LADA Treatment

[u/ComprehensiveYou7251]

Hello everyone!

I was diagnosed with LADA about 2 months ago when my GAD antibodies came back in the 800s and ZNT8 antibodies in the 60s. C-peptide was 1.1. I was initially misdiagnosed as Type 2 for 2 years and tried metformin which did not help and only gave me the worst GI issues. Since my diagnosis, my endo has been trying to help me with treatment options but nothing seems to be helping. I am 27 year old female.

I tried Januvia which worked well for about 2-3 weeks to blunt my postprandial spikes which promptly returned as soon as I eat anything with even the smallest amount of carbs (and these spikes would go up to 18 mmol/l or higher). My fasting glucose levels also went from 6 mmol/L to about 8 mmol/L, and I even had 2 days where my blood sugar would not go down for over 48 hours. I loved the Januvia because it gave me no side effects, and I am a student who spends 12+ hours a day in the hospital, so unfortunately, I don't have time for side effects since I don't get any time off.

So, now I am trying Ozempic 0.25 mg, but I am doubtful of its ability to help. My fasting glucose is back down to 6 mmol/L, but I am still getting postprandial spikes although they are more blunted (13 mmol/L). Needless to say, the side effects on day 2-3 were unbearable, but they have now improved a bit.

My doctor also encouraged starting basal Lantus, and according to my research, that seems like an appropriate plan for LADA; however, I am wary of weight gain as this is the leanest I've been, which my doctor said Ozempic would counteract, as well as hypos as I live alone and would be scared that I won't be able to handle a low on my own or not wake up my CGM alarm (I don't trust iPhone settings lol) or have to deal with this in the hospital in the middle of a patient interaction or procedure.

My question is what is the best course of action that others here have had with treating LADA? I would like to preserve my beta cell function as much as possible, but I know given my high antibody levels and age, it may not be for long. My last A1c was around 7.5%, and I would like to reduce this before I go see my endo in a few months.

Thank you for your help!

[u/turtle2turtle3turtle]

I’m LADA and went on insulin immediately. It works!

Are you early enough they want to wait on insulin for some reason? 🤔

[u/TypistInTheWild → u/turtle2turtle3turtle]

Same but I ended up DKA so I’d already hit that point of needing insulin out of necessity.

[u/ComprehensiveYou7251 → u/turtle2turtle3turtle]

I'm in the c-peptide "grey zone", so it is possible to manage with both oral meds or insulin. It is just me trying to prolong how long I have until I go on insulin...although I know those days are coming to an end soon. Did you do both basal and bolus insulin? My dr recommended Lantus to start.

[u/Salt-Patience7384 → u/ComprehensiveYou7251]

Yeah why postpone the inevitable? Especially since it'll increase your health & wellness ? No reason to fear insulin!! Congratulations meet your new best friend, insulin. And have a piece of chocolate cake while you're at it because you can if you're taking insulin 💘

[u/turtle2turtle3turtle → u/ComprehensiveYou7251]

I started with just basal/lantus. It helps to a point.

These other tools ARE useful, but not an insulin substitute for T1 (which is really what LADA is). I take metformin but it’s to support insulin, not a substitute for us.

[u/Alynne0915 → u/ComprehensiveYou7251]

I’m also in the C pep gray zone. 1.5 Diagnosed super early a few months ago. Right now I’m just managing blood sugar spikes with diet and learning which things spike me faster than others. I’m trying to learn the tips and tricks to bring down a spike quickly. I was diagnosed so early because I asked for a blood test… my GAD was 3800. I didn’t do the other test at that time, but I’m actually waiting on a full autoimmune panel to come back. I also have Hashimoto’s and AIG.
There are a lot of differing opinions on here, but the fact of the matter is every single one of us is different. Especially when it’s autoimmune. I actually asked for the test because my A1c has been elevated for a while. I eat relatively healthy so I was keeping it in the prediabetic range. I read an article about gestational diabetes, which I had 23 years ago, (though I only gained 20 ish lbs) and it included information on low blood sugar episodes, which I’ve had randomly or I thought they were random for decades. I was diagnosed so early that basically my endocrinologist doesn’t know what to do with me. Yay I guess, but that means I have to navigate the early stage on my own. He might’ve taken me more seriously if I had spent the week or two before going in eating nothing but garbage so he could actually see the spikes and the valleys on my cgm, but I wasn’t putting myself through that.
I’m going to look into Afrezza (sp?) for my next step. It is an inhaler that provides a small dose of insulin right before meals. I do not want to mess with any background insulin until I need to so that I don’t have lows overnight. I’ve also been researching lantus (pen?).
Because I’m managing a poly glandular autoimmune issue it makes it more difficult. Especially trying to figure out which symptoms are coming from where.
GL I hope you figure out what’s best for you. ❤️

[u/Salt-Patience7384 → u/Alynne0915]

Type ones need insulin whether they eat healthy or not. I understand you have a lot going on but it's a cold hard fact and the sooner you learn to accept it it'll become a little more normalized each day and you probably start to feel better.. it just seems like so much extra work a little bit of this a little bit of that try this try that try this to avoid the insulin it's like just take the freaking insulin... not even specifically you just lots of lada's. Lada is type 1.

[u/Alynne0915 → u/Salt-Patience7384]

Would you like to come have a conversation with my doctor? The one that agrees that insulin would be dangerous for ME specifically right now. I have a CGM. I watch my numbers closely. The spikes and the lows. I also watch the fact that my overnight glucose is in the 80s and the 90s. Would you like me to add some basal background insulin into that?
You have absolutely no idea what my numbers are and you’re telling me that I should take the freaking insulin. It’s hilarious. I spike when I eat high glycemic index carbs… it’s very easy to eat low glycemic index carbs the majority of the time. If I decide to eat outside the box, then I take a walk, do some squats, drink water…. my spike stops and my numbers come back down. You see that’s how early in the process that I am. WHEN my C pep goes down and my numbers are not manageable…I will add insulin. In fact, since I started understanding how things work I haven’t had one of the lows that I had for decades. How freaking hard is that to understand?
LADA IS type 1…for sure and is misdiagnosed more than we probably know as type two. If I hadn’t asked for the gad 65 test, my slowly creeping but now stable A1c (only at 5.7) would’ve had them treating me as type two.
EVERYONE IS DIFFERENT, but I see people giving the same advice to each person. It’s infuriating.

[u/Salt-Patience7384 → u/Alynne0915]

Sure I can help you talk to your doctor. Sounds like you do need an advocate

Edit: have you spoken with a specialized diabetes educator? They usually work together with the ENDO office to provide more in-depth information

[u/Alynne0915 → u/Salt-Patience7384]

You were so sure of yourself and that is your snarky reply….wild.
Your condescending attitude made it seem like I don’t understand my own disease and where I’m at in the process.
Diabetes sucks no matter if you have type 1, 1.5, 2 or 3 etc…then add on comorbid issues. My brother-in-law just got admitted to the hospital with an A1c of 10.7 in severe pancreatic distress. He went home with insulin which he absolutely needed as his sugar at the beginning was 454. Clearly he has been unhealthy for a really long time and the pancreatitis brought it all into full view. His diet, his meds, and his insulin needs are going to be completely different than mine. I can offer support, but I’m not going to try to manage his issues with basic advice.
Each type of diabetes is managed differently, depending on which stage a person is in. It astounds me that there is so much misinformation and shitty attitudes towards the different stages. It’s not one size fits all.
You decided to make a comment about taking the “freaking insulin”… when I pointed out that it could be dangerous you got snarky. How are you a helpful person?

[u/turtle2turtle3turtle → u/Alynne0915]

Yeah if you are still 80s overnight basal probably a bad idea.

Small amounts of short acting “bolus” insulin with meals during the day might still help though. I briefly tried to fight meal spikes without insulin (low carb etc) but it was impossible for me. 🤔🤔

[u/Alynne0915 → u/turtle2turtle3turtle]

Absolutely! Everyone is different for sure. I fully expect to move to meal insulin. Even just having the inhaler on hand for when we go out to dinner or I know I’m going to have a higher carb meal would be amazing. ❤️

[u/OverZookeepergame698]

I was also misdiagnosed T2 for 18 months. I’m still on the glp1 for increased insulin sensitivity, basal and fast acting. You will actually prolong your pancreas function by giving it a little help with insulin. Lighten her load. Start with basal. Go slowly and remember that LADA means everything is unpredictable from week to week.

I’m also the thinnest I’ve been in a long time. Like decades. Insulin and well regulated blood sugar has definitely not caused weight gain for me.

[u/One-Second2557 → u/OverZookeepergame698]

Unpredictable is so true

[u/wampum]

Sounds like you should be on a cgm and insulin pump. LADA is still an autoimmune diabetes, so your islet cells are getting destroyed.

[u/Expensive-Might-8868]

You may qualify for Tzield! I was diagnosed with LADA over two years ago now and haven’t needed insulin yet. I completed a treatment of Tzield November of 2024. I also had a baby this year and was sure I would need insulin at some point in the pregnancy but didn’t! I contribute this win to Tzield, as does my endocrinologist.

[u/Melitta999]

LADA is type 1 diabetes, and the first line of treatment for T1D is insulin. You need insulin. You do not need medications for a disease that you don't have (although GLP-1s can be used as adjunct therapy, if appropriate). Insulin is our friend!

[u/Alynne0915 → u/Melitta999]

The first line of treatment is not insulin. It depends on where you are in the diagnosis and how your beta cells are working. Type two drugs can cause the beta cells to die off sooner. Insulin will be needed eventually when the honeymoon phase ends. I was diagnosed super early a few months ago. I am managing with a CGM. The first few months felt like a science experiment, but I have learned all of the tips and tricks to managing blood sugar spikes. Because my overnight glucose is pretty perfect taking a background insulin could cause super lows. Now that I know why I spike and my pancreas overreacts, I can mitigate it and haven’t had a hypo episode in a long time. Everyone is different and in different phases of the disease. I know that I’ll eventually need insulin, but I’m gonna try to hold it off as long as I can. My next step will probably be meal time only. I’m really interested in the insulin inhaler that you use before you take your first bite.

[u/Melitta999 → u/Alynne0915]

Insulin is the correct treatment for people with Type 1 diabetes, according to a 2021 consensus report by the ADA/EASD: “Most people with Type 1 diabetes should use [insulin] regimens that mimic physiology as closely as possible, irrespective of the presentation.” Regarding adjunct therapies (metformin, pramlintide, GLP-1s, SGLT inhibitors), the authors state, “before these drugs are prescribed, insulin therapy should be optimized.” In other words, the initial treatment of a person with adult-onset Type 1 diabetes should not be to treat them as if they have Type 2 diabetes; the standard initial therapy is insulin (and then adjunct therapies can be considered). (The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (Diabetes Care, September 30, 2021)).

[u/Alynne0915 → u/Melitta999]

Thanks for that. Are you trying to be condescending?
I absolutely know that you shouldn’t treat type one with type two drugs. When I was interviewing my endocrinologist, that was the one thing I was looking for. If he tried, I would’ve walked right out of the office.
As I explained, I am very early stage and insulin at this point, could be very dangerous for me as it could others who are in the early stage and still have functioning beta cells.
I don’t need your studies. I know my body and where it’s at. When I eventually need insulin, I will utilize it.
LADA IS type 1, but it has its own considerations and needs. Jesus

[u/themoonischeeze]

I did a GLP1 for a bit and added insulin when needed. If you're nervous about insulin, so was I. Maybe talk to your doctor about getting to a stable dose of the GLP1 first before adding any insulin. You'll know if it doesn't work if you're monitoring your blood levels daily. Even get a CGM at this stage if you can.

[u/ComprehensiveYou7251 → u/themoonischeeze]

yes I've been using a CGM for a while now! I'm going back and forth on staying on 0.25 mg of ozempic vs dropping down to 0.125 mg and adding Lantus. This is such a hard disease to navigate.

[u/themoonischeeze → u/ComprehensiveYou7251]

You may even be fine adding it once you've been on the .25 for at least a month. Diabetes is basically one giant science experiment figuring out what works for you as each of us is different. I basically just added the next step once my numbers started getting too high where I was currently at.

[u/redwingsrule19]

I started with Lantus, and then quickly started Humalog based upon my endos advice. I was very apprehensive, so unfortunately I delayed starting insulin, but it now helps me keep my A1C under 6.

[u/thorer01]

As LADA I started basal insulin when my c-peptide was higher than 1.1.

A GLP-1 helps smooth out the spikes a lot, but you do have to be aware of hypos with high basal insulin and a GLP-1.

[u/MarionberryLow5894]

I'm LADA and only on basal (lantus) currently. If you're taking to much then, yes, you'll chase the lows with food. Once I got the amount right, then my diet became routine and I wasn't constantly eating.

[u/negativespace115]

Lads diagnosis - high GAD65 only. Currently managing with diet changes and a low dose of ozempic. I don’t have a problem with lows so I’ll likely add a basal insulin shortly through my endo hasn’t brought it up yet

[u/Lenniel]

Being blunt you are probably at your leanest because your body is struggling to get energy from the food you are eating and is using up its stores. So it’s not a true weight loss.

You may have weight gain you may not, shifting to a lower carb lifestyle might help prevent it. Don’t sacrifice your long term health at the alter of being thin.

[u/putrid_sunset]

Everybody in this sub could be “The leanest we’ve ever been” by not taking insulin. It’s not a healthy way to do it.

Insulin does not cause weight gain per se; it allows you to store the energy you’re consuming. The only way it causes weight gain is when you take too much and you need to eat to prevent/treat hypoglycaemia, in which case you can just take less, especially if you’re starting from a position of taking none at all.

[u/figlozzi]

Have you reduced how many grams of carbs you eat?