LADA

[JueB]

I have just been tested for LADA . I have GAD
have just been tested for LADA . I have GAD antibodies present but my c peptide came back normal . My GP said that because my c peptide was normal we can rule out LADA .
I am confused as to why GAD has come back abnormal.

I was diagnosed over 2 years ago , I have never been overweight and very active . Since diagnosis I have lost over a stone in weight . I’ve had many tests:scans to rule out anything else . My weight has stabilised now but I can’t seem to put weight on . All my symptoms seem to point to LADA . For a LADA diagnosis to both GAD and c peptide have to be abnormal.

 

[rebrascora]

Simple answer.... No.
LADA is a slow onset type 1. It means that your insulin producing beta cells don't all die off at once. It happens gradually and the remaining beta cells often work harder to try to keep your levels from going too high, C-peptide measures the amount of insulin you are producing.... (not how many beta cells you have left or how hard they are working. With Type 2 diabetes, at diagnosis, people usually have a high C-peptide result.... at the high end of the "normal range" or maybe even above it because they have insulin resistance, so the body has to produce extra to overcome that insulin resistance. My guess would be that you are at the bottom end of the normal range for C-peptide because your body is struggling to produce enough. This should indicate to your Dr that you are unlikely to be Type 2 and together with the GAD antibody test should indicate LADA.
Really these tests need to be interpreted by an experienced consultant rather than a GP who has little understanding of the situation and is usually just going off what is the normal range rather than looking at the bigger picture.

I would also question whether you had a blood C-peptide or a urine test. The blood test is more accurate but needs to be frozen within 20mins of obtaining it and then sent to the lab frozen. This means that most GP practices are unable to do the blood C-peptide and opt for the urine test which is cheaper and easier to facilitate but not always helpful if results are borderline or contradictory. My C-pep blood result was borderline at diagnosis (even though I had been started on insulin therapy) but my consultant was confident that I was Type 1 because of the positive GAD, my sudden onset symptoms, my weight loss etc. and gradually my insulin needs increased as more of my beta cells died off.

 

[JueB]

Thankyou

Simple answer.... No.
LADA is a slow onset type 1. It means that your insulin producing beta cells don't all die off at once. It happens gradually and the remaining beta cells often work harder to try to keep your levels from going too high, C-peptide measures the amount of insulin you are producing.... (not how many beta cells you have left or how hard they are working. With Type 2 diabetes, at diagnosis, people usually have a high C-peptide result.... at the high end of the "normal range" or maybe even above it because they have insulin resistance, so the body has to produce extra to overcome that insulin resistance. My guess would be that you are at the bottom end of the normal range for C-peptide because your body is struggling to produce enough. This should indicate to your Dr that you are unlikely to be Type 2 and together with the GAD antibody test should indicate LADA.
Really these tests need to be interpreted by an experienced consultant rather than a GP who has little understanding of the situation and is usually just going off what is the normal range rather than looking at the bigger picture.

I would also question whether you had a blood C-peptide or a urine test. The blood test is more accurate but needs to be frozen within 20mins of obtaining it and then sent to the lab frozen. This means that most GP practices are unable to do the blood C-peptide and opt for the urine test which is cheaper and easier to facilitate but not always helpful if results are borderline or contradictory. My C-pep blood result was borderline at diagnosis (even though I had been started on insulin therapy) but my consultant was confident that I was Type 1 because of the positive GAD, my sudden onset symptoms, my weight loss etc. and gradually my insulin needs increased as more of my beta cells died off.

Thankyou, I did have c peptide blood test . Results came in at 456 , normal range being 190- 990 . 2 years ago it was 793 so it has gone down but still well within normal range .
I suspect I am type 2 but have always felt I’ve had wrong diagnosis because of my symptoms.
The Gp did say he was going to drop the diabetologist a line regarding my GAD results so we’ll see .

 

[rebrascora]

Good that your GP is seeking guidance on the GAD result. I think he may have jumped the gun with saying that you are Type 2 from the C-pep and written off the GAD result although I appreciate that neither test is totally conclusive and they should be used for guidance along with clinical factors, rather than absolutes. It may be that in another 6 months or a year or 5 years or whatever you end up needing insulin, possibly despite your best efforts with lifestyle changes and I think if you should keep an open mind about LADA if that happens and perhaps push for clarification. I think it will also be important to keep a close eye on your BG levels particularly at times of illness in case they suddenly go off the scale as can happen when the body is challenged.
Hopefully though the diabetologist will ask for you to be referred and they will resolve the situation.

 

[SB2015]

Thankyou


Thankyou, I did have c peptide blood test . Results came in at 456 , normal range being 190- 990 . 2 years ago it was 793 so it has gone down but still well within normal range .
I suspect I am type 2 but have always felt I’ve had wrong diagnosis because of my symptoms.
The Gp did say he was going to drop the diabetologist a line regarding my GAD results so we’ll see .

Interesting that you c peptide shows quite a drop in insulin production over the past two years. That along with the positive GaD antibodies is shouting slow onset T1 to me. I am glad that your GP is following it up.

Do keep a watch on your BG levels, and as @rebrascora says this will be very important if you are ill. During illness you need more insulin to be produced, and this can sometimes send the remaining beta cells on strike as your body just asks too much of them.

 

[everydayupsanddowns]

I have no qualification to interpret your results, but of you’ve lost 350ish of CPep in 2 years, does that suggest that in another 2 years you might be running pretty low on the value you have left? And be below the reference range??

 

[EmmaL76]

We’re they both fasting c peptide blood tests ?

 

[JueB]

We’re they both fasting c peptide blood tests ?

I can’t remember if the first one was but the most recent one was . I just hope that my GP does follow it up with diabetologist , he seems to have ruled out Lada but I would just like a second opinion .

 

[JueB]

I have no qualification to interpret your results, but of you’ve lost 350ish of CPep in 2 years, does that suggest that in another 2 years you might be running pretty low on the value you have left? And be below the reference range??

I wish I understood it all better .