September 30, 2004
Diagnosis and Symptoms, LADA and MODY
Question from USA:
I was diagnosed with type 1 diabetes (LADA) two years ago. I was 17. My blood glucose was 352 mg/dl [18.1 mmol/L] and I had large ketones in my urine. I had all the diabetic symptoms and was hospitalized for five days. After two weeks of diagnosis, my A1c was 4.6%. After four months, I was able to discontinue my insulin.
I went to two endocrinologistss. One said that I probably had pre-diabetes and could prevent it by exercising. The other said that I had type 1 diabetes. After one year, my glucose started creeping up and I started eating less than 40 grams of carbohydrates and exercising more than I used to. My glucose is normal with a few spikes even with less than 40 grams of carbohydrates per day and one and a half hours of exercise (running, biking). A few months ago, I started having high glucoses and large amounts of ketones after exercise so I was given five units of glargine (Lantus). Throughout these two years, my A1c remains at 4.9%; I do this test every three months and it never changes. Can this be possible?
My new endocrinologist believes that something is wrong with my hemoglobin and is screening me for sickle cell anemia. But, I have no symptoms of sickle cell disease. Last week, I was checking my records and found out that by mistake they tested my A1c four years ago and it was 3.8%. I am sure I had no symptoms of hypoglycemia before being on insulin. What could this be?
Finally, my new endocrinologist decided to do some islet cell antibodies testing. I heard that the antibodies disappear after a while. Since it has been two years, would these tests be accurate?
I am slim, recovering from anorexia (three years ago) and have no history of diabetes in my family.
Answer:
Type 1 diabetes skips generations and is not necessarily part of a family history. It occurs in people most commonly less than 20 years of age. Most patients are thin. I cannot explain the high glucose levels. Even if there were a problem with your hemoglobin, the elevated glucose levels and ketones are a problem.
It is true that the antibodies are positive at first and can disappear over time. However, one of the antibodies, anti-GAD antibody, is more likely to stay up over time. This would be most helpful in your case. I would suggest you also need to have your insulin secretory reserve tested. People with type 1 diabetes cannot make insulin because the insulin-producing cells have been destroyed. This is often tested with a drug that induces insulin secretion and the measurement of C-peptide levels.
JTL
