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August 31, 2008

Diagnosis and Symptoms, LADA and MODY

Question from Thailand:

I'm 24 years old and very thin. I was diagnosed with diabetes two years ago with a blood sugar of 250 mg/dl [13.9 mmol/L]. I took an oral medication for two years and saw no improvement in my fasting blood sugars, which ran from 160 mg/dl [8.9 mmol/L] to 350 mg/dl [19.4 mmol/L]. My most recent A1c was 11% so my doctor put me on insulin. Last month, I took Humulin 70/30 and experienced both hyper- and hypoglycemia. This month, I am on Lantus and Humalog and have good control. My C-Peptide, after Isocal for a two-hour test, was 1.01. According to my doctor, less than 0.60 is indicative of type 1. I was not in DKA but did have urine ketones. So, is it likely I have LADA or type 2?

Answer:

You have a good story for a person who may have LADA. However, I did not see that you had anti-GAD antibodies drawn. These are a marker of autoimmune diabetes. The rest of the story would fit with LADA. As for your C-Peptide levels, this is above the absolute cutoff, but it is not a vigorous response.

JTL