Type 2, Type 1 or LADA and Treatment -- Help!

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Type 2, Type 1 or LADA and Treatment -- Help!


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Old 09-14-2012, 16:48   #1
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Default Type 2, Type 1 or LADA and Treatment -- Help!

I was diagnosed with Type 2 Diabetes on May 12, 2012, when my A1c was 11.7%. I was started on Levemir FlexPen, 100 mg Januvia and 10 mg Lisinopril immediately. I reached a maximum dose of Levemir Flexpen of 18 units daily, which I was on for approximately 2 months, at which point my dosage was decreased to 10 units. From there, my Levemir FlexPen dosage was decreased incrementally and discontinued.

The Lisinopril, an ACE inhibitor medication, was started to protect my kidneys, as my initial random microalbumin level was 1461mg on May 12, 2012 and a subsequent random microalbumin level on June 13, 2012 was 131mg.

I have lost 48 pounds since May 12, 2012, through diet modification and daily vigorous exercise. My recent A1c, performed on September 6, 2012 was 4.8%.

I saw my endocrinologist for the first time on September 12, 2012. She ordered a Basic Metabolic Profile, a Random Microalbumin test, a C-Peptide test and a GAD-65 (A-2 and Insulin Auto-antibody) test.

When I asked her rationale for doing these, she indicated that she wanted to rule out LADA and Type 1 Diabetes due to my significant weight loss, the dramatic improvement with my A1c level in less than 4 months, how quickly my blood glucose levels were in normal range after starting insulin and no family history of Diabetes.

I asked her how likely it is that I am LADA, not Type 2. She said considering the above facts, the likelihood of my being LADA is 50/50 and that the likelihood of me being Type 1 is about 1 in 10.

At present, my Levemir FlexPen and Januvia have been discontinued. I am still taking the Lisinopril daily.

The endocrinologist said that I can continue managing my Diabetes with diet and exercise only if the lab tests indicate that I am Type 2.I expect to get the lab results back by September 21, 2012.

If the random microalbumin comes back elevated, the endocrinologist will likely keep me on Lisinopril to prevent any possible further kidney damage.

The C-Peptide test will determine if I am Type 1 by measuring the amount of C-Peptide in my blood, which is an indicator of how much insulin my body produces.

If the GAD-65 (A-2 and Insulin Auto-antibody) test comes back positive, that will indicate that I am LADA, not Type 2, and she will likely recommend that I restart 100mg Januvia daily to help preserve my pancreatic beta cells.

I discussed my successful weight loss via diet modification and exercise with my endocrinologist and she was quite pleased with my results. She said that even if I am Type 1, I may be able to maintain normal A1c levels for a period of time without requiring insulin.

If I am LADA, but able to keep my A1c level in normal range, is it reasonable for me to not restart 100 mg Januvia daily until such time as my A1c level increases?

I know that preserving pancreatic beta cells can help delay the need to start insulin for some patients. I would prefer not to take unnecessary medication for financial reasons, side effects (runny nose) I experience on the medication and potential side effects, which include pancreatitis and pancreatic cancer, among other things.

I will meet with my PCP on September 17, 2012, before the test results come back, and plan to discuss this information with him, but wanted some input from others to help me to ask the right questions and make the right decisions.
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Old 09-14-2012, 19:45   #2
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If what you're doing is working, then continue doing what you're doing. It's great that your doc is ordering the GAD antibodies & c-peptide. We grump & groan all the time that these tests are ignored while other docs use trial and error in diagnosing their diabetic patients. But oddly enough, your doc seems intent on proving that you are type 2. Why doesn't she just keep an open mind, get the test results and take it from there? If you have antibodies, you are type 1 or 1.5 (LADA) . . . LADA being type 1 but with late/slow onset.

The c-peptide can tell if you're still making significant amounts of insulin, but if you have antibodies, it is proof of an autoimmune attack on your beta cells, and you will eventually need to go back on insulin since, as the damage continues, eventually the beta cells will be gone & your pancreas will no longer be producing any insulin.

If I were you, I would continue what is working for you now - cross the other bridges when you come to them, and I would smile & nod when your doc starts issuing all the possible scenarios. She is seeing something fairly rare in diabetes treatment, and she may not know what to make of it. You must continue educating yourself in these matters, so you'll be able to separate the wheat from the chaff regarding suggestions from the often clueless medical community.



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Old 09-14-2012, 21:22   #3
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I was diagnosed Type 2 in December 2011 when I was finally tired of going to the bathroom constantly and drinking water all day long and all night long. My A1C at dx was 9.3 and my sugar was 330. I go to an endo now because I requested it. Initially they did not do all those cool tests to determine mu type because I too responded so well to treatment! I have recently had the tests and They believe I'm LADA but could be Type 1. Apparently LADA is closely related to BOTH type 1 and type 2. I go back in October and plan to ask what type I am. I am on insulin 3 times a day as well as Kombiglyze 5/1000, glipizide, and 500 mg xr met. I'm sure they will be taking me off some of this. Keep in mind, I'm only 29 and typically you get an LADA dx after the age of 30. My family doctor as well as my endo says that I'm a very unusual and unique case. I just want to manage it. Diabetes is very frustrating and expensive!
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Old 09-14-2012, 21:43   #4
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Quote:
Originally Posted by Shanny
If what you're doing is working, then continue doing what you're doing. It's great that your doc is ordering the GAD antibodies & c-peptide. We grump & groan all the time that these tests are ignored while other docs use trial and error in diagnosing their diabetic patients. But oddly enough, your doc seems intent on proving that you are type 2. Why doesn't she just keep an open mind, get the test results and take it from there? If you have antibodies, you are type 1 or 1.5 (LADA) . . . LADA being type 1 but with late/slow onset.

The c-peptide can tell if you're still making significant amounts of insulin, but if you have antibodies, it is proof of an autoimmune attack on your beta cells, and you will eventually need to go back on insulin since, as the damage continues, eventually the beta cells will be gone & your pancreas will no longer be producing any insulin.

If I were you, I would continue what is working for you now - cross the other bridges when you come to them, and I would smile & nod when your doc starts issuing all the possible scenarios. She is seeing something fairly rare in diabetes treatment, and she may not know what to make of it. You must continue educating yourself in these matters, so you'll be able to separate the wheat from the chaff regarding suggestions from the often clueless medical community.
I think my endocrinologist is so intent on determining whether I'm Type 2, LADA or Type 1 because I want to know as much as possible about my condition and because of my rather dramatic weight loss and decrease in A1c in just 4 months.

I plan to continue eating the way I have been and exercising vigorously daily, but would prefer not to take Januvia, Lisinopril or other meds, unless really necessary.
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Old 09-14-2012, 21:53   #5
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Quote:
Originally Posted by mmckie
I was diagnosed Type 2 in December 2011 when I was finally tired of going to the bathroom constantly and drinking water all day long and all night long. My A1C at dx was 9.3 and my sugar was 330. I go to an endo now because I requested it. Initially they did not do all those cool tests to determine mu type because I too responded so well to treatment! I have recently had the tests and They believe I'm LADA but could be Type 1. Apparently LADA is closely related to BOTH type 1 and type 2. I go back in October and plan to ask what type I am. I am on insulin 3 times a day as well as Kombiglyze 5/1000, glipizide, and 500 mg xr met. I'm sure they will be taking me off some of this. Keep in mind, I'm only 29 and typically you get an LADA dx after the age of 30. My family doctor as well as my endo says that I'm a very unusual and unique case. I just want to manage it. Diabetes is very frustrating and expensive!
Mmckie,

I completely agree! I'm grateful for having some health insurance, the support and information I find here and elsewhere online.
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Old 09-15-2012, 05:08   #6
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Get a meter and test your blood glucose daily. Why wait 3 months for A1c? You keep your daily numbers low and the meds will stay away.

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Old 09-15-2012, 05:34   #7
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Get a meter and test your blood glucose daily. Why wait 3 months for A1c? You keep your daily numbers low and the meds will stay away.
I have been testing since the day I was diagnosed. I tested 10 times per day initially, but now test anywhere from 2 to 5 or more times per day, depending on whether I eat foods I've eaten before or try a new food item, if I alter my exercise regimen somehow, or if I suspect my blood glucose level may be too low. I have learned a lot by testing and eating to my meter.

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Old 09-15-2012, 08:49   #8
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Januvia to preserve beta cells ? I don't get it. Sitagliptin gets the pancreas to secrete more insulin very much like the SUs. Only it uses a different method. It does so by suppressing 2 enzymes DPP-4 and GLP-1. These are the enzymes that work to secrete glucagon from the pancreas. So in effect it stops glucagon secretion thereby increasing insulin secretion.

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Old 09-15-2012, 09:35   #9
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SKB is right - Januvia is not going to preserve your beta cells. While it may not be the villain that the sulfonylurea drugs are, it still works to squeeze more insulin from your pancreas. If you are found to be type 2, more insulin is not what you need - your cells need to be able to access the insulin already available. And if you are found to be type 2, then insulin resistance is the biggest issue you have, and I agree, the longer your beta cells can be preserved, the better. But Januvia is not the best drug to do that - metformin is the one.

Our wise mentor from BloodSugar 101 explains it here. As you read farther down in this article to the paragraphs about The Dream of Beta Cell Regeneration, you'll find where it states that it's the drug companies telling the doctors that this drug can regenerate beta cells. I take that with a grain of salt - a large grain of salt.




Last edited by Shanny; 09-15-2012 at 09:40.
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Old 09-15-2012, 13:19   #10
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Quote:
Originally Posted by Shanny View Post
SKB is right - Januvia is not going to preserve your beta cells. While it may not be the villain that the sulfonylurea drugs are, it still works to squeeze more insulin from your pancreas. If you are found to be type 2, more insulin is not what you need - your cells need to be able to access the insulin already available. And if you are found to be type 2, then insulin resistance is the biggest issue you have, and I agree, the longer your beta cells can be preserved, the better. But Januvia is not the best drug to do that - metformin is the one.

Our wise mentor from BloodSugar 101 explains it here. As you read farther down in this article to the paragraphs about The Dream of Beta Cell Regeneration, you'll find where it states that it's the drug companies telling the doctors that this drug can regenerate beta cells. I take that with a grain of salt - a large grain of salt.
Thanks for this info, skb and Shanny!

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