Opinions - Lada or not?

[Lucyr]

presumably if your BG is normal you can get a false reading?

Yes as there’s no need for your body to make insulin if your bg is normal so it can appear that your body isn’t making much. Normally you have a high carb meal without insulin 1.5-2 hrs before the test then your bg is high and body making as much insulin as it can for the test. Do check your instructions though as there are different normal ranges for stimulated vs unstimulated

 

[Inka]

Thank you! That’s very interesting regarding the correct info about being carb loaded … I was not given any of this info AT ALL. Just a blood form with c-peptide ticked. I have a colleague who is also T1 and she has had this test too - she follows a low carb diet so there is no way she would have had a BG in the teens, and she never mentioned this to me when we were discussing it in passing. I’m intrigued now - presumably if your BG is normal you can get a false reading?

Also, like yourself, my symptoms just appeared one day - I found myself needing the toilet desperately and almost constantly. It really felt like one day I was normal and the next I had this … then all the other symptoms arrived too!

The speed of onset strongly suggests Type 1 too. LADA is a slow onset. I too would refuse the C Peptide test and I’d personally forget any of that was said by the doctor. The only time I’d consider testing is if they thought you had MODY and there was a chance you could have/needed different meds.

 

[eggyg]

Why does a consultant/GP/DSN think if your TIR is excellent you must be something else? Why complicate things, would they change your treatment? Probably not, why can’t they just be happy for you, say well done and think about the money the NHS will save in the long run. Maybe it’s purely down to your hard work and resilience. My TIR over a three month period is 95% but I’ve definitely not grown a new pancreas! It has purely been my hard work, stubbornness and the fact I want to live a long and happy life without complications.

 

[SB2015]

I was diagnosed with LADA at 53 but told that it is the same as Type 1 and just describes how it might have developed. I lost 1 1/2 Stone in a week as I developed DKA. I was under a lot of stress at work, got a cold pushing my needs for insulin way over what my body was able to produce and that was that.

My understanding, supported by info from consultant, is that it makes no difference once you have been diagnosed. So just stick with the diagnosis of Type 1

The use of Metformin is generally due to misdiagnosis rather than a better treatment. I think they now suggest going straight onto Basal Bolus regime straight away in order to protect the remaining beta cells.
It is common for Practice staff to make the assumption that if you are older high Bg must be T2 and often don’t do the T1 tests and just prescribe Metformin. This will work for a while if the LADA/T1 is picked up early but the destruction of beta cells will continue and lead to insulin being needed.

Personally I wouldn’t worry about whether they call it LADA or T1. A label of T1 can help give access to tech, and some people had found that LADA can muddy the water.

 

[Tdm]

Congrats on your good blood sugar control and very well done on all the work you put into it!

 

[CliffH]

Again I very much doubt there is a cut off age.
I was 55yrs old but my symptoms came on very suddenly one night after a meal out when the unquenchable thirst hit me just as I was leaving the pub to go home. I spent all night and the following fortnight drinking pint after pint of water day and night and weeing for England before I got a blood test and (Type 2) diabetes diagnosis and then 5 weeks of progressively lower carb diet down to keto level plus full dose Metformin and full dose Gliclazide and a repeat HbA1c which had increased from 114 to 116, so they started me on insulin. I didn't get Type 1 testing for another 2 months. I will never forget that night that it happened or that thirst! It was very much a watershed moment for me!

Wow! Very different from my experience - and it sounds like it was extremely scary for you . From being on this Forum for a few weeks now, I'm wondering if it makes sense to regard 'diabetes' as simply shorthand for "problems metabolising sugars", given how many different types of experience people report?

Could it be, for example, that 'traditional' severe Type 1 (starting in childhood) is at one end of a spectrum, with 'pure' obesity-related (reversible) Type 2 being at the other end? Certainly it makes sense with my own "LADA" to conceptualise it as something like 'Type 1.5', given that it seems to exhibit characteristics of both Type 1 and Type 2.

 

[rebrascora]

No, not particularly scary as I was pretty certain before I contacted the doctors that it must be diabetes, so I had already started cutting right back on sweet stuff about 10days before my first blood test which diagnosed me and together with drinking lots of plain water and then going very low carb probably saved me from a DKA event which I am sure would have been scary.

Did you get antibody and C-peptide tests straight away or were you assumed to be Type 2 first as well and started on oral meds first or as well as insulin?

 

[Inka]

Wow! Very different from my experience - and it sounds like it was extremely scary for you . From being on this Forum for a few weeks now, I'm wondering if it makes sense to regard 'diabetes' as simply shorthand for "problems metabolising sugars", given how many different types of experience people report?

Could it be, for example, that 'traditional' severe Type 1 (starting in childhood) is at one end of a spectrum, with 'pure' obesity-related (reversible) Type 2 being at the other end? Certainly it makes sense with my own "LADA" to conceptualise it as something like 'Type 1.5', given that it seems to exhibit characteristics of both Type 1 and Type 2.

Ah, now this is the other issue @CliffH People can use LADA/Type 1.5 interchangeably, but my consultant thinks of them as two separate things not names for the same thing. Type 1.5, as you say, has elements of both Type 1 and Type 2, largely the insulin resistance, as I understand it. That’s different from LADA/slow-onset auto-immune diabetes of adulthood.

No, I don’t think there’s a simple spectrum. Type 1 and Type 2 are very different conditions, and both equally as serious. Type 1 is an auto-immune condition. It has more in common with things like coeliac and auto-immune thyroid problems IMO.

 

[CliffH]

No, not particularly scary as I was pretty certain before I contacted the doctors that it must be diabetes, so I had already started cutting right back on sweet stuff about 10days before my first blood test which diagnosed me and together with drinking lots of plain water and then going very low carb probably saved me from a DKA event which I am sure would have been scary.

Did you get antibody and C-peptide tests straight away or were you assumed to be Type 2 first as well and started on oral meds first or as well as insulin?

My optician sent me to my GP because of picking up a small retinal bleed. With hindsight, for about the previous year I'd been thirsty all the time and ravenously hungry. I put it down to doing lots of cycling.

My GP tested my blood and assumed that his meter must be faulty, because the reading was so high - and because I was slim. He clearly didn't know about LADA. Anyway, he referred me to the local Diabetes centre, who told me that my average blood sugar for the previous three months had been >13 and diagnosed LADA. They started me that day on injecting insulin four times per day, which very quickly brought things under control.

 

[helli]

What is the reason/value of distinguishing between Type 1 and LADA?
My understanding is the same as has been expressed here - LADA is an ill-defined variant of Type 1 diabetes which is managed in the same way. When it is used, LADA is typically used to describe Type 1 which has been diagnosed in an adult and comes on slower than it would as a child which may mean that the honeymoon phases is longer and insulin doses may increase slower (although children have to go through adolescence which is another ball game).
Unless someone with LADA is incorrectly diagnosed as type 2, they are treated the same as someone with any other form of Type 1.

In the past, when I have posed this question, the only reason I have received is it highlights that high blood sugars as an adult are not necessarily symptoms of type 2. But isn't it easier to educate that more than 50% of people with Type 1 are diagnosed as adults rather than confusing the medical profession with another acronym?

 

[rebrascora]

My optician sent me to my GP because of picking up a small retinal bleed. With hindsight, for about the previous year I'd been thirsty all the time and ravenously hungry. I put it down to doing lots of cycling.

My GP tested my blood and assumed that his meter must be faulty, because the reading was so high - and because I was slim. He clearly didn't know about LADA. Anyway, he referred me to the local Diabetes centre, who told me that my average blood sugar for the previous three months had been >13 and diagnosed LADA. They started me that day on injecting insulin four times per day, which very quickly brought things under control.

So your cycling lots probably helped prevent you from reaching crisis point and developing DKA but if you were symptomatic for a year without insulin then perhaps more LADA than a straight forward Type 1, but then again I think the term is subjective and not clearly defined. Like @Inka I was also of the opinion that Type 1.5 can be used as an indication of Double Diabetes where people have the autoimmune diabetes but also perhaps put on a lot of weight and develop insulin resistance and therefore elements of Type 2 diabetes as well as having Type 1 and can sometimes benefit from Metformin as well as insulin to improve their resistance and reduce the output of glucose from the liver.

 

[CliffH]

Ah, now this is the other issue @CliffH People can use LADA/Type 1.5 interchangeably, but my consultant thinks of them as two separate things not names for the same thing. Type 1.5, as you say, has elements of both Type 1 and Type 2, largely the insulin resistance, as I understand it. That’s different from LADA/slow-onset auto-immune diabetes of adulthood.

No, I don’t think there’s a simple spectrum. Type 1 and Type 2 are very different conditions, and both equally as serious. Type 1 is an auto-immune condition. It has more in common with things like coeliac and auto-immune thyroid problems IMO.

So your cycling lots probably helped prevent you from reaching crisis point and developing DKA but if you were symptomatic for a year without insulin then perhaps more LADA than a straight forward Type 1, but then again I think the term is subjective and not clearly defined. Like @Inka I was also of the opinion that Type 1.5 can be used as an indication of Double Diabetes where people have the autoimmune diabetes but also perhaps put on a lot of weight and develop insulin resistance and therefore elements of Type 2 diabetes as well as having Type 1 and can sometimes benefit from Metformin as well as insulin to improve their resistance and reduce the output of glucose from the liver.

"Double diabetes": I'd never heard of that before!

 

[rebrascora]

I think this is why @pawprint91 needs to ask the doctor what they mean by LADA because if it is purely an age thing with Type 1, then only their age is relevant and not a C-peptide test. If it is the speed of onset, then their clinical presentation is surely the only issue plus being an adult and again it would appear they are Type 1. If this doctor wants a C-peptide test to decide it, then that brings into question potentially the length of the honeymoon period as a defining factor.
I am pretty sure there was some research by the Joslin Institute on people with 50 60 and even 70 years of living with diabetes, who still had some endogenous insulin production at that time and they had obviously been diagnosed as children to get that many years under their belt, so would definitely not qualify as LADA, so I really cannot fathom what this C-peptide test is going to prove as regards diagnosis and I do not think it is beneficial to the patient to have it done.

 

[Proud to be erratic]

What is the reason/value of distinguishing between Type 1 and LADA?
My understanding is the same as has been expressed here - LADA is an ill-defined variant of Type 1 diabetes which is managed in the same way. When it is used, LADA is typically used to describe Type 1 which has been diagnosed in an adult and comes on slower than it would as a child which may mean that the honeymoon phases is longer and insulin doses may increase slower (although children have to go through adolescence which is another ball game).
Unless someone with LADA is incorrectly diagnosed as type 2, they are treated the same as someone with any other form of Type 1.

In the past, when I have posed this question, the only reason I have received is it highlights that high blood sugars as an adult are not necessarily symptoms of type 2. But isn't it easier to educate that more than 50% of people with Type 1 are diagnosed as adults rather than confusing the medical profession with another acronym?

Perhaps this question will not be fully answered while DUK have their own explanation, that includes saying LADA and T1.5 are the same thing.

Latent Autoimmune Diabetes in Adults (LADA)

Latent Autoimmune Diabetes in Adults is called LADA for short. It's a different form of diabetes. What is LADA? It's a type of diabetes which seems to straddle type 1 and type 2 diabetes. Bits of it are more like type 1, and other bits are more like type 2. That's why some people call it type...

www.diabetes.org.uk

Educating people, myself included, can only be started (never mind successful) when there is a common definition. I found the same when in Feb '20 after my total panc'y I was discharged as T1. Subsequently @everydayupsanddowns introduced me to the existence of T3c, which I've been happy to adopt. But in mid 2020 the NHS was not recognising the existence of T3c and the first NHS reference that I found was an inclusion in a NICE document; meanwhile at least 1 Consultant I briefly came under was effectively saying I was T1 because the treatment was the same, and T3c was not a recognised diagnosis. Having said that, the Consultant wasn't instantly recommending I should be given a CGM.

I haven't bothered to go on a rummage and see what the NHS (or NICE) has to say about LADA or T1.5; apologies, another busy day today (just taking a late lunch break!).

 

[Inka]

So your cycling lots probably helped prevent you from reaching crisis point and developing DKA but if you were symptomatic for a year without insulin then perhaps more LADA than a straight forward Type 1, but then again I think the term is subjective and not clearly defined. Like @Inka I was also of the opinion that Type 1.5 can be used as an indication of Double Diabetes where people have the autoimmune diabetes but also perhaps put on a lot of weight and develop insulin resistance and therefore elements of Type 2 diabetes as well as having Type 1 and can sometimes benefit from Metformin as well as insulin to improve their resistance and reduce the output of glucose from the liver.

I’m a tedious pedant, I know but Type 1.5 is different than double diabetes, to my mind. The former is someone who has just developed diabetes but there is confusion as to what type they are as, although, they seem to be Type 1, they also display Type 2 characteristics like insulin resistance. So, they are categorised as Type 1.5. Someone with double diabetes is just a normal Type 1 who has had Type 1 for years but has developed insulin resistance on top of the Type 1 - ie so-called double diabetes. This is usually because they’ve put on weight, etc, similar to Type 2.

 

[PattiEvans]

It is common for Practice staff to make the assumption that if you are older high Bg must be T2 and often don’t do the T1 tests and just prescribe Metformin. This will work for a while if the LADA/T1 is picked up early but the destruction of beta cells will continue and lead to insulin being needed.

Personally I wouldn’t worry about whether they call it LADA or T1. A label of T1 can help give access to tech, and some people had found that LADA can muddy the water.

I was diagnosed T2 purely because of my age (57 at the time). However when tested the meter read "Hi" and I had all the symptoms + some Ketones. I was on insulin very quickly thereafter. However it took 8 years to get that diagnosis overturned, meanwhile I was refused carb counting education, a meter that calculated doses and told I'd never have a pump and that even if I was LADA I'd not get a pump or carb counting.. Had to kick up a fuss to get tests and the consultant then said the whole diagnosis was ridiculous and I was T1. My treatment has been chalk and cheese before and after. So I'd say stick to your guns @pawprint91 and do all you can to keep the T1 diagnosis.

Oh and congratulations on your hard work and great results!

 

[everydayupsanddowns]

I was diagnosed T2 purely because of my age (57 at the time). However when tested the meter read "Hi" and I had all the symptoms + some Ketones. I was on insulin very quickly thereafter. However it took 8 years to get that diagnosis overturned, meanwhile I was refused carb counting education, a meter that calculated doses and told I'd never have a pump and that even if I was LADA I'd not get a pump or carb counting.. Had to kick up a fuss to get tests and the consultant then said the whole diagnosis was ridiculous and I was T1. My treatment has been chalk and cheese before and after. So I'd say stick to your guns @pawprint91 and do all you can to keep the T1 diagnosis.

Oh and congratulations on your hard work and great results!

I remember that time -absolutely appalling!

I really hope we can move away from T2 being so stigmatised and unsupported - especially where people are on MDI and intensive insulin management.

I get the feeling that LADA as a classification was somewhat falling out of favour, and that the WHO were considering adopting ‘auto immune mediated’ or something? But I’ve not heard that for a few years.

 

[mashedupmatt]

I was initially diagnosed (incorectly) as T2 BUT my GP didn't agree with her own diagnosis! (She is very good!) - so she immediately sent me for antibody tests which proved (after a week or so on Metformin (not fun!)) that she was right to doubt her own diagnosis (in which time I'd lost almost a stone in weight) - I was immediately treated and diagnosed as T1 - no mention whatsoever of LADA or 1.5 which I think was correct - I have an auto-immune condition which has got slowly worse, BUT I've had access to the right treatment to deal with it - all as a result of a brilliant GP, and swift, correct (eventually!) diagnosis

 

[PattiEvans]

I remember that time -absolutely appalling!

I really hope we can move away from T2 being so stigmatised and unsupported - especially where people are on MDI and intensive insulin management.

I get the feeling that LADA as a classification was somewhat falling out of favour, and that the WHO were considering adopting ‘auto immune mediated’ or something? But I’ve not heard that for a few years.

As it happens I have a raft of other auto-immune diseases. I sympathise @mashedupmatt

 

[CliffH]

I’m a tedious pedant, I know but Type 1.5 is different than double diabetes, to my mind. The former is someone who has just developed diabetes but there is confusion as to what type they are as, although, they seem to be Type 1, they also display Type 2 characteristics like insulin resistance. So, they are categorised as Type 1.5. Someone with double diabetes is just a normal Type 1 who has had Type 1 for years but has developed insulin resistance on top of the Type 1 - ie so-called double diabetes. This is usually because they’ve put on weight, etc, similar to Type 2.

My friends utter less polite phrases than "tedious pedant" when I drone on about diabetes 🙄