August 17, 2005
Diagnosis and Symptoms, LADA and MODY
Question from Lisle, Illinois, USA:
In March 2005, I had my blood sugar checked and it was 330 mg/dl {18.3 mmol/L]. At that time, I was 5 feet, 1 inch tall, 102 pounds, and exercised three times a week. I’m a 46 years old female. I went to my family doctor who said I have type 2. I really didn’t question it because type 2 diabetes runs in both my mother�s and father�s side.
I was put on Actos, 30 mg in the morning and 30 mg at night, for four weeks and I saw no change in my blood sugars. Then, I started taking metformin, 1000 mg in morning and 1000 mg at night, in addition to the Actos. There was very little change in my blood sugar. Two more weeks went by and I had to insist that the medication was not helping me. The doctor took me off Actos and put me on glipizide, 10 mg in the morning and 10 mg at night. My blood sugar finally started to come down.
Then, I wasn’t able to get an appointment with an endocrinologist until July. She took me off 10 mg of glipizide at night and ran some blood tests. I’m currently taking 10 mg of glipizide in the morning, with 1000 mg of metformin in the morning and at night. The nurse faxed me the blood test results, but she couldn’t tell me what they meant.
My next appointment with the endocrinologist is in four weeks. I now think I might be type 1.5. My islet cell antibody screen is negative, which is in range. The GAD65 was 1.1, out of range (range is 1.0 or less) and my C-Peptide was 0.8, in range (range is 0.8 to 3.1). I’m still very active, but my weight keeps going up. I’m now 118 pounds. If I am a type 1.5, would I be better off being on insulin? Also, am I more likely to gain more weight being on insulin?
Answer:
The C-Peptide sounds low. The antibody level is high for anti-GAD65. These are findings that point to late-onset autoimmune diabetes of adulthood (LADA). You need to talk with your endocrinologist about whether you should be on insulin therapy or not. Whether you are treated now or not is based on what your blood sugars are showing. If you have a more rapid decline in insulin production, you will eventually lose response to your oral medications and it will be obvious you need insulin. There may be some theoretical benefit to being on insulin as this may help “rest” the pancreas and allow longer survival of the insulin-producing cells. It sounds like you are on to this issue already and have a fairly good idea of its significance.
JTL
