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Diabetes

LADA

05/11/2009

Question:

My husband is a new Type 2 diabetic(pre-diabetic for 3 years). he is 6`4 and 185 pounds. No family history. healthy w/ exeception of lymes dz (twice). tested neg GAD antibodies w/ a boderline low insulin level (at the cutoff). all CT/MRI scans are negative.

NOW: maxed out on metformin - amaryl.

he is compulsive about counting CHO & exercise.

glucose levels have skyrocketed over past 6 months despite med increase,etc.

just placed on insulin 1 week ago. BS FINALLY starting to come down- 130`s FBS and 180 -2hr PP

would it be valuable to repeat antibodies ? labs ?

he is getting conflicting advise/recommendations from endo/family practice. endo says type 2, FP says Type 1.5.

my husband just feels something "bad" is going on w/ his body. 2nd opinion from another Endocrinologist ??

Answer:

While we cannot make diagnoses on NetWellness, the bottom line is that the development of hyperglycemia at this relative body weight (body mass index calculates to 22) at this age sounds like a very insulin-deficient form of diabetes.  That can occur either due to Latent autoimmune diabetes of the adult (LADA) or to end stage deterioration of insulin-producing pancreatic beta cells from type 2 diabetes.  Whichever, the source, my suspicion is generally that such an individual will need combined basal and meal bolus insulin replacement, and that it is likely that they will be fairly insulin sensitive.  There is not much practical difference for this individual which diagnosis is made; there is some implication for family members as the familial/genetic risk of others developing a similar picture will differ.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati