LADA?

[jocat]

how would I know if I am lada, don't think my gp surgery have even heard of it, I was diagnosed t2 end of July 2009 was started immediately on metformin SR. And gliclazide cause my levels were so high. Muddled through until my sugars started creeping last October and kept on creeping. Middle of Jan suddenly shot of scale with HI readings all the time and never any readings below 25mmol/l . End of Jan started on insulin, middle of Feb started basal bolus and still working on getting bs levels under control. I am overweight but somehow my story doesn't seem to fit the typical t2 story, nothing like my mum for instance who was diagnosed t2 30 days before me, I was 35 when diagnosed. Just keeps whirring am I missing something? Why did this all happen so quickly in Jan it's almost like my pancreas suddenly gave up the ghost, I can give the date
Jo

 

[Rosiecarmel]

That's exactly how I feel! I don't fit the typical type 2 criteria but my GP surgery (and maybe yours) looked at my weight and went YEP type 2. Now, 10 months after diagnosis I am on insulin. My levels slowly crept up and up and no medication was working at all. There are a couple of tests to "define" LADA such as a test called a GAD anti body test but even people that are definitely LADA can come back negative for antibodies. Mine came back negative and they've just done it again so waiting for results but it'll probably still come back negative. It doesn't necessarily mean I'm NOT LADA, it just means I don't have antibodies (yet?)

It's worth asking your doctor about it. Have you ever been seen by a diabetic hospital team or DSN? You could ask them if your GP isn't much help

 

[Ljc]

Hi Jocat. This is just my opinion, just because a person is overweight and develops D , it doesn't mean they have to be type 2.
I suggest you ask for a referral to a hospital diabetics team.

 

[jocat]

Thanks Rosie and ljc, my gp is not good on diabetes she passed me very quickly on to the practice nurse who deals with diabetics once it became clear I needed insulin. The nurse has been very good to me and when I requested the change from mixed to basal bolus she admitted she didn't do it very much but she sorted me out. She's sorted me out with extra large sharps bins from surgery own supply because the 1l ones they can prescribe were not lasting me long on min of 5 injections a day and at least 10 finger pricks. As soon as she realised I was self funding my blood testing stuff she prescribed me lancets strips and a new meter and apologised for not having asked me sooner. I would like to see a dsn at the hospital to get more information cause the practice nurse admits she doesn't deal with basal bolus often, I think I'm her only patient but I have no arguements with my gp practice and don't want to fall out with them. I am so confused what to do for the best. I've had to teach myself carb counting and correction doses, some actual information from a hcp would be nice!
Jo

 

[mikeyB]

I agree with Ljc, you need to be seen by a hospital diabetes team. Your GP and Practice nurse are clearly not competent to initiate treatment with insulin, nor make a diagnosis as to what type of diabetes you have.

I don't think they'll be offended if you ask for that, they'll probably be relieved to pass on the responsibility.

 

[Ljc]

Thanks Rosie and ljc, my gp is not good on diabetes she passed me very quickly on to the practice nurse who deals with diabetics once it became clear I needed insulin. The nurse has been very good to me and when I requested the change from mixed to basal bolus she admitted she didn't do it very much but she sorted me out. She's sorted me out with extra large sharps bins from surgery own supply because the 1l ones they can prescribe were not lasting me long on min of 5 injections a day and at least 10 finger pricks. As soon as she realised I was self funding my blood testing stuff she prescribed me lancets strips and a new meter and apologised for not having asked me sooner. I would like to see a dsn at the hospital to get more information cause the practice nurse admits she doesn't deal with basal bolus often, I think I'm her only patient but I have no arguements with my gp practice and don't want to fall out with them. I am so confused what to do for the best. I've had to teach myself carb counting and correction doses, some actual information from a hcp would be nice!
Jo

Sorry I didn't realise you had already switched to basal and bolus.
No of course you don't wish to fall out with them esp as they do seem to be doing there best for you.
I think the troubles is that the practice nurses don't get anywhere near enough training and updating on D , Plus the majority of pwd they see are aT2s who are on pills or diet and exersize controlled.
I remember when i saw my practice nurse after the hospital put me on insulin,
She looked terror stricken when I asked her about carbs and bolusing.
Tbh I think you should explain you would really like to learn how to bolus for carbs and see what she suggests, also let her know your are wondering if you are really T2.

 

[KookyCat]

I'd talk to them very openly, and see how they react. My practice doesn't know anything about basal bolus and I don't think they really want to if I'm honest. They're OK with mixed and basal only. If they can't meet your needs then they should provide you with access to someone who can. You don't need to fall out with them over it, I don't think. LADA is still quite a contentious area, not everyone agrees what it is or even that it exists so it's not unusual for a GP to be unaware, I think the problem these days is, they see an adult with diabetes and immediately think T2, they were debating if I was T2 when I was in a coma with DKA, was seriously underweight, and had all the classic signs of autoimmune (parotid glands the size of tennis balls) because I was 40 (and literally only just) and type 1 occurs under 40 🙄. Talk about linear, the line they walk is so straight it's a circle.

You have to do what's right for you, and if you need access to someone with more expertise in basal bolus then that's what you need 🙂

 

[jocat]

Thanks people, I might ask if there is any chance I am lada and see what the response is and ask her what catastrophic event would have happened in middle of Jan for it to appear that pancreas just packed up to such a dramatic extent. This would appear to tie in more with t1/lada, from everything I've read t2 decline seems to be more gradual, have I got this right?
Thanks jo

 

[Ljc]

I don't know about LADA , usually t2s is slower in the beginning I know mine was.

 

[DaveB]

Hi. I tend to use the term Late onset T1 rather than LADA. Many medics have never heard of LADA but have heard of T1. Any medic who says T1 only occurs in the young should be asked at what age the possibility of T1 finishes; of course there is no age limit (literally). My extremely thin nephew went DKA at age 22 and my diabetes GP said 'that's unusual' which of course it isn't but reflects gaps in GP diabetes training as she had only just come off the 1 week Warwick training. BTW the c-peptide test is pretty conclusive of the need for insulin, it it's low, regardless of diagnosis or negative GAD.

 

[mikeyB]

I'm not a big fan of all these labels, for the simple reason that you treat patients, not labels. When I was first "diagnosed" age 43 my GP put me on tablets. (I had diagnosed myself on my type 1 mother's testing kit). Lots of tablets. Not long after this I developed severe ulcerative colitis, which resulted in food not staying long enough inside me to affect my blood sugar. When this settled down, my blood sugars became astronomical. The hospital diabetic specialist said this was because I was Type 1, and stuck me on insulin, since when I've never looked back. He did not say that I was type 1a, or LADA, or indeed any other label apart from type 1, because the treatment is the same.

If it looks like a duck, quacks like a duck....

 

[trophywench]

Mikey - apart from people other than you wanting to know what they have - and were I them - so would i want to know! in most parts of the country - T1s and T2s get treated differently. For instance - and its a biggie - a T2 my well do absolutely fine just on insulin alone. Great. After a few years on it, they'd like to try an insulin pump, cos you really can fine tune a lot more with a pump than you ever can on MDI.

Get knotted - T2s can't have them.

Plus there are lots of GPs who would still be insisting that YOU have to try every T2 drug ever invented before even considering insulin at all - despite the fact that a person is walking about and trying to function and old down a job, with a BG in the high 20s. This forum to a man all told one of our members within a week of joining us that they weren't T2 and they've been banging their head on a brick wall for a YEAR trying to get their stupid GP to act.

YOU were bloody lucky mate and clearly - not everybody is!

 

[mikeyB]

Dont disagree with any of that, Jenny. That's the trouble with labels, and GPs, the point I was making. I've got friends who've been banging their heads against that same brick wall.

Anyway, It's not my fault, I can't help what happened. I suppose I was bloody lucky to get UC, which shortened the discussion, though I wouldn't recommend it as a routine shortcut to insulin therapy. I nearly ended up with no colon. Lucky again, though.

Earlier this year I acquired another autoimmune condition, chronic pancreatitis, without ever having had any pain. That's more than lucky, it's amazing.

One of these days, my lucks gonna run out, but I don't want to be around when that happens.

 

[trophywench]

LOL - we are ALL different, Mike. But getting EVERY GP to get their head round that fact, sadly, isn't a message that seems to be getting through too quickly - though it IS absolutely definitely, recognised in High Places.

 

[mikeyB]

The trouble with getting EVERY GP to agree on anything is it would be a miracle. If you have a gathering of 10 GPs you couldn't get them to agree on the time of day. It's all to do with when they qualified, and whether they have gotten off their well paid backsides to go on updating courses.

I should know. I was one from 1981 to 1992, when I came to my senses.🙂

 

[trophywench]

LOL Mike - things have changed for the better actually in that GPs and surgery nurses are now obliged to attend X amount of training/updating every year, if they still want to get their funds from the NHS - and oddly enough - they seem to want to !