Question

[Jlewis]

So basically I was talking to a friend who's a doctor and I just casually mentioned about my onset type 1 diabetes and he said he'd never really heard of that. By him saying it really got me thinking a lot that a lot of my answers ive been given just don't make sense.

First I was diagnosed because of high blood sugar. They said immediately that I'd be type 1 as my mum has type 1 as well. But they put me on glicazide which is a type 2 drug. After doing the glicazide for a few months my blood sugar was dangerously low constantly at 2s or 3s so they kept trying to reduce it before taking me off completely. Then they said i might have MODY so did a blood test then said it wasn't that and it was the onset type 1 and that I'm guaranteed to get it but they can't say when and I don't have it yet....but when I've been there with high levels to question they said it's fine as I've been ill and illness can affect levels. But another doctor said it only affects diabetics but apparently Im not one...things just really are getting confusing and I know that exercise brings my sugars to a low point as the days I exercise most they're at the lowest...it's just very hard to know what's going on

Also to add I've not really reduced a huge amount from my diet either. Okay I've not eaten chocolates or sweets or fizzy drinks that kind of stuff but mainly I've eaten what I've always eaten burgers, hot dogs, steaks (not all the time but once in a while) and most of the time my sugars haven't been dramatically high I've only had a few instances of high sugars and even then I wouldn't say dramatically high

 

[Bertyboy]

Funnily enough, I visited my friends last night, one of whom is a GP, and mentioned about being diagnosed and treated initially as type 1 (although I'm still awaiting GAD, c-peptide etc. test results at the moment).
She was very sceptical about it being type 1 at age 39 with no family history of it, and that it could be type 2 that they just want to initially stabalise quickly before trying Metformin. I live in hope that this is the case, but it's interesting that your friend said something similar.

 

[Deleted Account]

She was very sceptical about it being type 1 at age 39 with no family history of it,

More than 50% of people with type 1 diabetes are diagnosed as adults (aged 20 or over). It is not a childhood disease.
In addition, type 1 is less likely to be hereditary than type 2.

So I have no idea why your GP is sceptical about your diagnosis.

 

[Bertyboy]

More than 50% of people with type 1 diabetes are diagnosed as adults (aged 20 or over). It is not a childhood disease.
In addition, type 1 is less likely to be hereditary than type 2.

So I have no idea why your GP is sceptical about your diagnosis.

To clarify, she's not my own GP (I've still never met my own GP!), just a friend who happens to be a GP. And she wasn't giving me a diagnosis (she mentioned she would have dealt with it in the same way as the private GP I saw did). I think she was more trying to reassure me that until the GAD, c-peptide and other tests have come back, it shouldn't be assumed to be de-facto type 1 and that it may be treatable without insulin at some point.
The first thing I asked when I joined here last week was about whether a type could be diagnosed on the basis of a few days of BG measurements and ketone levels. I'm still not clear in my mind if I had high BG because of type 2 - would that not cause the high ketone levels anyway?

 

[Daibell]

Hi. A few points. The GPs responses make the point in a post I made yesterday that too many GPs don't understand late onset T1 and are in fact quite ignorant on the subject as mine was. Gliclazide is really a late onset T1 drug not a T2 drug. It works by simulating the pancreas to produce more insulin which will be lacking in Late onset T1. T2s will generally have excess insulin unless well into the damage T2 can do and don't need even more insulin as the body can't use it. This will be due to insulin resistance thru excess visceral fat.

 

[Jlewis]

Well I definentely don't think I'm late type 1 I mean it's been months now with no medication and my levels are still getting down the 3s and 4s and the glicazide took them to very dangerously low very quickly

 

[catapillar]

To clarify, she's not my own GP (I've still never met my own GP!), just a friend who happens to be a GP. And she wasn't giving me a diagnosis (she mentioned she would have dealt with it in the same way as the private GP I saw did). I think she was more trying to reassure me that until the GAD, c-peptide and other tests have come back, it shouldn't be assumed to be de-facto type 1 and that it may be treatable without insulin at some point.
The first thing I asked when I joined here last week was about whether a type could be diagnosed on the basis of a few days of BG measurements and ketone levels. I'm still not clear in my mind if I had high BG because of type 2 - would that not cause the high ketone levels anyway?

It's very unusual for a type 2 to be diagnosed with ketones. Diagnosis with blood sugar over 20 and ketones certainly points towards type 1. Diabetic ketones aren't caused by high blood sugar. They are caused by lack of insulin. Most type 2s have too much insulin, so ketones are unlikely, while type 1 is the inability to produce insulin, so 85% of type 1s have ketones on diagnosis.

 

[Jlewis]

It's very unusual for a type 2 to be diagnosed with ketones. Diagnosis with blood sugar over 20 and ketones certainly points towards type 1. Diabetic ketones aren't caused by high blood sugar. They are caused by lack of insulin. Most type 2s have too much insulin, so ketones are unlikely, while type 1 is the inability to produce insulin, so 85% of type 1s have ketones on diagnosis.

That's another funny thing that because on my tests it was said I had no ketones in my results yet I'm diagnosed as type 1

 

[catapillar]

That's another funny thing that because on my tests it was said I had no ketones in my results yet I'm diagnosed as type 1

Yes. That's very common with LADA or type 1.5 because the lack of insulin in a LADA is low enough to not cause ketones.

The 85% figure is from a podcast talking about trialnet: so 85% of type 1s are diagnosed with ketones in DKA, but for those who have had trialnet screening (so have a parent or a sibling with type 1 well aware of the symptoms) only 15% have ketones on diagnosis. They are diagnosed earlier without the trauma of DKA because they are being watched for the risk.

I didn't have ketones on diagnosis because I'm a well informed hypochondriac. It doesn't make me not type 1. It makes me a lucky type 1.

It's not unheard of for confirmed LADA (so someone who is antibody positive, definitely type 1) to have a long strong honeymoon, managing without insulin for maybe 3 years.

 

[Bertyboy]

It's very unusual for a type 2 to be diagnosed with ketones. Diagnosis with blood sugar over 20 and ketones certainly points towards type 1. Diabetic ketones aren't caused by high blood sugar. They are caused by lack of insulin. Most type 2s have too much insulin, so ketones are unlikely, while type 1 is the inability to produce insulin, so 85% of type 1s have ketones on diagnosis.

Thanks. I understand now.

I don't know if my GP friend is in need of extra information or if she was just perhaps trying to stop me worrying so much. She also convinced me it was alright to have a glass of red wine! I assumed all alcohol was now right out...

 

[catapillar]

She also convinced me it was alright to have a glass of red wine! I assumed all alcohol was now right out...

It's fine to drink on insulin. A glass of red wine will have basically 0 carbs in. And 1 glass of wine isn't really enough to keep your liver busy. If you do drink more then the thing to be aware of is that your liver can't multi task. If it's busy processing alcohol it won't do what it usually does which is release glucose overnight. The glucose released from your liver is what your basal insulin deals with. So your basal insulin will be in, but your liver will be too busy dealing with alcohol to release glucose increasing a risk of overnight hypos - the hypos you really want to avoid. So the advice is if you've been drinking, you should test before bed and have an uncovered snack (like a bit of toast) to keep you up overnight.