carb intake was probably around 100-120g max per day, but for the past 18 months its been around 50g.

I have had a C-peptide test done whilst on the LC diet, and the results were within normal range, but at the low end. My fasting BG has always been good, typically between 3.3 an 4.5 mmol.

However, my BGs tend to creep up during the day. A meal with around 7-10g carb is usually OK, only taking me to 6.7 or so. But if I have around 20-25g carb then it will take me to 7.5-8.9 easily, and often taking 3 or 4 hours to come back down. So, I assume that as I am producing insulin, that maybe I just don't produce enough. But, having said that, I managed to pass an OGTT without any problems, was that because it was just the one hit of high carb first thing in the morning when my Beta cells have fully recharged? I also find that a reading of over 8mmol will make me feel very sick - clearly not a 'normal' level for me.

What is your take on this, do you think that maybe I am heading for LADA? I also have auto-immune thyroid disease and there is arthritis, asthma, allergies, croop, exzema, etc in the family, also type II and gestational diabetes.

Jenny said...

Unknown,

Thyroid disease and resulting low thyroid homone (even with supplementation) can increase insulin resistance. So does eating a very low carb diet like the one you describe eating. That would be sufficient to explain the slightly elevated blood sugars you report.

However, it's a big step to diagnosing LADA, especially with normal range C-peptide and the normal OGTT. Unless you see your blood sugars relentlessly rising into the diabetic range (over 11 mmol/L) I wouldn't be too concerned about it.

The presence of any inflammatory condition can raise blood sugars to some extent, but LADA involves a specific attack on the beta cells, which doesn't seem to be the case with you right now.

Unknown said...

Thanks Jenny. My Thyroid has always been slow, so I have battled, successfully, all my life to keep the weight down, but having said that, treatment was only finally given about 2 years ago when it really started to play up big time. I didn't know that auto=immune thyroid condition, or a slow thyroid could lead to insulin resistance.

I have been reluctant to have a GAD test yet as its still early stages and in a way I fear a false negative. My doctor is still dismissing me as diabetic because I am slim ! ! even though 2 slices of bread and scrambled eggs will put me in double figures. So I am just doing my own thing in cutting right down on the carbs and will wait and see what happens.

Not sure how insulin resistance would affect you, I understand what is going on, but not the physical effect. I've been physically active all my life (really active) its only now that I have started to slow down due to age and the associated aches and pains, can't really see why I should have developed insulin resistance.

Unknown said...

Sorry Jenny, just going to add a bit more. As I have always been thin, and exercised a lot, never eaten very much, (used to give my sweets to my brother!). How can I be insulin resistant. I have obviously only recently started having slightly elevated numbers and 8.5 makes me feel very ill, so its obviously not the norm for me, also a low BG in the 3's is absolutely fine for me, in fact first thing in the morning, before eating anything is when I feel at my best, its only later that it all starts to go wrong if I eat carbs.

Jenny said...

Insulin resistance is common among people who are overweight, but you don't need to be overweight to develop insulin resistance. I know people who weigh a lot less than I do who need ten times as much injected insulin as I do to cover a set amount of carbs.

IR occurs when receptors in muscle and liver cells don't take in insulin properly, so that it takes a lot more insulin to lower a set amount of blood sugar. Low thyroid seems to cause this to happen.

In the past you probably were secreting enough insulin that you could make enough to cover a higher need. Now your production may be slowing down. This happens with age. If it keeps slowing down and your blood sugars continue to rise, it would be worth having the GAD test. But large numbers of normal people see their insulin resistance rise as they get older as part of the aging process.

Cor Thompson said...

Hi! I got diagnosed 5 years ago with type 2. When I was 21. I am overweight so I assume that's why they jumped to type 2. I went into the hospital with diabetic ketoacidosis. They did put me on insulin straight away, but within a few months I was able to stop taking it. And then for 5 years I was perfectly fine. Able to control my sugars with very minimal diet change, even though every once in awhile I'd notice them getting a bit worse, but I would just work my butt off a bit to stabilize them. I even had a healthy pregnancy in 2012 with zero meds. But over the last year and a half my blood sugar levels have changed dramatically. I've slowly gone downhill and can't control them. I have a history of autoimmune disease (psoriasis), and I've been told on another diabetes forum that I should get tested for LADA. Metformin never really worked for me. I'd have to take doses of like 850mg or more for it to do anything. Idk. Does this sound like LADA to you? I was just dropped from my Endo's care as I hadn't seen her since 2011, and to get another referral will take months. My family doctor is giving me grief about wanting this blood test done and won't do it and no other doctor will do it either since I am not their patient.

I think I can force him to give me the blood test, but is it worth the fight? I just don't know.

This was the thread I had originally posted in, and was told to get tested for LADA. So you can see the other peoples replies.
diabetesforum.com/diabetes/16938-postpartum-advice-blood-sugars-wonky.html

Jenny said...

Can you get your current doctor to prescribe insulin? If not, how high are your blood sugars right now? Are they high enough that you might be headed for diabetic ketoacidosis (DKA). With one episode in your past, your need to concentrate first on getting insulin, to avoid the ER visit, then on getting a diagnosis, later.

The pattern of your diabetes is unusual, especially with a normal pregnancy without insulin in the near past, as pregnancy usually brings out any hidden blood sugar problem. So you were fine during the pregnancy.

But there are more forms of diabetes than the Type 1 and Type 2 that doctors are familiar with. You might have LADA. You might have something odd that runs in your family, you might have some new and medically interesting condition, but no matter WHAT you have, the important thing is to get your blood sugars down out of the range that could cause serious problems.

So the most important thing is that if you can't control your blood sugars with cutting back on carbs and your current meds, you need to get some insulin (basal AND fast acting) to control your blood sugars until you see the endo. If you do have LADA and it came on suddenly, it could take a few months for the antibodies to show up. But the blood sugars are there. So concentrate on lowering them.

Point out to your doctor that you have already been hospitalized in the past for DKA which can be fatal, and remind the doctor that people with Type 2 don't GET DKA. (They get hyperosmolar hypoglycemia which is just as fatal but a slightly different condition.) I don't know if you are in a situation where the threat of a law suit changes doctor behavior, but if it does, that argument should be helpful. if you run into obstruction, mail a brief, polite note to the doctor (or whoever is the head of the practice) documenting your concerns and laying out the argument the doctor gave you for refusing you the care you need. There is nothing like a paper trail to make people think twice.

Cor Thompson said...

Hi! Yes I can get him to prescribe insulin most likely. He gave me my metformin prescription back just by asking. But like I predicted, he refused to do the blood test. Said it was a special one and their office doesn't do those so I'll have to wait for my referral to go through (Canada. Takes longer to see specialists).

I have always been able to stay between 5-7, but now I'm hovering around 10-12 with my sugars (sorry I don't know the conversion).

I'm definitely going to bring up the past DKA and demand they rush my referral through. Thank you for confirming my research that type 2 doesn't get DKA. That was always a concern of mine! Which made it not sit well that they said I was type2.

Jenny said...

To convert to mg/dl jusy multiply by 18. I hope you can get to see the specialist soon.

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