type 1 or 2

[joneswood]

Can you please tell me how they find out if you are type 1 or 2? At the moment they seem undecided.

Clive

 

[RickScott]

Watch this space, I'm going in for a 'confirmation of diabetes' blood test tomorrow morning. following that, I have an appointment with the diabetic nurse on monday afternoon, and one with my GP on thursday. I will let you know what I find out.
This comes from a routine blood test taken just over a week ago, after I had been feeling very tired for a couple of days, and went to my GP to see if he could tell me what was causing it.
At the moment, I know nothing of my condition, other than I have all these appointments comming up soon. I am desperate to know if I am type 1 or 2, and what I need to do to control this. My initial thoughts of 'it will all be fine' are starting to wear thin, especially after all these appointments getting made for me to attend. The meeting with the diabetic nurse on monday is to arrange appointments with a dietician and a chiropodist and get to know the local support group. As this is ALL the information I have just now, you can imagine I am getting kinda scared about the whole thing.

Do I gather from your post that you are in not too different a position to myself??

 

[joneswood]

Hi Rickscot

I was found to be diabetic some three months ago with a BG of 40.2, after a week in hospital I was put onto Insulin Glargine. I am now upto 50 units administered at bedtime, but the hospital is now wondering if I'm type 1 and I wondered how they establish which type I am.

Regards

Clive

 

[gbtyke]

Serum insulin and Anti GAD are the tests you need to ask for.

 

[phoenix]

Tests and a bit of guesswork (clinical judgement)

The serum insulin test mentioned above tests insulin resistance. (I 've only come across that one mentioned as being used in a couple of cases but fairly recently... perhaps its cost has come down ) Insulin resistance would indicate type 2

They could do a c peptide test. This determines how much insulin you are producing. A high amount would indicate type 2, a low amount either type 1 or someone who has had type 2 for some time and has lost insulin production

Type 1a, is a result of an autoimmune attack on the pancreas . They may do one or more antibody tests. There are tests for various antibodies [ICA, IA2, GAD65 and IAA ].Older people with type 1.5 or LADA often have GAD antibodies
( latent autoimmune diabetes of adults, a slower onset form of type 1)
see for more detail
http://www.labtestsonline.org/understanding/analytes/diabetes_auto/test.html

Unfortunately antibody tests are not always indicative as these antibodies are present in the non diabetic population and people with type 2. They are also absent in some cases of type 1.

There is also a classification type 1b (idiopathic...in other words, not proven to be autoimmune, but no-one knows what caused it!)

This is where clinical judgement may come in. Things like unexplained weight loss before diagnosis, glucose levels at diagnosis, presence of ketones or DKA at diagnosis, amount of insulin needed (ie this can indicate insulin sensitivity/resistance without a specific tes)

It's not necessarily clear cut.! (but then the official definitions aren't clear cut either)

 

[hanadr]

Very often they decide on T1or T2 by assumption
ie if the patient is over 40 and over weight, it must be T2. If the patient is young and symptoms came on fast, it must be T1
Much of the time this is going to be right.
If however, they assume T2 and treat with oral medication, the medication won't work on T1 and needs to be changed FAST.
Insulin works for ALL kinds of diabetes.

 

[phoenix]

If however, they assume T2 and treat with oral medication, the medication won't work on T1 and needs to be changed FAST.Insulin works for ALL kinds of diabetes

Thats where the problem of LADA comes to the fore.It is a type of type 1 but the destruction of the beta cells is more gradual than often occurs in children. People with it may be able to manage with oral medication or even sometimes diet and exercise for some time.
When people are diagnosed early in the process, in some places, people with LADA go straight onto insulin as there is some slight evidence that it may slow down the beta cell destruction In other parts of the world, people with the antibodies are carefully monitored whilst using diet or oral medications followed by a gradual move to insulin when it becomes necesssary. (though there is some evidence that the use of sulphonylureas could make people with LADA become insulin dependent sooner)(Cochrane)
The following is from the Swansea LADA research unit.

Evidence suggests that people will LADA will eventually become unable to make sufficient insulin of their own, however this is often a slow process taking an average of 2 to 6 years. The GAD titre usually determines the progression of disease i.e. people with a high GAD result (>100 u/ml) progress insulin more quickly, as does those people who have more than one of the auto antibodies specific to LADA.

When does a person with LADA start insulin therapy?

Many places in Europe including Barcelona, Odense and Rome treat LADA with insulin following diagnosis. In the UK, people with diabetes are not routinely tested for auto antilbodies (GAD) so health professionals do not differentiate between LADA and type 2 diabetes. Therefore people with LADA have the same treatment as people with type 2 diabetes. Typically, people will be managed in response to their blood glucose control, usually starting with diet, followed by oral hypoglycaemic agents (tablets) in the first instance. Insulin therapy is initiated if the former treatment has failed to control blood glucose

I have to say I'm not impressed by the UK approach, which is reactive rather than managed!