Long-term Discontinuation Of Insulin Treatment In A Type 1 Diabetic Patient
A case for late autoimmune diabetes of the adult? Type 1 diabetes is a well-defined condition requiring life-saving insulin replacement therapy immediately after diagnosis (1). It is also a well-known fact from the natural course of the disease that soon after the insulin therapy has been initiated, insulin requirements decrease, sometimes rapidly, and patients who stopped taking insulin shortly after diabetes diagnosis have been reported (2). However, this so-called “honeymoon period” usually starts several weeks after the diagnosis and rarely exceeds several months’ duration. It is believed, however, and has been unfortunately shown in the past, e.g., during wartime, that insulin discontinuation in a long-standing type 1 diabetic patient poses a serious threat to health and life (3,4). We describe a case of a patient with a definite diagnosis of autoimmune diabetes who, 2 years after having been diagnosed with diabetes, stopped insulin treatment for a period of 17 months and did not develop ketoacidosis. In April 2000, a 19-year-old woman was admitted to the Metabolic Diseases Department due to profound weakness, dizziness, and increased thirst, as well as a 10-kg weight loss in 6 months. The symptoms occurred several months earlier but became more severe within the previous 8 weeks. The patient was diagnosed with type 1 diabetes in November 1998. Her symptoms at the time gradually developed for 4 months and included increased thirst, polyuria, weight loss, and mild ketoacidosis. At the time of diagnosis, her blood glucose was 17.8 mmol/l. She was positive for islet cell autoantibodies (ICAs), with a titer of 90 JDF units, as well as positive for antibodies against GAD (anti-GAD, 80 units/ml). The treatment on discharge consisted of an intensive insulin regimen: Continue reading >>
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Type 1 diabetes trial patient insulin-free after treatment
- Type 1 diabetes treatment could end need for insulin shots
Type 2 Diabetic Misdiagnosis Discovering Type 1 In Adults
Type 2 diabetic misdiagnosis may happen to one in five people who have been told they have adult-onset diabetes. That's 20% of new diabetics. Doctors look at high blood sugar, age and being overweight as the top defining factors for diabetes. Vast numbers of us are becoming type 2 diabetics. In the U.S. the number grew from 8 million in 1995 to 25.8 million in 2010. If you are normal or underweight but develop high blood sugar, your doctor should suspect latent autoimmune diabetes in adults (LADA). But you will probably get the type 2 diabetic misdiagnosis, because we think of type 1 as a children's disease. Experience has taught us to expect age to be a factor in type 2 diabetes. So if you develop diabetes as an adult, doctors will assume you are one of the 90% of diabetics who are type 2. There are stories on the LADA websites of diabetics who found out they were type 1 after ending up in the hospital. Believe it or not, some doctors do not suspect that type 1 diabetes has developed in a grownup. Mary Tyler Moore was diagnosed with type 1 diabetes when she was 33. That was years ago, so doctors ought to be looking for latent autoimmune diabetes in adults. So how can 20% of patients with high blood sugar have type 2 diabetic misdiagnosis? Some have developed ketoacidosis before someone caught the mistake. In adult onset type 1 diabetes the beta cells are being slowly destroyed by the person's own T-cells. It is an autoimmune disorder. To see this attack in action, go to your web browser and type in "T cells attack pancreatic islets." You will be directed to a video made with a proton camera at the La Jolla Institute for Allergy and Immunology. It captures the T cells attacking a beta cell in a mouse, the first live proof of what happens in a type 1 diabetic. Latent aut Continue reading >>
Losing To Diabetes And Learning From It
Milestones I’ve experienced in the past week: receiving a new glasses prescription, acquiring a queen-sized bed, and ending the “Honeymoon Phase” of Type I Diabetes. Probably. I say probably because I can’t actually verify that this is the end. I remember my doctor telling me that it would most likely be a gradual transition and that I would begin to notice that my usual doses of Humalog just weren’t cutting it. I would see some of the original symptoms of diabetes creeping back into my life caused by higher blood glucose levels that weren’t kept in check as easily. Well, friends, I’m there–right there. I know that Type I is forever (at least for now). I know that I have Type I. And I’ve known this day would come. I feel fortunate to have been in the Honeymoon Phase for as long as I have been and I’m thankful that I have a visit with my endocrinologist this Friday. All of these intellectual reflections do nothing for me, though, when I see my meter repeatedly flash numbers in the upper 200s despite my Humalog correction doses. I’m sure any endocrinologist out there–and many of you, as well–would tell me that the corrections aren’t so good for me and I need to be injecting higher doses with meals. Try telling yourself that when you have the QwikPen in hand and you’re cranking the dial. It feels like a death wish to inject more insulin than I’m used to and it’s honestly quite terrifying to think about increasing doses without any exact measurement or ratio. This period of harder-to-control blood glucose levels has lasted for just over a week. I can remember a couple months ago when I had a few days of these same symptoms and it almost took me out, emotionally speaking. I sunk into a pretty angry phase, feeling like nothing I could do woul Continue reading >>
Honeymoon Phase
Tweet The Honeymoon Phase (or Honeymoon Period) amongst people with type 1 diabetes refers to the period of time shortly following diabetes diagnosis when the pancreas is still able to produce a significant enough amount of insulin to reduce insulin needs and aid blood glucose control. This does not, unfortunately, indicate that the diabetes is in remission or can be cured. How is the honeymoon period caused? Type 1 diabetes develops because the body begins to kill off its own insulin producing cells – know as islet cells. When a patient starts on insulin injections, the pancreas is under less pressure to produce insulin. This period of rest, afforded by the injections, stimulate the pancreas to produce insulin from the remaining beta cells. However, after a period of months, the vast majority of these remaining beta cells will also be destroyed, and the honeymoon period ends when the pancreas stops producing sufficient insulin to aid blood glucose control any more. What happens during the honeymoon phase? During the honeymoon phase, blood sugar levels are generally easier to control as the body still has some ability to help itself. Blood glucose levels may even return to normal levels during the honeymoon phase. Insulin doses may therefore need to be re-adjusted during this period and it is essential to communicate with your healthcare professional during this time. Can I stop taking insulin during the honeymoon period? A balance needs to be found between not taking too much insulin, and risking hypoglycemia, but also ensuring your body is not at risk of high blood glucose levels and the possibility of diabetic ketoacidosis. For this reason, you’ll need to discuss closely with your doctor the insulin doses you take. How long does the honeymoon period last? There i Continue reading >>
My Honeymoon Period Is Over | Diabetic Connect
By WASHED OUT Latest Reply2016-06-14 00:09:02 -0500 I haven't been on this site much within the last month or so and I know many of you friends have questioned why. Well it has become a rude awakening that my progress from a 13+ hbA1C to a 5.4 hbA1C has been a amazing journey. I learned much here on this site with the help of friends and the research I have run across in my Journey. I also had testing done as to why this disease was always changing within me. These test some time ago showed me a problem that I would face in my future. It showed an autoimmune problem known by the medical field known as LADA or type 1.5 instead of the type 2 I was originally diagnosed with. LCHF diet and fasting helped me to get off insulins and medications but that was only to be short lived. It was told in some of the research and by professional doctors that people with LADA would be insulin dependent anywhere within a few months to 6 years. Well my time has run out and diabetes has reemerged within my life in a major way. I have had to go back on insulins and still have been holding to the LCHF diet and fasting that I found such improvement doing. My morning fasting numbers have greatly increased again and the insulins are not dropping my glucose numbers like they once did, which shows me that my honeymoon period is over. From here it will become much tougher to maintain control, I will have to go back to my doctor to see what adjustments can be done to find my balance once again. I may even in the near future need to check on an insulin pump to give a more constant control. Over the last period of days I have been getting glucose rises that I understand shows negative changes in my body, that by my diet shouldn't be happening unless my body insulin level has dropped below control le Continue reading >>
Lada Honeymoon Period- Advice Needed
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community I was diagnosed with LADA in Sept 2017 with and Hb1ac of 111. I take 4x500 metformin a day and have followed a very low carb diet. I also use a freestyle libre which has been fantastic. My January blood test has Hb1ac was 47 and I have a BMI of 25. Tomorrow I have my first appt at the hospital clinic with a consultant. If they want to start me on insulin- should I agree- or try to keep going with my current regime, which has had a positive effect on bloods and weight. I have read conflicting articles about preserving pancreas function. I am also worried that I will have hypos as my blood sugars currently range between 3.5 and 7.5 all day. Any advice/experiences from those who have been in my position would be very welcome. Hi @Cageytigers! If you are eating very low carb, you could also take on the same strategy that I am using. I am currently using 8-10(depends on your personal profile) units of Lantus once a day injected at bed time. I some time take maybe 1 or 2 units of novorapid If i decide to eat a meal a little higher in carbs. This regime will also give you more freedom, as you will always be able to do a correction when necessary! As I realize you are newly diagnosed you may not be mentally prepared to go on a basal bolus regimen but in time you will see this as an advantage Hi @Cageytigers! If you are eating very low carb, you could also take on the same strategy that I am using. I am currently using 8-10(depends on your personal profile) units of Lantus once a day injected at bed time. I some time take maybe 1 or 2 units of novorapid If i decide to eat a meal a little higher in carbs. This regime will also give you more freedom, as you will Continue reading >>
9 Surprising Truths You Haven't Heard About Diabetes
9 Surprising Truths You Haven't Heard About Diabetes Cutting-edge research and studies are changing how this disease (which strikes 29 million Americans) is classified, treated and prevented. 1. Diabetes can be prevented with a pill. Youve probably heard the name of this drug before. Its called metformin and its a common first-line defense for type 2 diabetics. But what you havent likely heard is that by reducing glucose production by the liver and improving insulin resistance, metformin can help keep prediabetes from turning into full-blown diabetes. Its safe and effective, yet one study revealed doctors only prescribe the drug to about 8% of those the American Diabetes Associations guidelines recommend it for: prediabetics who are under age 60, severely obese or have a history of gestational diabetes. Experts surmise its being underprescribed because many doctors and patients seem to be unaware of the drugs effectiveness, and a spate of studies have found that lifestyle changes were more effective than metformin at preventing diabetes. An aversion to daily medicine could also make some people refuse the prescription, explains Kevin Goist, MD, an assistant professor of internal medicine at The Ohio State University Wexner Medical Center . However, the Centers for Disease Control and Prevention estimates that 15% to 30% of prediabetics will progress to type 2 within five years. For those who are unable to change diets and incorporate more physical activity into their lives, metformin is a realopportunity to prevent or delay the onset of diabetes, says endocrinologist Tannaz Moin, MD, the studys lead author and an assistant professor at the David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System . 2. Even slim adults get diabetes. Its been c Continue reading >>
10 Facts About Latent Autoimmune Diabetes
10 Facts About Latent Autoimmune Diabetes Join the fight against diabetes on Facebook Latent Autoimmune Diabetes in Adults, or LADA, has long been classified as simply the other diabetes. Typically misdiagnosed as Type 2 because of its late age of onset, LADA is actually a slowly progressing variation of Type 1 diabetes. But what else do you need to know about this form of diabetes? Well, well tell you: LADA appears to be a hybrid form of diabetes, sharing symptoms with both major types. Despite developing in adulthood like Type 2 diabetes, LADA is characterized by an inability to produce insulin, similar to Type 1. As the name suggests, its an autoimmune disease. The primary difference between Types 1 and 2 is the existence of antibodies that attack the bodys ability to produce insulin. Patients with LADA do show presence of these antibodies. Its more common than you think. Roughly 10 percent of adults with diabetes actually have LADA, making it even more widespread than Type 1. However, many of these patients were initially diagnosed with Type 2 diabetes. LADA is a controversial diagnosis in the diabetes community. Many people in the medical community do not distinguish it from Type 1 or compromise by labeling it Type 1.5. Patients diagnosed with LADA can often experience a longer "honeymoon" period, the period during which the body can continue to produce insulin without the aid of medication. For some, this can go on for up to six months. In this particular instance, a misdiagnosis is not harmful. The most important thing with any form of diabetes is managing your glucose levels, so whether you are diagnosed with Type 2 or LADA, the overall goal is the same. A diagnosis of LADA may not change your treatment plan. For very obese patients, the course of action for tr Continue reading >>
Lada Honeymoon? Mody Honeymoon?
How long would a LADA honeymoon be? How long would a Mody honeymoon be? And just what exactly IS a honeymoon? Is that the period from "diagnosis" to insulin? I'm already getting tangled up, because so many people are "dx'd late". D.D. Family T1 since 1977 - using Novolog in an Animas pump. The "honeymoon" is the period during which the beta cells of a T1 or LADA still produce some insulin. It is called "the honeymoon" because controlling blood sugar is relatively easy during this period. Ultimately, the beta cells all die off. And all required insulin has to be injected. Matching insulin action with the insulin requirement becomes more tricky, especially at meatimes - the honeymoon is over! With a T1, the honeymoon is usually quite short. But it can take years for residual insulin production to dry up completely. Aftyer starting insulin therapy, the beta cells often seem to regain some functionality and it almost looks like the diabetes has gone away. With LADA, the "honeymoon" is longer and there may be some insulin production many years after the initial diagnosis. The honeymoon concept doesn't really apply to MODY because beta cells aren't being destroyed. With T2, beta cells are lost as the condition progresses. But this happens over many years, and is not refered to as a "honeymoon". Friend Diagnosed thin T2 1998, turn out to be MODY The "honeymoon" is the period after diagnosis of Type 1 when people start using insulin and sometimes see their blood sugars improve dramatically so they don't need much insulin. Dr. Bernstein claims that if Type 1s keep normal blood sugars they can prolong their honeymoon indefinitely. High blood sugars are toxic to beta cells, and for most people with any diabetes diagnosis, whatever the original cause of high blood sugars, if they Continue reading >>
Www.realitycheck.org.au
This is a secure and safe place for people to bitch, moan, argue, or rejoice (yes, really) about having Type 1 Diabetes. If something has inspired you or enraged you, here's your opportunity to let everyone know. I'm hoping some of you will please share a little experience and wisdom...and well if it doesn't help me directly, it'll make my endo work a little harder for his money if I have more questions to ask. :D My picture so far is slender, active, young, no antibodies, beta cell deficiency, family history, perfect triglycerides and cholesterol. ie did you start out early days with them? do you still present with them after 10 or more years on insulin? Have you ever had a relative tested in order to clear up your own diagnosis? And what were the markers you were looking for? How early in the picture did you get diagnosed? What % of beta cell function did you have at diagnosis and how rapidly did that percentage fail? Are there any questions that you can think of that definitively eliminate or confirm LADA? What are the early signs of deterioration? If you were misdiagnosed, how did it get corrected and why did they mistake it for something else? I was diagnosed by my GP type 2 and put on diabex (late Sept 06). Two days later I was seen by an endo who told me I was not type 2 but LADA/slow onset T1. I was put on diamicron and almost 1 month later diagnosed plain old regular type 1 - I was in DKA + lactic acidosis. I changed endo's soon after and glad I did. Btw, my symptoms started Aug 06. The weight loss wasn't too extreme except the week before I was diagnosed T1 I dropped 8 kilos! I was probably misdiagnosed d/t age (GP - he said adults don't get T1) and slow onset b/c I was caught early. The only results I have now are from the OGTT. by deviation72 Wed Nov 05, 20 Continue reading >>
All About Lada (adults With Type 1)
Written by Amy Tenderich on April 14, 2008 Today is a special day for the diabetes community, and hopefully for those around us to hear our voices and gain better understanding of our plight. Honestly, I try to raise my voice to this challenge every day. But for that little something extra, today I'd like to extend a special welcome to all the LADAs of the world -- a little-recognized or understood subgroup of our PWD community: Who here got diagnosed with Type 1 diabetes in their '20s, '30s, or even '40s? If so, you are (like me), a victim of Latent Autoimmune Diabetes in Adults (LADA), once considered exceedingly rare but less and less so each year. LADA is also referred to as "Slow Onset Type 1" or sometimes " Type 1.5 " diabetes. Note that lots of physicians are still unfamiliar with it (!) Often, because of their age, patients with LADA are automatically assumed to have Type 2 diabetes. That's what the doctors told me during my initial hospital stay. I was 37 years old , and had lost 20 pounds within less than three weeks. (I was close to going into ketoacidosis and diabetic coma, although I didn't feel that sick.) It is now thought up to 20 percent of patients with apparent Type 2 diabetes really have LADA. Read the basics on LADA over at Diabetes Monitor. A few essential things to know if you've been diagnosed with LADA: The Viral Theory - Why did you suddenly develop Type 1 diabetes at this "late age"?Many researchers believe that "one or more viral infections may triggerthe disease in genetically susceptible individuals." Insulin Honeymoon - For a happy period right after diagnosis, your pancreas is still ableto put out some small amounts of insulin, so your necessary doses willbe low, and you'll likely achieve very good BG results. Unfortunately,the honeymoon Continue reading >>
Are You Still Considered 1.5 After The Honeymoon Phase?
Are you still considered 1.5 after the honeymoon phase? Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. Are you still considered 1.5 after the honeymoon phase? I am new to type 1.5, or LADA, which is what I have been recently diagnosed as. I understand that in the honeymoon phase, LADA is a disease distinguishable from both type I and type II because it has characteristics of both. From everything I've read, however, once the honeymoon phase is over, there is really nothing different betweem being a "type 1" and type "1.5" - - unless I am understanding things incorrectly. So, I was wondering if type 1.5 refers simply to that period when the disease is between types in charactersitics, or are you considered type 1.5 for the rest of your life since you acquired diabetes through latent onset?? There is no 'official' definition of 1. 5 so theres no real answer The accepted definitions are defined by a World Health Organisation committee LADA is mentioned and classified not as 1.5 but as type 1a (autoimmune) see page 21 : Definition, diagnosis and classification of diabetes mellitus and its complications Report of a WHO consultation, WHO | Current WHO publications on diabetes .... From everything I've read, however, once the honeymoon phase is over, there is really nothing different betweem being a "type 1" and type "1.5" - - unless I am understanding things incorrectly.... That pretty much sums it up. The key difference is that T1 diabetics become totally dependent on injected insulin much sooner than T1.5s. In other words, T1.5s have a much longer honeymoon. It typically lasts for many years. With T1, it can be as short as a few months. Actua Continue reading >>
Caroline’s Story: Overcoming Type 1 Diabetes With Real Food
Today, Caroline Potter from Colorful Eats, has an amazing story of recovery for you. She’s worked with the same nutritionist that I have these last few years, and has been able to treat Type 1 diabetes with a nutrient-dense diet and natural supplements. It’s another encouraging story of how food can play a significant role in our fight against disease! Treating Diabetes with Real Food Life in your 20s seems pretty grand. You feel powerful, youthful and energized. Dreams seem within your reach and challenges seem conquerable. Then out of the blue, college bliss turns into doctors offices and waiting rooms. Countless tests of all forms, vague results and no answers as to what was wrong with me. As I came home from college that winter for Christmas break, I laid on the couch for most of my vacation. I was constantly starving, eating everything in sight but quickly loosing weight. Finally, one day while out to dinner with my family, I broke down in tears because my mouth was so dry, I could barely talk. I was experiencing dry mouth, one of the major symptoms of diabetes. Diabetes? I was 20, a seemingly healthy young girl, who grew up in a home where my mother fed us all organic food. I was the one in school with her carrot sticks and tuna salad sandwiches. I never drank soda or ate Oreos, so the thought of diabetes was never even on my radar. Barely able to walk up a flight of stairs, I checked myself into the ER to discover my blood sugar levels were in a diabetic coma range. Later the next morning, the doctor diagnosed me with type 1 diabetes. I was scared, hopeless and confused. The days that followed were difficult to say the least. I still felt sick all the time, gained over 20 pounds in 2 weeks and felt terribly alone. My legs turned black and blue from giving mys Continue reading >>
Four-year Clinical Remission Of Type 1 Diabetes Mellitus In Two Patients Treated With Sitagliptin And Vitamin D3
Four-year clinical remission of type 1 diabetes mellitus in two patients treated with sitagliptin and vitamin D3 We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Four-year clinical remission of type 1 diabetes mellitus in two patients treated with sitagliptin and vitamin D3 Marcelo Maia Pinheiro, Felipe Moura Maia Pinheiro, and Margareth Afonso Torres Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by autoimmune destruction of pancreatic beta cells and inadequate insulin production. Remission criteria in T1DM take into account serum levels of C-peptide and glycosylated hemoglobin, as well as the dose of insulin administered to the patient. However, remission of T1DM lasting longer than 1 year is rare. We describe here the cases of two young women who presented with positive glutamic acid decarboxylase (GAD) antibody and classic clinical manifestations of T1DM. Both patients had a prior history of Hashimotos thyroiditis. They were initially treated with a basal-bolus regimen of insulin (glargine and lispro/glulisine). Once their blood glucose levels were controlled, they were started on oral sitagliptin 100 mg and vitamin D3 5000 IU daily. After this therapy, both patients achieved clinical diabetes remission for 4 years, along with a decrease in anti-GAD antibody levels. These benefits were probably associated with immunological effects of these medications. Inhibition of dipeptidyl peptidase 4 (DPP-4) in anima Continue reading >>
Combined Treatment With Sitagliptin And Vitamin D In A Patient With Latent Autoimmune Diabetes In Adults
and K Kotsa1 [1] Diabetes Center of 1st Department of Internal Medicine, AHEPA University Hospital , Thessaloniki, Greece [2] 1st Department of Internal Medicine, AHEPA University Hospital , Thessaloniki, Greece Summary Latent autoimmune diabetes in adults (LADA) is a relatively new type of diabetes with a clinical phenotype of type 2 diabetes (T2D) and an immunological milieu characterized by high titers of islet autoantibodies, resembling the immunological profile of type 1 diabetes (T1D). Herein, we report a case of a young male, diagnosed with LADA based on both clinical presentation and positive anti-glutamic acid decarboxylase antibodies (GAD-abs), which were normalized after combined treatment with a dipeptidyl peptidase-4 inhibitor (DPP-4) (sitagliptin) and cholecalciferol. Anti-glutamic acid decarboxylase antibodies (GAD-abs) titers in young patients being previously diagnosed as type 2 diabetes (T2D) may help establish the diagnosis of latent autoimmune diabetes in adults (LADA). Sitagliptin administration in patients with LADA might prolong the insulin-free period. Vitamin D administration in patients with LADA might have a protective effect on the progression of the disease. Background Latent autoimmune diabetes in adults (LADA) is a slowly progressive form of autoimmune diabetes mellitus characterized by older age at diagnosis compared with type 1 diabetes (T1D) and the presence of pancreatic islet cell autoantibodies (1). This results in the development of glucose intolerance and overt clinical disease when the majority of pancreatic cells are not functional due to the chronic autoimmune inflammation. This pathophysiological process is characterized by the presence of circulating antibodies against pancreatic islet cells and islet cell infiltration by mono Continue reading >>
