Type one-and-a-half diabetes

Now, let's take the same general scenario as I described in the prior paragraph, but modify it so BG and A1C control can't be maintained, and insulin needs to be added within a year of diagnosis to control the hyperglycemia: that's typical of what's seen with LADA/type 1.5 diabetes. And if somewhere along the line your physician is astute enough to consider the possibility of LADA/type 1.5, and orders diabetes antibody testing, and the results are positive, the diagnosis is made.

There are a number of experts who feel that as soon as LADA is diagnosed, the patient should be on insulin therapy. This is based on the logic that the diabetes will prove impossible to control on diet, exercise, and oral medications, and hence might as well "bite the bullet" and start insulin immediately.

One might also make the suggestion that all people diagnosed with apparent type 2 diabetes should have antibody testing to see if they might instead be LADA diabetes. That suggestion hasn't been routinely implemented in the past, probably because of the twin demons of added cost and unreliability of the antibody assays, but doing antibody testing would seem reasonable if the patient's hyperglycemia fails to respond to the usual treatment program, or if there are atypical features about the patient's initial presentation.

Getting back to you, the patient: if you have apparent type 2 diabetes, but your BG and A1C remain high, ask to get diabetes antibody testing done. Or if you were just diagnosed with type 2 diabetes, and you don't fit the usual picture, ask for diabetes antibody testing. In either case, if you have one or more diabetes antibodies present, you have LADA. Or if you prefer, type 1.5. And start insulin therapy; you'll need it sooner, so might as well get started.