1. Antonella Gilmour, NP-PHC November 13, 2015

2. Statistics Site #1Site #2 Total # of patients 4027 4623 Total # of patients with diabetes 344 387 Total # of patients with Type 1 DM 18 20 % with Type 1 5.23% 5.17% Thanks to K Love who assisted with data collection

3. Patient Demographics Site 1 n=18 Site 2 n=20 Combined Sites # of females 7 942.11% # of males 11 57.89 % Average age (years) 41.6 44.5 43.1 Range of Ages (years) 4 - 8414 - 66 4 - 84

4. Insulin Therapy Delivery System 18 using insulin pump (47.4%) Avg A1C 7.86% 20 using multiple insulin injections (52.6%) Avg A1C 9.73%

5. So how does this relate to my experiences working with patients who have type 1 diabetes?

6. LADA Latent Autoimmune Diabetes in Adults

7. “LADA Phenomenon”  Identified in the 1970’s  Researchers were trying to prove that type 1 DM was an autoimmune disease by looking for auto antibodies  Found auto antibodies in patients with type1 and 10% of pts with type 2  2008 study in Diabetes found genetically LADA has features of both type 1 and type 2

8. Autoantibodies  Glutamic Acid Decarboxylase Autoantibodies (GADA or Anti-GAD)  Insulin Autoantibodies (IAA)  Insulinoma-Associated-2 Autoantibodies (IA-2A)  Islet Cell Cytoplasmic Autoantibodies (ICA)  Zinc Transporter 8 (ZnT8Ab)

9. Why is it Important to Identify LADA?  Early insulin treatment may keep functioning beta cells  May provide insulin pump therapy as treatment option  Would allow SGLT2 for those that are not LADA

10. Case Study # 1 Ms. E.W. Generally healthy 35yr old female  G4T4  BMI 24  GDM requiring insulin (for last 10 weeks of her pregnancy which was 2 yrs ago)  father, brother, sister, paternal aunts x2, paternal uncle with type 2 DM  2 months of ongoing vaginal yeast infections, blurry vision and 30 lb wt loss and feeling fatigue- still working FT  A1C 12.4%; no ketones in urine  No medications at present.

11. Outcome Visit 1- start metformin; discussed insulin as treatment option; urgent RD consult Blood sugars running mid 20’s 1 week later- phone f/u- blood sugars 12 ac meals and 17 pc meals Visit 2- 3 weeks later ; vision better; wt stable; ac meals 9-13; start basal insulin A1C 8.5% Visit 3- 1 month later- add apidra; insulin adjustments via phone calls A1C 6.0% (which was 6 mos after initial visit)

12. Case Study # 2  Mr. R G  26 yr old  Mental health- olanzapine x 5 yrs 12.5 mg  BMI 21 ; wt: 66.2kg; ht: 177.2cm  Polyuria, polydypsia, 20 lb unintentional wt loss  A1C 12.6%; office reading 29.4; no ketones in urine

13. Case Study # 3  Mr. B J  Age 45  Ht: 176 cm; wt. 70.6  20 lb unintentional wt loss over 3 mos; polyuria, polydypsia  Father type 2 DM  Smokes ½ ppd  A1c at 14.8%  Pancreatitis in past

14. Case study # 4  Mr. T. S.  51 yr old- diagnosed 12 yrs prior  Has been coming q3-4 mos for office visits  Started on basal insulin 5 yrs ago and rapid 3 yrs ago  A1c’s never below 7.6  Wt; 84 kg; BMI 24; ht: 183

15. Data for Case Study 4: Mr. J.S.