February 19, 2005
Diagnosis and Symptoms, LADA and MODY
Question from Philadelphia, Pennsylvania, USA:
I’m confused about my diagnosis. I went into DKA mid-pregnancy last year, and the high risk doctors felt I had type 1 uncovered by pregnancy rather than gestational diabetes. My insulin needs fell off dramatically postpartum, so I declared myself cured. Seven months later, I started feeling bad, went to the doctor’s and found I was spilling ketones and had an A1c of 14.9.
My internal medicine practice has me officially diagnosed as type 2, but is treating me as if I were type 1 (24 units of insulin glargine per day and lispro with meals) after a week of no blood glucose improvement and increased ketones on metformin. I just saw an endocrinologist who says I’m definitely type 1 based on my case history and weight. His tests show that I’m antibody negative, with low insulin levels. Doesn’t the lack of antibodies preclude LADA or type I? I’m very confused.
Answer:
Antibodies are helpful if present, but they do not rule out type 1 diabetes if they are absent. This diagnosis is a clinical diagnosis. I am concerned you really do have type 1 diabetes with thin body habitus, low endogenous insulin levels, and such bad blood sugars.
JTL
