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Ben and I chatted via messaging yesterday, and found out we use the same practice group! The doc who overlooked the opportunity to make a recommendation of GAD-65 testing for me (barely obese, but yes, obese; diagnosed in DKA with a prior history of autoimmune thyroid disease ... ) is in fact his doc. I am hoping this guy learned from my case, and my pushing for testing and insulin, in his practice group!
 

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(sorry to break in before Neinstein).

Ben have you looked at PubMEd articles on LADA and GAD-65, yet?

I have combed through them -- although sometimes people on the boards still can point me to some -- and from what I can tell, there is a correlation between high titers and progression, as well as young age at detection, and progression.

If the units reported and test types are comparable, between Mayo Labs (which our practice uses for anitbody testing) and Quest Labs, mine went down after a year of low-carbing, if that provides any insight to you ...
 

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Here is a very recent one -- I ahven ot even read it yet, but it looks promising! This link may not work -- I am behind a firewall and cannot test it, but you can go to PubMed and find it by the title.

World J Diabetes. 2010 Sep 15;1(4):111-5. Latent autoimmune diabetes in adults: A distinct but heterogeneous clinical entity. Nambam B, Aggarwal S, Jain A. Source Bimota Nambam, Shakti Aggarwal, Anju Jain, Department of Biochemistry, Lady Hardinge Medical College, New Delhi 110001, India. Abstract Latent autoimmune diabetes in adults (LADA) accounts for 2%-12% of all cases of diabetes. Patients are typically diagnosed after 35 years of age and are often misdiagnosed as type II Diabetes Mellitus (DM). Glycemic control is initially achieved with sulfonylureas but patients eventually become insulin dependent more rapidly than with type II DM patients. Although they have a type II DM phenotype, patients have circulating beta (β) cell autoantibodies, a hallmark of type I DM. Alternative terms that have been used to describe this condition include type 1.5 diabetes, latent type I diabetes, slowly progressive Insulin Dependent Diabetes Mellitus, or youth onset diabetes of maturity. With regards to its autoimmune basis and rapid requirement for insulin, it has been suggested that LADA is a slowly progressive form of type I DM. However, recent work has revealed genetic and immunological differences between LADA and type I DM. The heterogeneity of LADA has also led to the proposal of criteria for its diagnosis by the Immunology of Diabetes Society. Although many workers have advocated a clinically oriented approach for screening of LADA, there are no universally accepted criteria for autoantibody testing in adult onset diabetes. Following recent advances in immunomodulatory therapies in type I DM, the same strategy is being explored in LADA. This review deals with the contribution of the genetic, immunological and metabolic components involved in the pathophysiology of LADA and recent approaches in screening of this distinct but heterogeneous clinical entity. PMID: 21537436 [PubMed - in process] PMCID: PMC3083891 Free PMC Article
 

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Ha -- I do wonder if my case influenced him? Hopefully it was that, because I am basically a fat ol' lady ... but I was in DKA and with thyroid autoimmune process should not have been overlooked for LADA. Even if it was the weekend ...

My first test was 5 - 6 mos after dx; I had been moderately low-carbing for a few weeks. It came back at 30. I was then referred back to the endo practice.

My second, when I switched endos within the practice, came back from Mayo at 3. I had then been low-carbing for about a year. He apparently did not like Quest labs for antibodies and shipped it to Mayo. He also ran TPO antibodies (thyroid) since he did not have a history in hand, and thyroid disease goes with LADA ... Which was huge, though I do not recall #s.

Two yrs and 3 mos out, I am more like insulin-ASSISTED, really. I use 9U Levemir at night to help with overnight numbers and DP. I added a low dose of Novolog in January, my A1c was not bad, 6.3. It was prescribed for dinner only, I use 3 - 4 U, but I do use it at lunch sometimes and to correct if I still have DP -- 1 or 2 U at a time. My doses are slowly creeping up, no real jolts in need. Yet.

My pharmacist actually called to ask if the prescription was a typo, because the dose is so low! And then got flustered ... ha!
 
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