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October 4, 2009

Diagnosis and Symptoms, LADA and MODY

Question from Australia:

In 1978, when I was 25, I was diagnosed with type 2 diabetes. I was slightly overweight, but I proceeded to lose 20 pounds in three months. I had no more diabetes until pregnant in 1988 to 1989 at 18 to 19 weeks. I was normal weight and only gained 7 kg (15 pounds) for the pregnancy and used insulin. Within a year, my type 2 was back. I treated it with tablets I couldn't tolerate (gastrointestinal problems), but they worked to bring down my blood sugars. I went on insulin in 2006 at which time my C-Peptide was 0.8 (falling). At that time, my BMI was around 27 and weight was almost impossible to lose. I gained 14 kg (almost 30 pounds) with insulin and my BMI is now 30. At my insistence, in January 2009, antibody testing was done, two tests, three months apart. I had highly positive GAD both times so I have LADA. My latest C-Peptide was 0.1, and likely, by now, could be zero. I have been on an insulin pump since June and never better. My A1c has dropped from 11 to 9 to 7 in early August (two months on a pump while still adjusting doses) and is still improving. My late mother had been diagnosed with type while youngish. She was normal weight and never had any antibody testing. I also have another musculoskeletal autoimmune disease, diagnosed just after pregnancy. At the time, I also had positive anti-thyroid antibodies but nothing has come of it and they are now negative. My TDD (total daily dose) of insulin on the pump is between 25 and 40 units, depending on what I eat. Does this indicate much insulin resistance for my BMI? Did I really have type 32 years ago? Was gestational diabetes early? What's the longest honeymoon for LADA? Can you have MODY and LADA together? Do I have type 2 and LADA? Or, did I have LADA all along (no way to go back and test)? If it were LADA all along, surely I should have been insulin dependent long before this. I would appreciate your opinion.


It could have been LADA all along. However, the only way to know would have been to have measured antibody levels. There are also patients with autoimmune diabetes who have type 2 diabetes in families where type 2 diabetes is quite frequent. I am not sure you could have done anything different. Pregnancy is a window into the future because the placenta makes human placenta lactogen and induces insulin resistance. However, this insulin resistance gets better with delivery of the baby and placenta. The total dose of insulin up to 40 units is not that great and suggests you are not overtly insulin resistant. This would suggest the insulin resistance is minimal and less likely to be type 2 diabetes.