Possible symptoms of early LADA?

[EBMuso]

Hello!

So I've recently been told I might have LADA, which I'd never heard of before. I have family history of T1D and other autoimmune conditions, and have textbook diabetic symptoms, but only mildly compared to what I read about normal T1D diagnosis stories and built up over several months.

The thing that is confusing me is that I appear to be having reactive hypos post meal, which are generally worse after a carbier meal. Apparently this can happen in early LADA as the insulin production is delayed and can then overreact to a glucose spike. Anyone else experienced this? I don't understand how this can happen unless my glucagon production is also impaired. It seems odd to have hypos if my insulin production is impaired. Any thoughts?

Also my HbA1c was in non-diabetic range, although I have had a positive for glucose in urine and Dr said about LADA entirely based off symptoms and history and that HbA1c can miss LADA early on. It may not be that, but I'll find out soon when I can make it to an appointment.

 

[Inka]

Welcome @EBMuso 🙂 You’ve kind of answered your own questions there. LADA is just slower-onset Type 1 in adults (you mention building up over several months). Hypos aren’t uncommon, both in LADA and sometimes in Type 1. As you suggest, it’s a delayed insulin response - hence the spike - then an overcompensation, where too much insulin is realised, causing sugars to drop a bit low.

I’m presuming you have a blood glucose meter? Some careful testing will give you useful information about what’s happening. I see you’re only 20. That’s a bit young for LADA, as I understand it, so perhaps you’re simply in the early stages of Type 1. In young adults that can come on in a bit of an erratic fashion, but things can change quickly. Do you have ketone testing strips?

 

[EBMuso]

So do the hypos negate the spike when it comes to HbA1c? I actually don't have a BG meter, as I don't yet have a diagnosis and my family history is not within my immediate local family. But I'm recognising hypo symptoms and it's treatable with sugar.

If if were just Type 1, I'd surely have a significant problem by now? The hypos are pretty new, but the rest has developed over probably about 8 months to a year. I haven't done anything about it until now as I've been very worried about seeing a Dr having not been since the age of 10! I know I'm young for LADA, but reading about it it completely fits.

 

[mashedupmatt]

Hi @EBMuso and welcome to the forum - unusual that LADA was mentioned straight away given your age - it could be Type 1 that is just progressing slowly (mine certainly did, although my HbA1c was in the "diabetic zone") - you mention other classic symptoms - have you lost any weight unexpectedly and rapidly?

 

[EBMuso]

Hi @EBMuso and welcome to the forum - unusual that LADA was mentioned straight away given your age - it could be Type 1 that is just progressing slowly (mine certainly did, although my HbA1c was in the "diabetic zone") - you mention other classic symptoms - have you lost any weight unexpectedly and rapidly?

Hi
I think it came up as I mentioned I was aware I wasn't typical Type 1 in terms of speed of progression, and have no risk factors of Type 2 so she told me that other forms exist and suggested LADA.
I haven't got a lot of weight to lose, but I've not put on any weight with an increased appetite

 

[trophywench]

Confused here - who on earth has suggested it could be LADA if you haven't seen a doctor in years?

 

[EBMuso]

Confused here - who on earth has suggested it could be LADA if you haven't seen a doctor in years?

I haven't seen a Dr until 2 weeks ago. Had a chat and ran bloods, but haven't been back for further tests yet for various reasons.

 

[Inka]

So do the hypos negate the spike when it comes to HbA1c? I actually don't have a BG meter, as I don't yet have a diagnosis and my family history is not within my immediate local family. But I'm recognising hypo symptoms and it's treatable with sugar.

If if were just Type 1, I'd surely have a significant problem by now? The hypos are pretty new, but the rest has developed over probably about 8 months to a year. I haven't done anything about it until now as I've been very worried about seeing a Dr having not been since the age of 10! I know I'm young for LADA, but reading about it it completely fits.

The HbA1C gives a kind of idea of your average blood sugar over the last 3 months, so in theory a spike followed by a hypo might come out as a normal range average, but it would be strange. As you’re not testing your blood sugar and have no symptoms of Type 1, it’s more likely that your normal HbA1C is just that: a normal non-diabetic HbA1C because you don’t have diabetes.

LADA is Type 1 - it just comes on slower and usually appears in older adults, with some developing it over a few years. My consultant doesn’t use the term unless the person is over 55yrs of age. If you’re 20, you’d have Type 1 not LADA (if you had anything at all).

When you say “the rest has developed over 8 months”, what do you mean? What symptoms? Why did you go to the doctor? Reading your further posts where you say you don’t have a glucose meter, I’m confused about why you think you have diabetes. People without diabetes can have low blood sugar especially if they aren’t eating well or have exercised strenuously. How do you know you’re having spikes if you aren’t testing?

 

[Inka]

Hi
I think it came up as I mentioned I was aware I wasn't typical Type 1 in terms of speed of progression, and have no risk factors of Type 2 so she told me that other forms exist and suggested LADA.
I haven't got a lot of weight to lose, but I've not put on any weight with an increased appetite

So it was you who went to the doctor and suggested diabetes even though you aren’t testing your blood sugar. Everyone without diabetes gets a boost when they eat sugar. You’ll frequently hear people without diabetes complaining about “low blood sugar” and how they need a snack/chocolate/food. Those aren’t hypos, they’re just the normal movements of blood sugar. Some people are more aware of these movements than others.

If you had Type 1, you’d have symptoms, and LADA wouldn’t apply to you because you’re far too young. You have a normal non-diabetic HbA1C. I’d say it’s more likely you’re either not eating enough/regularly/correctly or are simply susceptible to the feeling when blood sugar goes down into a normal lower range - ie not an actual hypo. The answer to this is to eat regularly, make sure you have enough protein with your meals, and include snacks if needed.

 

[everydayupsanddowns]

The hypos are pretty new, but the rest has developed over probably about 8 months to a year

Hope you get some clarity soon @EBMuso

Not sure how you are identifying your hypos, but if it’s by symptoms (which is perfectly valid), and if you’ve been having glucose in your urine, it may be that your levels have been running (erratically) slightly high for a while, so your body is firing warning signs a little early.

Glucose in urine usually happens with BG concentrations above the ‘renal threshold’ (about 10mmol/L). It’s these elevated BGs, followed by the kidneys attempting to ‘flush out’ the excess glucose with extra urination that leads to the Thirsty and Toilet of the classic 4Ts (thirsty, toilet, tired, thinner).

Have you lost any weight without meaning to?

If there’s the possibility of LADA, you may have an extended period of creeping glucose dysfunction as your beta-cell mass reduces, but simultaneously while there is still a degree of insulin production that can sometimes work double-shifts to try to clear the backlog.

The good news (perhaps) is that your HbA1c remains relatively unaffected, so possibly your BGs are in-range at least a decent proportion of the time?

I wonder if perhaps one of the free-trials of something like Libre might help you to see what was happening behind the scenes?

 

[harbottle]

Yes. Both early 'LADA' and Type 2 diabetes can see high peaks and sudden drops because of erratic insulin release caused by insulin resistance or beta cells starting to fail. Glucose can be seen in urine due to levels going over 10 after a meal, but it may be only if the meal is high carb and its probably intermittent (Unlike if levels are always high.)

HBA1C can also be normal in these early stages. These symptoms can be a clue.

But for a proper diagnosis you'd need tests for antibodies and maybe c-peptide.

And the symptoms may well be something completely different.

Normally, the release of insulin slows when glucose levels reach around 7 and then slows down even more around 6. This is a mechanism to prevent sudden drops and hyperglycaemia. Reactive hypos are a sign that something is off with the whole system.

 

[Inka]

Yes. Both early 'LADA' and Type 2 diabetes can see spikes following an overreaction. Glucose can be seen in urine due to levels going over 10 after a meal.

HBA1C can also be normal in the early stages.

But for a proper diagnosis you'd need tests for antibodies and maybe c-peptide.

Type 2 would be rare in a slim woman of 20 years old, I presume.

 

[harbottle]

Type 2 would be rare in a slim woman of 20 years old, I presume.

Yep, indeed. Very rare, but possible if it's secondary to another condition.
Still possible due to fatty liver (Thin outside, fat inside)
LADA or MODY are far more likely.

 

[Inka]

LADA is older adults though @harbottle MODY is a possibility, I suppose, but the OP says it’s not her close family that have the conditions she mentioned.

With a normal HbA1C the answer is very possibly she doesn’t have diabetes at all 🙂

 

[harbottle]

With a normal HbA1C the answer is very possibly she doesn’t have diabetes at all 🙂

Hopefully that is the case.

I guess even a non-diabetic can get sugary pee after a high carb meal.

And non diabetics can get blood sugar crashes as well.

 

[EBMuso]

Thanks guys you all say interesting stuff. Yes I am experiencing symptoms I just didn't list them for you. Feeling far more tired than I should be and generally feeling dehydrated while any water I drink I just seem to pee out. Not as extreme as most people's diagnosis stories suggest, but now enough to have a significant impact on my life. No significant weight change, but I've not got a lot of weight to lose. Like I say, built up over several months and the hypo symptoms are new ish. I was spurred to finally get it checked out recently as I had a particularly bad hypo-like episode where I felt unsafe to drive home which my T1 friend recognised as a hypo as gave me a dextrose pouch which made an enormous improvement.
So it does point towards diabetes it's not just plucked out the air, it's just my age and the slow rate of development that doesn't make a lot of sense to me.

 

[Leadinglights]

Thanks guys you all say interesting stuff. Yes I am experiencing symptoms I just didn't list them for you. Feeling far more tired than I should be and generally feeling dehydrated while any water I drink I just seem to pee out. Not as extreme as most people's diagnosis stories suggest, but now enough to have a significant impact on my life. No significant weight change, but I've not got a lot of weight to lose. Like I say, built up over several months and the hypo symptoms are new ish. I was spurred to finally get it checked out recently as I had a particularly bad hypo-like episode where I felt unsafe to drive home which my T1 friend recognised as a hypo as gave me a dextrose pouch which made an enormous improvement.
So it does point towards diabetes it's not just plucked out the air, it's just my age and the slow rate of development that doesn't make a lot of sense to me.

Sometimes it is difficult to diagnose some conditions despite all sorts of tests that can be don't they don't always make sense.
If you drink caffeinated drinks you may have a sensitivity and it is causing bladder irritation which could explain your frequent loo visits and thirst.
But getting a home testing blood glucose monitor to do finger prick tests when you feel unwell and to see the effect meals have, so testing before you eat and after 2 hours to see the difference as that will indicate how your body copes with carbohydrates. That alongside a food diary with an estimate of the carbohydrate content of your meals and drinks and snacks as that would provide evidence for your GP and aid a diagnosis.

 

[Inka]

Thanks guys you all say interesting stuff. Yes I am experiencing symptoms I just didn't list them for you. Feeling far more tired than I should be and generally feeling dehydrated while any water I drink I just seem to pee out. Not as extreme as most people's diagnosis stories suggest, but now enough to have a significant impact on my life. No significant weight change, but I've not got a lot of weight to lose. Like I say, built up over several months and the hypo symptoms are new ish. I was spurred to finally get it checked out recently as I had a particularly bad hypo-like episode where I felt unsafe to drive home which my T1 friend recognised as a hypo as gave me a dextrose pouch which made an enormous improvement.
So it does point towards diabetes it's not just plucked out the air, it's just my age and the slow rate of development that doesn't make a lot of sense to me.

If you had Type 1 and the extreme drinking and urination associated with that that would also be causing weight loss (which can be extreme too). It wouldn’t matter that you didn’t have weight to lose. The body basically ‘eats’ itself with Type 1 and even very slim people can lose significant amounts of weight very quickly.

People without diabetes can get lower blood sugars. They can, on occasion, also get hypos eg after significant exercise. There are also some medical conditions that can cause hypos. There are also conditions that can cause physical effects that mimic hypos. Without a blood test, you don’t know whether you were hypo or not.

A short time before I was diagnosed with Type 1, I had what I thought was awful low blood sugar. I had to walk up a hill and couldn’t do it. I felt better after a bar of chocolate. However, it’s extremely unlikely I had a hypo, as shortly after that, feeling the same and by now quite unwell, I was diagnosed with Type 1. My point there is not that it sounds like you have Type 1, but that you can’t tell a hypo by how you feel nor can you deduce you had one simply because sugar or glucose makes you feel better.

You’re clearly being bothered by symptoms and you’ve gone to the doctor, which is very sensible, but I recommend you keep an open mind as to what the problem is, if any. Reading up about diabetes could be taking your attention away from other things that might be causing this. You’ve had an HbA1C test that says you don’t have diabetes. Look further afield and do go back to your doctor for further tests if needed.