Type 1 diagnosis Vs. GAD test results?

xsarndwich

Member
Messages
9
Type of diabetes
Type 1
Treatment type
Insulin
Hi all

As a newbie, hoping I can benefit from the wisdom of forum members!

I was diagnosed T1 ten days ago. Presented at A&E with raging thirst, all peed out (sorry, too much info) and Blood Glucose of 18 and Ketones. Bingo! T1 Diagnosed. I'm 45, not especially overweight, no particular recent weight loss.

At the time I explained family history (the consultant didn't believe me):

- Mother diagnosed at age 60, initially on insulin control (3 months) then diet controlled for 12 years (T2)
- Brother diagnosed around 40yrs as T2 - diet controlled for 17 years until recently - within last 18 months (Metformin)

So here's the thing....

The medics (who are largely wonderful) are pretty adamant I have T1. I'm injecting Humalog and Humalin.

Today though I got my GAD results: 0.2. (bloods taken whilst in hospital a week ago)

Medics seem still to be convinced I'm T1. Recommended carrying on with current treatment until I can see the consultant in a few months.

Slightly confused :eek:/

Any advice welcome.

Thanks!

C
 

tim2000s

Expert
Retired Moderator
Messages
8,934
Type of diabetes
Type 1
Treatment type
Other
It's a difficult one to say @xsarndwich - unless you know the reference range for your laboratory for GAD antibodies, we can't answer your question based on that. From what I've read, 0.2 seems low enough to be discounted. Not all T1s show GAD though.

The best way to test from here would be C-Peptide. Normal or elevated C-Peptide levels would indicate type 2. Low levels would concur with a Type 1 diagnosis.
 

xsarndwich

Member
Messages
9
Type of diabetes
Type 1
Treatment type
Insulin
Thanks!
The medical team said they don't do C Peptide tests when I asked.
 

Daibell

Master
Messages
12,642
Type of diabetes
LADA
Treatment type
Insulin
Hi. I agree that a c-peptide would help. My GAD was negative but the c-peptide showed I had low insulin and my continued use of insulin proves I need it. In many ways if the two insulins help and work it proves that you are a LADA and not all T1s have the same degree of islet cell degradation. I would go along with the medics as you are lucky that they seem clued-up. My GP refused to say I was LADA and initially refused insulin thru ignorance. If thru a lower carb diet you get the weight into the right BMI area (perhaps it is already) and you still need the insulin the T1 is sort-of proved.
 

Andy-Sev

Well-Known Member
Messages
303
Type of diabetes
Type 1
Treatment type
Tablets (oral)
Your case sounds similar to mine as I was sent to hospital with high blood glucose and high ketones at the age of 42 where a consultant said I was Type 1 even though my brother and father both have type 2. But when my GAD results came back and I was told they were negative, don't know the actual values, I found myself in this situation of depending who I spoke to I got a different answer; the diabetic specialist nurse says I am most likely type 2, a consultant says ketones are more indictive of type 1, a regular GP says most likely Type LADA and my last consultant admitted he hadn't got a clue.

Sadly there are quite a few of us around who on presentation don't fit neatly into the standard diabetic type boxes and it seems current practice we are left in limbo to see how things play out over time, that can be a long time in the case of LADA which is a slow progressing form of Type 1.

Having gone through the confusion, the frustration and anger of an uncertain diagnosis I know exactly how you feel and all I can say is that whilst pushing for answers you need to read up yourself so that when you get to see a consultant you go in there with the knowledge to ask the right questions. Although don't be shocked if you find yourself coming away even more frustrated as most consultants struggle to deal with those who don't fit the types perfectly.
 

TorqPenderloin

Well-Known Member
Messages
1,599
Type of diabetes
Type 1
Treatment type
Insulin
I think you certainly deserve a definitive diagnosis, but I'd consider it a good thing that they're treating you as a T1 patient.

The worst thing that can happen is that they misdiagnose a T1 and treat them as a T2. If your pancreas no longer produces insulin, metformin and sulfonylureas (like Gliclazide) are going to be useless.

Unfortunately, your numbers fall into a bit of a "Grey area" in that 18 mmol/L is definitely high, but it's not astronomically high. When someone has levels nearing 30 mmol/L, their response to artificial insulin paints a much clearer picture about their insulin resistance. Of course, that doesn't mean it's an effective way to diagnose someone, but it does help. To explain, someone with very low insulin resistance might need less than 10 units to drop from 30 mmol/L. However, someone with very severe insulin resistance might need more than 100 units to drop from that level.

The people who are very difficult to diagnose are often those with type 1.5/LADA and people with type 2 who don't produce much natural insulin (have c-peptide levels that are considered on the low end of "Normal").
 

xsarndwich

Member
Messages
9
Type of diabetes
Type 1
Treatment type
Insulin
Hi. I agree that a c-peptide would help. My GAD was negative but the c-peptide showed I had low insulin and my continued use of insulin proves I need it. In many ways if the two insulins help and work it proves that you are a LADA and not all T1s have the same degree of islet cell degradation. I would go along with the medics as you are lucky that they seem clued-up. My GP refused to say I was LADA and initially refused insulin thru ignorance. If thru a lower carb diet you get the weight into the right BMI area (perhaps it is already) and you still need the insulin the T1 is sort-of proved.

Thanks Daibell. This is all alot murkier than I thought ;)
 

xsarndwich

Member
Messages
9
Type of diabetes
Type 1
Treatment type
Insulin
Your case sounds similar to mine as I was sent to hospital with high blood glucose and high ketones at the age of 42 where a consultant said I was Type 1 even though my brother and father both have type 2. But when my GAD results came back and I was told they were negative, don't know the actual values, I found myself in this situation of depending who I spoke to I got a different answer; the diabetic specialist nurse says I am most likely type 2, a consultant says ketones are more indictive of type 1, a regular GP says most likely Type LADA and my last consultant admitted he hadn't got a clue.

Sadly there are quite a few of us around who on presentation don't fit neatly into the standard diabetic type boxes and it seems current practice we are left in limbo to see how things play out over time, that can be a long time in the case of LADA which is a slow progressing form of Type 1.

Having gone through the confusion, the frustration and anger of an uncertain diagnosis I know exactly how you feel and all I can say is that whilst pushing for answers you need to read up yourself so that when you get to see a consultant you go in there with the knowledge to ask the right questions. Although don't be shocked if you find yourself coming away even more frustrated as most consultants struggle to deal with those who don't fit the types perfectly.

Hi Andy

Thanks for replying. I sympathise - sounds like it's been a frustrating time for you.

It's certainly not clear-cut is it! It's early days so I'll see how it pans out; a little frustrating but I'll have to embrace the ambiguity for a while it seems. ;)

Am educating myself gradually (I don't want my head completely filled with Diabetes stuff) and have a follow up appointment with NHS Consultant (tbd). Luckily I have health insurance through my employer so seeing a private endocrinologist on Monday - armed with questions and test results! So we'll see what point-of-view that yields into the mix!
 

xsarndwich

Member
Messages
9
Type of diabetes
Type 1
Treatment type
Insulin
I think you certainly deserve a definitive diagnosis, but I'd consider it a good thing that they're treating you as a T1 patient.

The worst thing that can happen is that they misdiagnose a T1 and treat them as a T2. If your pancreas no longer produces insulin, metformin and sulfonylureas (like Gliclazide) are going to be useless.

Unfortunately, your numbers fall into a bit of a "Grey area" in that 18 mmol/L is definitely high, but it's not astronomically high. When someone has levels nearing 30 mmol/L, their response to artificial insulin paints a much clearer picture about their insulin resistance. Of course, that doesn't mean it's an effective way to diagnose someone, but it does help. To explain, someone with very low insulin resistance might need less than 10 units to drop from 30 mmol/L. However, someone with very severe insulin resistance might need more than 100 units to drop from that level.

The people who are very difficult to diagnose are often those with type 1.5/LADA and people with type 2 who don't produce much natural insulin (have c-peptide levels that are considered on the low end of "Normal").

Hi Torq

Thanks for replying.

It is murky non!? The clinic team since 'diagnosis' have been very helpful and yes - it's probably for the best that I'm whacked on Insulin currently. Luckily my BG levels have come down to normal levels over the last week with a revolution of my diet + Insulin.

We'll see what the future holds. Currently, checking BG and injecting feels like a bit of a game; this is how I'm framing it in my mind. I'm **** sure the novelty will wear off and I'll need a new angle ;)