How is type1 1/2 differentiated from type 2?

Sobeit

Well-Known Member
Messages
227
Type of diabetes
Type 1
Treatment type
Insulin
I know this is discussed a lot here .Lots of great explanations but I still dont" get it". I have this yearning need to know if I am definitely a type 1 1/2. Ive been told I am ,but I still dont get how they know. . My GAD test is negative for antibodies. I know I have posted on this before so apologies.. but I just wish it was more clearcut as in how type 1 1/2 is differentiated from type 2. Thoughts anyone? :)
 

catapillar

Well-Known Member
Messages
3,390
Type of diabetes
Type 1
Treatment type
Insulin
Is confusion over whether you are type 1.5 or type 2 impacting on your care or treatment?

I think @phoenix 's reply in your previous thread is as close to an answer as you are going to get - http://reading-well.org.uk/books/books-on-prescription/common-mental-health-conditions

Unfortunately, there is no one test that gives you an answer as to what type of diabetic you are. Tests you can have include:

- GAD test - if you have GAD antibodies you are definitely in the type 1 family (so I'm including type 1/1.5/LADA here). However, if you are GAD negative that doesn't mean you aren't type 1, something like 30%of type 1s don't have GAD antibodies...
- C-peptide tests - if you have c-peptide that means you are producing some of your own insulin. However, honeymooning type 1s will still be producing some endogenous insulin (cos that's the point of the honeymoon) and some type 2s make no c-peptide because they are no longer making any insulin - so a c-peptide test doesn't tell you what type you are.
- genetic testing for MODY
- other antibody tests can be done, but I'm really not sure how worthwhile they are as a diagnostic test or how available the tests actually are - http://www.diabetesandenvironment.org/home/mech/autoimmunity

So I think they differentiate between types by looking at all of the tests, and your clinical presentation (in particular presentation on diagnosis - were you losing weight and in DKA or overweight and older - and how your blood sugar levels/HbA1C are doing / what treatment is required for this - are you keeping your blood sugar down with diet and exercise or are you on insulin).

I'm afraid it just isn't clear cut.
 
  • Like
Reactions: 4 people

Daibell

Master
Messages
12,642
Type of diabetes
LADA
Treatment type
Insulin
Hi. I think I may have replied previously. As you have realised it's a lottery out there with regard to late onset T1 and T2 diagnosis. Some GPs, like mine, didn't recognise late onset T1 as a condition so that's not a good start. Other GPs assume that you have to be GAD positive to be a T1 which isn't true. The fact is in many ways it doesn't matter. It's important to have a c-peptide test to check what you natural insulin level is and to be given insulin if it's too low and also your HBa1C is too high. Like you, my GAD was negative but that doesn't mean you aren't a Late onset T1 (the latest NICE Diabetes T1 DEC 2015 Guidelines point this out) as there are other causes of islet cell failure and the GAD is less reliable as time elapses after diagnosis.
 

Sobeit

Well-Known Member
Messages
227
Type of diabetes
Type 1
Treatment type
Insulin
catapillar said:
Is confusion over whether you are type 1.5 or type 2 impacting on your care or treatment?

I think @phoenix 's reply in your previous thread is as close to an answer as you are going to get - http://reading-well.org.uk/books/books-on-prescription/common-mental-health-conditions

Unfortunately, there is no one test that gives you an answer as to what type of diabetic you are. Tests you can have include:

- GAD test - if you have GAD antibodies you are definitely in the type 1 family (so I'm including type 1/1.5/LADA here). However, if you are GAD negative that doesn't mean you aren't type 1, something like 30%of type 1s don't have GAD antibodies...
- C-peptide tests - if you have c-peptide that means you are producing some of your own insulin. However, honeymooning type 1s will still be producing some endogenous insulin (cos that's the point of the honeymoon) and some type 2s make no c-peptide because they are no longer making any insulin - so a c-peptide test doesn't tell you what type you are.
- genetic testing for MODY
- other antibody tests can be done, but I'm really not sure how worthwhile they are as a diagnostic test or how available the tests actually are - http://www.diabetesandenvironment.org/home/mech/autoimmunity

So I think they differentiate between types by looking at all of the tests, and your clinical presentation (in particular presentation on diagnosis - were you losing weight and in DKA or overweight and older - and how your blood sugar levels/HbA1C are doing / what treatment is required for this - are you keeping your blood sugar down with diet and exercise or are you on insulin).

I'm afraid it just isn't clear cut.
Thanks for your reply Caterpillar
Is confusion over whether you are type 1.5 or type 2 impacting on your care or treatment?

I think @phoenix 's reply in your previous thread is as close to an answer as you are going to get - http://reading-well.org.uk/books/books-on-prescription/common-mental-health-conditions

Unfortunately, there is no one test that gives you an answer as to what type of diabetic you are. Tests you can have include:

- GAD test - if you have GAD antibodies you are definitely in the type 1 family (so I'm including type 1/1.5/LADA here). However, if you are GAD negative that doesn't mean you aren't type 1, something like 30%of type 1s don't have GAD antibodies...
- C-peptide tests - if you have c-peptide that means you are producing some of your own insulin. However, honeymooning type 1s will still be producing some endogenous insulin (cos that's the point of the honeymoon) and some type 2s make no c-peptide because they are no longer making any insulin - so a c-peptide test doesn't tell you what type you are.
- genetic testing for MODY
- other antibody tests can be done, but I'm really not sure how worthwhile they are as a diagnostic test or how available the tests actually are - http://www.diabetesandenvironment.org/home/mech/autoimmunity

So I think they differentiate between types by looking at all of the tests, and your clinical presentation (in particular presentation on diagnosis - were you losing weight and in DKA or overweight and older - and how your blood sugar levels/HbA1C are doing / what treatment is required for this - are you keeping your blood sugar down with diet and exercise or are you on insulin).

I'm afraid it just isn't clear cut.
 

Sobeit

Well-Known Member
Messages
227
Type of diabetes
Type 1
Treatment type
Insulin
Thanks for your reply Caterpillar
Thanks for replying with all that info and No diagnosis is not really impacting on my treatment as I am on insulin and managing my blood sugars well! Thanks again :)
 

Sobeit

Well-Known Member
Messages
227
Type of diabetes
Type 1
Treatment type
Insulin
Hi. I think I may have replied previously. As you have realised it's a lottery out there with regard to late onset T1 and T2 diagnosis. Some GPs, like mine, didn't recognise late onset T1 as a condition so that's not a good start. Other GPs assume that you have to be GAD positive to be a T1 which isn't true. The fact is in many ways it doesn't matter. It's important to have a c-peptide test to check what you natural insulin level is and to be given insulin if it's too low and also your HBa1C is too high. Like you, my GAD was negative but that doesn't mean you aren't a Late onset T1 (the latest NICE Diabetes T1 DEC 2015 Guidelines point this out) as there are other causes of islet cell failure and the GAD is less reliable as time elapses after diagnosis.
Thanks for explaining it all again.I'm obviously a bit slow on the uptake regarding all of this . Its frustrating in a way that my GAD is negative as it seems to be the one defining factor. I dont know why I feel its so important to know and when I try discuss it with the professionals they hmm and haw as if to say yes your type 1 but theres a question mark ower that ...if that makes any sense . I find it a bit of frustrating but I'm happy to be managing my blood sugars well which is the main thing . My latest hba1c was 40 ,or 5.8 % so they were pleased with my management of my sugars .Many thanks again :)
 

tim2000s

Expert
Retired Moderator
Messages
8,934
Type of diabetes
Type 1
Treatment type
Other
There is a way of testing. A true T1.5 doesn't show an Insulin reaction to a glucagon injection (as C-Peptides) whereas a T2 does.
 

catapillar

Well-Known Member
Messages
3,390
Type of diabetes
Type 1
Treatment type
Insulin
There is a way of testing. A true T1.5 doesn't show an Insulin reaction to a glucagon injection (as C-Peptides) whereas a T2 does.

Even if they have some endogenous insulin production? Why's that? I want to use the words liver & enzymes, but I'm not really sure why? Just interested to understand more so if you have a link that would be lovely :) if not, don't worry, will google it later...
 

catapillar

Well-Known Member
Messages
3,390
Type of diabetes
Type 1
Treatment type
Insulin
There is a way of testing. A true T1.5 doesn't show an Insulin reaction to a glucagon injection (as C-Peptides) whereas a T2 does.

Nope, I give up. Google doesn't have the answer! All I can find are papers which suggest that a glucagon simulation test (a glucagon injection) can be used to measure a c-peptide response to test to see if type 1s have any residual beta cell function - http://care.diabetesjournals.org/content/early/2008/07/15/dc07-2451.full.pdf - which suggests that a honeymooning type 1 or 1.5 would respond with an insulin production to a glucagon injection.

Help a curious mind & point me in the right direction? Please?
 

Sobeit

Well-Known Member
Messages
227
Type of diabetes
Type 1
Treatment type
Insulin
Nope, I give up. Google doesn't have the answer! All I can find are papers which suggest that a glucagon simulation test (a glucagon injection) can be used to measure a c-peptide response to test to see if type 1s have any residual beta cell function - http://care.diabetesjournals.org/content/early/2008/07/15/dc07-2451.full.pdf - which suggests that a honeymooning type 1 or 1.5 would respond with an insulin production to a glucagon injection.

Help a curious mind & point me in the right direction? Please?
I would be very interested to read also any links and would wish if there was a definitive test that people like me who were diagnosed supposedly wrongly at first could be offered! :)
 

catapillar

Well-Known Member
Messages
3,390
Type of diabetes
Type 1
Treatment type
Insulin
There's a link in here to a study that looked at insulin response to glucose and glucagon, where I got the idea from: http://bit.ly/LADA_T1

Thank you. Sorry, I thought your previous post was referring to an actual diagnostic test that is currently used to determine diabetic status. Looks like a glucagon stimulation test would just be a c-peptide test by another method, which wouldn't be definitive in sorting type twos whose beta cells are worn out from LADAs/1.5s whose beta cells are clinging on - although I appreciate that careful interpretation of the response might give an indication as to type it doesn't look like there is currently sufficient data to set the levels or to give a definitive diagnosis.
 

tim2000s

Expert
Retired Moderator
Messages
8,934
Type of diabetes
Type 1
Treatment type
Other
Thank you. Sorry, I thought your previous post was referring to an actual diagnostic test that is currently used to determine diabetic status. Looks like a glucagon stimulation test would just be a c-peptide test by another method, which wouldn't be definitive in sorting type twos whose beta cells are worn out from LADAs/1.5s whose beta cells are clinging on - although I appreciate that careful interpretation of the response might give an indication as to type it doesn't look like there is currently sufficient data to set the levels or to give a definitive diagnosis.
Not at all. A glucagon stimulation test specifically tests the relationship of the signalling receipt of beta cells to glucagon and the sudden release of glucose from the liver.

The point the paper is making is that in wrongly diagnosed T2 patients displaying antibodies, the c-peptide response after a year was the same as that of a T1 patient. Although the data is admittedly limited, I think it's very clear that at diagnosis and for three years afterwards, T2 patients had a much greater insulin response to glucagon than "t2s with antibodies".

His is the link to the full paper: http://m.diabetes.diabetesjournals.org/content/54/suppl_2/S68.full#F3
 
  • Like
Reactions: 2 people

phoenix

Expert
Messages
5,671
Type of diabetes
Type 1
Treatment type
Pump
This paper which I have to say goes round in circles is a recent British offering on differentiating between T1 and T2 .http://bjgp.org/content/66/646/e315.short#F1
(I would have been T1 under the guidelines because I needed insulin straight away but that was only because I| didn't turn up at the doctors before the symptoms forced me to do so)
 

tim2000s

Expert
Retired Moderator
Messages
8,934
Type of diabetes
Type 1
Treatment type
Other
This paper which I have to say goes round in circles is a recent British offering on differentiating between T1 and T2 .http://bjgp.org/content/66/646/e315.short#F1
(I would have been T1 under the guidelines because I needed insulin straight away but that was only because I| didn't turn up at the doctors before the symptoms forced me to do so)
For me the issue with that paper lies in the the following paragraph, which we know not to be true of many late onset T1s.

The fundamental difference between type 1 and type 2 diabetes is the rapid development of absolute insulin deficiency in type 1, forming the basis of their different treatment and management.
 
  • Like
Reactions: 2 people

wiserkurtious

Well-Known Member
Messages
368
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
diabetes :P having to eat food in moderation
I know this is discussed a lot here .Lots of great explanations but I still dont" get it". I have this yearning need to know if I am definitely a type 1 1/2. Ive been told I am ,but I still dont get how they know. . My GAD test is negative for antibodies. I know I have posted on this before so apologies.. but I just wish it was more clearcut as in how type 1 1/2 is differentiated from type 2. Thoughts anyone? :)

I had GAD done and mine come back negative but still classed as type 1,even though I've been off of insulin since sept of last year after been diagnosed type after been hospitalised for 3 days with DKA
 

Sobeit

Well-Known Member
Messages
227
Type of diabetes
Type 1
Treatment type
Insulin
I had GAD done and mine come back negative but still classed as type 1,even though I've been off of insulin since sept of last year after been diagnosed type after been hospitalised for 3 days with DKA
Thanks for reply.Sorry u were hospitalised. Must have been a scary time! Sounds like honeymoon period perhaps that u were able to come off insulin :)
 
  • Like
Reactions: 2 people

Sobeit

Well-Known Member
Messages
227
Type of diabetes
Type 1
Treatment type
Insulin
My insulin requirement has changed and I take a lot more insulin now then I did when I first began using insulin My ratio now is 1 unit/ 6 carbs when at first it was 1unit /17 carbs and I'm also taking basal insulin now of 10 units in the morning and 10 in the evening. Does that mean if I was to get another GAD antibody test that antibodies would show up now? I would just (sorry to repeat myself )love definitive proof :-( My doctor recommended me to do a local course but it was for type 2's. I was very happy to attend and met some nice people but the leader of the course basically told me not to come back ,in a nice way of course! it was nice to meet with people for support because in my opinion we're all In it together regardless of type 1 or type 2 .She said it would be confusing for me and I think she meant for others also from me being there( but never said that) Its just frustrating for me because I don't know which group I fit into I'm never told by any medical professionals that yes me that you're type 1 (or LADA but they dont really say that here in Ireland it seems)100-percent ! My husband doesn't know why this bothers me at all but I can't help this it does I would just like a test to prove and to be told" yes there you go type one proof" and I would feel more contented and less in limbo so does anybody know if I was to get another GAD antibody test now would antibodies show up? thanks in advance and sorry for harping on about this same issue still...x
 

Daibell

Master
Messages
12,642
Type of diabetes
LADA
Treatment type
Insulin
My insulin requirement has changed and I take a lot more insulin now then I did when I first began using insulin My ratio now is 1 unit/ 6 carbs when at first it was 1unit /17 carbs and I'm also taking basal insulin now of 10 units in the morning and 10 in the evening. Does that mean if I was to get another GAD antibody test that antibodies would show up now? I would just (sorry to repeat myself )love definitive proof :-( My doctor recommended me to do a local course but it was for type 2's. I was very happy to attend and met some nice people but the leader of the course basically told me not to come back ,in a nice way of course! it was nice to meet with people for support because in my opinion we're all In it together regardless of type 1 or type 2 .She said it would be confusing for me and I think she meant for others also from me being there( but never said that) Its just frustrating for me because I don't know which group I fit into I'm never told by any medical professionals that yes me that you're type 1 (or LADA but they dont really say that here in Ireland it seems)100-percent ! My husband doesn't know why this bothers me at all but I can't help this it does I would just like a test to prove and to be told" yes there you go type one proof" and I would feel more contented and less in limbo so does anybody know if I was to get another GAD antibody test now would antibodies show up? thanks in advance and sorry for harping on about this same issue still...x
Hi again. As time passes the GAD test becomes less reliable so you need to assume that it would still show no antibodies. Like you, I'm still irritated that I'm listed as a T2 because it messes-up the statistics used for diabetes research. I'm afraid like me you will have to live with the fact that you haven't had a firm T1 diagnosis but the c-peptide test I had done privately showed my insulin was low and this proves to me that I am not a T2 as T2s would typically have too much insulin due to insulin resistance. There are so many medical conditions where there is no test available e.g. frozen shoulder where steroids are often wrongly given; at least we are having the correct insulin treatment.