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Suggest treatment for Hashimoto's disease

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Posted on Thu, 13 Apr 2017
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?
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Answered by Dr. Shehzad Topiwala (31 minutes later)
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.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shehzad Topiwala (1 hour later)
Are there any other tests that could give an indication? My fasting bg is 4.5 (range 3.3-6). C-peptide .75 (.4- 1.5). Fasting insulin 5 (0-20). My 2 hour post prandial after a carby meal is about 8. Highest has been 10.4. Fasting on meter is always lower when carbs eaten the night before.
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Answered by Dr. Shehzad Topiwala (20 hours later)
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.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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Suggest treatment for Hashimoto's disease

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.