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Suggest Treatment For Hashimoto's Disease
Question: I've had Hashimoto's for 20 years, Addisons Disease for 18 years and have tested positive for anti-gad antibodies 3 tmes during the last 4 years. HbAlc has just crept into the early pre-diabetic range (only by one point but up by 3 points since last test 3 years ago). I mostly follow a low carb diet which makes me think my HbA1c would have been higher if I ate a lot of carbs. Does this mean I am early LADA?
Brief Answer:
LADA
Detailed Answer:
I follow your question. It is fair to not expect GPs to have detailed knowledge of profound endocrine matters, just like the converse would be applicable too ie most endocrinologists I know, including myself are unfamiliar with matters that GPs deal with on a daily basis. Medical education and training is designed as such. Moreover, it is not possible for one doctor to be proficient in the colossal ever-expanding body of medical information.
Coming to your question of whether or not you have early LADA. It is possible.
Typically pre-diabetes refers to a pre-T2D (Type 2 Diabetes) state. This is because T2D is the most common type of diabetes globally. Furthermore, it's preceding stage is well characterized as Pre-Diabetes which is well established as a risk factor for future development of T2D as well as heart problems.
However, considering your individual circumstance of being affected by 2 other unique auto-immune diseases, in addition to persistently positive anti-GAD , indicates a strong likelihood for the LADA or even Type 1 Diabetes.
The gradually climbing A1c suggests a trend towards occurrence of diabetes. At this point, it will be challenging to predict which type you are heading towards.
For LADA to be diagnosed, one has to get diabetes first. The there is a certain evolution of the condition that helps distinguish it from T2D and T1D. A 'pre-clinical' stage for T1D has been described in published medical literature.
You will need to consult an Endocrinologist in-person for a thorough physical examination, who will then counsel you on these risks.
LADA
Detailed Answer:
I follow your question. It is fair to not expect GPs to have detailed knowledge of profound endocrine matters, just like the converse would be applicable too ie most endocrinologists I know, including myself are unfamiliar with matters that GPs deal with on a daily basis. Medical education and training is designed as such. Moreover, it is not possible for one doctor to be proficient in the colossal ever-expanding body of medical information.
Coming to your question of whether or not you have early LADA. It is possible.
Typically pre-diabetes refers to a pre-T2D (Type 2 Diabetes) state. This is because T2D is the most common type of diabetes globally. Furthermore, it's preceding stage is well characterized as Pre-Diabetes which is well established as a risk factor for future development of T2D as well as heart problems.
However, considering your individual circumstance of being affected by 2 other unique auto-immune diseases, in addition to persistently positive anti-GAD , indicates a strong likelihood for the LADA or even Type 1 Diabetes.
The gradually climbing A1c suggests a trend towards occurrence of diabetes. At this point, it will be challenging to predict which type you are heading towards.
For LADA to be diagnosed, one has to get diabetes first. The there is a certain evolution of the condition that helps distinguish it from T2D and T1D. A 'pre-clinical' stage for T1D has been described in published medical literature.
You will need to consult an Endocrinologist in-person for a thorough physical examination, who will then counsel you on these risks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Follow up
Detailed Answer:
I see your fasting glucoses are normal while the 2 hour post prandial ones rise into the IGT (Impaired Glucose Tolerance) range. This is compatible with a diagnosis of Pre-Diabetes.
Please note that meter readings can fall within 10-20% of the actual value because they are not perfect.
There is a test called Glucagon stimulated C peptide which is more informative than a random/ fasting/ morning C peptide or Insulin blood test. It is complex to perform and requires the expertise of an Endocrinologist to interpret.
The current C peptide and Insulin levels are not very helpful.
When type 1 diabetes fully sets in, typically the body makes no Insulin/C peptide.
Follow up
Detailed Answer:
I see your fasting glucoses are normal while the 2 hour post prandial ones rise into the IGT (Impaired Glucose Tolerance) range. This is compatible with a diagnosis of Pre-Diabetes.
Please note that meter readings can fall within 10-20% of the actual value because they are not perfect.
There is a test called Glucagon stimulated C peptide which is more informative than a random/ fasting/ morning C peptide or Insulin blood test. It is complex to perform and requires the expertise of an Endocrinologist to interpret.
The current C peptide and Insulin levels are not very helpful.
When type 1 diabetes fully sets in, typically the body makes no Insulin/C peptide.
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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