July 20, 2007
Diagnosis and Symptoms
Question from Lawton, Michigan, USA:
I have been participating in the TrialNet Natural Family History study for the last two and a half years because my mom and my son both have type 1 diabetes. Through the study, they have found that I have high levels of GAD-65, ICA512, and ICA antibodies. Every six months, I go in for a two hour OGTT through TrialNet. The last test that I had diagnosed me with diabetes. My blood sugar at two hours was 258 mg/dl [14.3 mmol/L].
I am currently awaiting an appointment with an endocrinologist and have been monitoring my blood sugars at home. So, do I have type 1 diabetes or do I have LADA? Two doctors have said I have type 1 diabetes, but from what I read, it looks like LADA. I’m 31, slim, had insulin dependant gestational diabetes, antibodies, and Hashimoto’s thyroiditis. I also do not have ketones. I am still making some insulin. My fasting numbers at home are in the 135 mg/dl [7.5 mmol/L] range, postprandial at home averages around 180 mg/dl [10.0 mmol/L] and up to 200 mg/dl [11.1 mmol/L], if I eat a moderately high carbohydrate meal. If I eat fewer carbohydrates, my numbers stay around 100 mg/dl [5.6 mmol/L].
Can you explain the difference between type 1 and LADA? Do I have type 1 since I have all three antibodies and just caught it early? One doctor told me I was in the honeymoon phase of type 1, but I have not started any insulin yet, or had any typical symptoms or ketones. Wouldn’t LADA be a better diagnosis — a slow onset of symptoms in an adult?
What are the treatments for this when I am still producing insulin and I don’t always know if I will come down on my own or not? For example, one night I was 195 mg/dl [10.8 mmol/L] after dinner, but came down to 95 mg/dl [5.3 mmol/L] at bedtime. But, last night I was 143 mg/dl [7.9 mmol/L] after dinner and went up to 176 mg/dl [9.8 mmol/L] at bedtime. How do you treat this?
Answer:
Type 1 diabetes and LADA are both autoimmune forms of diabetes. The only difference is that we think of LADA as being slowly progressive and the reason for the presentation later in life. You have all the autoimmune markers of type 1 diabetes. I thank you for participating in TrialNet. Without your participation, and others like you, we would not be able to learn more about some of the questions you raise. For instance, we are now picking up people earlier in their course of type 1 diabetes. We know they have diabetes but still make insulin, like yourself. These are not mutually exclusive. It is just that the diagnosis is being made earlier. LADA is typically in people who are over 40. We do not know how long the typical patient with LADA has had autoantibody markers or how long they have experienced a fall in insulin secretion. This information needs to be learned from studies like the one in which you are participating. Another thing to note with patients with autoimmune diabetes, whether we call it type 1 diabetes or LADA, is how long beta cell function can be maintained and can it be augmented by some therapy so that insulin secretion may be maintained longer than the natural history. Whatever you call it, you have autoimmune diabetes. For you, an additional question is whether you are better off with early insulin therapy or not. There is likely some stress on the beta cells when your blood sugars rise higher than desired. Would it be better to be on small doses of insulin and help rest the beta cells? That’s something to discuss with an endocrinologist.
JTL
