Replies

• I forgot, Hgb A1c 5.4%
  May 1, 2024

• Mark, GLP1 are a godsend, if it wasn’t for side effects. After about 18 months on dulaglutide, I developed macular edema and moderate to severe gastroparesis. The latter, at least, helped me get used to OMAD. Metformin does all the right things, but overall weak benefit. My FBS was 123 yesterday, after overnight 12 hrs from last meal. And, 115 this morning after 36 hours fasting. Both my fasting insulin and c-peptide are low. Antibody panel (4 antibodies) all negative. Strict LCHF for 16 months and mostly carnivore for the last 10 months. Wt loss 95 lbs. I guess I need to continue my daily dose of vitamin P (patience), since I’ve been T2DM x nearly 29 years. I was using up to 300 units of insulin daily before starting to be strict. No fatty liver. I haven’t used insulin in ~100 days. I stopped the dulaglutide 10 months ago. BMI 33 and visceral fat 16%, so I still have more to go.
  May 1, 2024

• Thank you! This client actually isn't obese (though he could still have visceral fat that hasn't been measured). He does also fit the phenotype of LADA - not significantly overweight, "normal" insulin and c-peptide, negative GAD antibodies, elevated TPO antibodies with normal thyroid markers. He does have a lot of T2D (possibly some T1D) and other autoimmune family history.
  April 30, 2024

• I have seen LADA in patients with significant abdominal/ visceral obesity with negative antibodies. I believe the mechanism is a paracrine effect, whereby reduced arterial inflow to the pancreas or reduced outflow with venous congestion with localized congestion leads to a high local concentration of insulin/glucagon and then inhibits production. Radiologists have previously demonstrated that stenting the pancreas blood supply open increases arterial inflow and temporarily increases serum insulin measurements until the stenting fails with weight gain.
  April 30, 2024

• Hey Kendrick, Thanks for your answer. I have several patients with very similar lab results as what Andrea reports. I have checked C-peptide in these patients and have found them low or borderline low. In my research, you can have LADA and have negative antibodies. Have you seen this? Also, I have seen patients with hyperglycemia and insulin in the 6 range, C-peptide in the 2 range..... what are you doing with patients like this? I have worked up glucagon as well, and it seems to be elevated in these patients. Would love to hear your thoughts.
  April 30, 2024

• Hi Diana, have you seen any robust scientific evidence that shows that artificial sweeteners cause a rise insulin? They may exist, but I have not seen any. There is a chapter in Gary Taubes' book 'The Case Against Sugar' that visits this subject and the real root of this claim in a lot of detail.
  April 11, 2024

• I agree with Kendrick. Stop the magnesium and see what happens. If the magnesium is truly helping to improve insulin sensitivity so much, it might be the cause. Is the patient having no-carb sweeteners? Those can all cause increased insulin release in absence of carbs coming in; along with improve insulin sensitivity, it could cause problems.. It might be time to stop the sweeteners too.
  April 10, 2024

• Only 1 way to find. out...hold the magnesium and see what happens?!
  April 9, 2024

• May want to consider a workup for type 1/LADA. In my clinic the docs and/or I will usually order the following labs: C peptide, GADA, islet cell antibodies, and zinc transporter 8 antibody.
  April 9, 2024

• Sorry, this got stuck in the pending folder. Maybe we can still learn something from it.
  April 9, 2024