Test for 1.5/LADA

[John__ch]

Hi all,
Well it's been a year since I started on Isulin. The DSN moved me to Insulin after 4 months on oral medication was making no differance to my bg readings! (High teens to 20's)
My starting dose was 10 units of Lantus at night and 4 Novorapid before meals.

Fast forward a year and my current insulin regime is: 44 units of Levimir (going up to 46) at night and my Novo ratio is 1:5 during the day and 1:8 at dinner. My HbA1c is down to 7%. Fasting bg is 6-9. Bedtime readings are still a bit high (8-10) and might drop my ratio down to 1:6

My question is.... Is there a way to test if you have type 1.5 after you have started on Insulin? From what I have been reading, it sounds more like 1.5 than 2?

Thanks

 

[everydayupsanddowns]

Hi John!

Welcome to the forum 🙂

There are two tests which are considered when trying to seek a clarification on your diabetes classification.

One is an antibody test that identifies GAD (and other) antibodies connected with autoimmune T1 or LADA (1.5) diabetes.

The other is to test for cPeptide, an amino-acid that is part of natural/internal insulin production.

The tricky thing is that neither test is particularly clear cut or conclusive. You can be positive for GAD antibodies with classic T2 and positive for cPep with confirmed T1. The basis of diagnosis/classification for diabetes is still really best done on clinical grounds (presentation, speed of onset, family history, blah blah blah).

They *can* help to clarify thinking though, and can provide very useful clues for clinicians wanting to investigate.

Some might argue, 'what's the point?' if the treatment (basal/bolus insulin replacement) is the same either way, but I think an accurate classification is vital - especially where access to some technologies (test strips/pumps) can vary widely depending on what is written on a piece of paper in your medical records!

Good luck with it.

 

[trophywench]

LOL - when I read you introductory post, I thought Oooh - this bloke sounds more like a 1.5, I wonder if he is? LOL I can't help with tests I'm afraid, but I believe the level of c-peptide can help them to say. Cos the thing is here you know, it isn't straightforward because in recent years they have discovered that even people who have had T1 for 70+ years may actually still produce some insulin. Never enough to be of any actual use and sustain life, but nevertheless they do still produce it and therefore this is shown by their C-pep level.

Meanwhile the test costs a few £100 each and only a few labs in the country do it and it takes weeks and weeks to get an answer (for all I know the actual tests themselves might take weeks - but all I do know is it can be a couple of months before anyone gets an answer) so consequently, they don't do the test as a matter of course.

The GAD65 antibodies thing anyway, becomes less accurate the longer you've had the diabetes - and OK if you are T1 it's probably only a few weeks before you get diagnosed but T2 can take years brewing before somebody notices summat is up.

 

[John__ch]

Hi, thanks for the quick response
I have an appointment with my GP next week, I will ask if he can arrange the C-Peptide test. GAD antibody test can't be done because being on insulin throws the test results
Will let you know how I get on!

 

[AlisonM]

I was also diagnosed as T2 at first, purely because of my age and weight. But, the T2 medications didn't work very well on their own. I did some research and found that there are no other diabetics in my family that I can find, save one (possibly) of my great grandfather's brothers - it's hard to be sure because he died as a child in 1888. The onset of my diabetes was a good bit faster than normal T2, but perhaps not quite as fast as T1, it was a matter of about 9 weeks I recall. Getting re-diagnosed was relatively easy for me, it only took about six months of constant whingeing for the GP to give in and order the C-peptide and GAD tests and the result for me was fairly clear, I wasn't producing enough insulin on my own for the T2 meds to work and needed insulin. That wasn't the end of the saga, but it's enough for now. My suggestion is that you do your research, not that having other T2s in your family is a bar to you having LADA, but it is an indicator. It certainly sounds as though you could be either LADA or T1 simply because the T2 medications don't work. Good luck with it and let us know how you get on.

 

[DaveB]

Hi. I think the c-peptide can be a help because it will show whether your natural insulin is low and hence insulin is needed (which it appears to be). I prefer to be guided by the new NICE T1 guidelines which talk about presenting having lost weight or being slim; like myself even though diagnosed as T2 and still am. Once on insulin obviously your weight can go up as the added insulin can aid that if you eat too many carbs. So, one question would be were you slim/lost weight when diagnosed? I gave up arguing with the GP(s) and they finally saw I needed to go onto Basal/Bolus when all the tablets failed.

 

[John__ch]

My weight stayed constant until I started on Insulin... Put on 5kg.

 

[DaveB]

Hi. Weight gain when on insulin would usually be caused by having too many carbs. You must control the carbs even when on insulin.

 

[AlisonM]

Oh and one other indicator is that I have other immunological issues, chronic anaemia and rheumatoid arthritis among them. I forgot to mention those in my last post.