How is type 2 diagnosed

[Claire007]

Hello, I’m asking on behalf of a friend of mine, I know plenty about type 1 (as Youll see from my signature) but not so much about type 2!
My friend recently had her BG rested at work as part of a health screening event. Her reading was 11.9. (1hour post cheese sandwich, a small one) She went back an hour later and it was back in the normal range. The following day I tested her on my spare monitor and again, an hour & 3/4 after eating it was 11.5 but returned to normal again within the hour.
Now I know everybody’s BG can rise post meal but I think this is high for a non diabetic. She doesn’t have any symptoms like blurred vision/excessive thirst/excessive passing of water.
The nurse told her it was nothing to worry about and that the cheese will have slowed down the carb absorption but that doesn’t sit right with me and I don’t think from a sandwich I’d estimate to have around 16g of carb, & a 10g Apple (sorry forgot that,) her BG should raise that much. If she ate something very high in carb, then I’d be concerned just how high she’d go.
Btw I, not trying to diagnose her! And she has booked a gp appointment, I’d just
I’d to be a bit more informed about bg in non type 1’s

 

[Squire Fulwood]

I think that those tests would qualify as random tests. Anything over 11 would gain the interest of the doctor but he will need an Hba1c for diagnosis.

Look at the second chart down on this page.

http://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html

 

[Bluetit1802]

Random testing isn't reliable for T2s and neither is fasting, come to that. Her levels do seem to spike quite high, but the good thing is, she does return to normal.

Not all T2s have symptoms, I certainly didn't have any. In fact when I was diagnosed I asked the nurse how she knew it was T2. She replied that had it been T1 I would have presented with a lot of symptoms and been quite poorly.

If her doctor follows the correct procedure he will order an HbA1c. If that is borderline or not very high, he will order a second HbA1c to confirm the first. If it is 48 or above, he will diagnose diabetes. If it is between 42 and 47 he should diagnose pre-diabetes, or "at risk of diabetes". In the first instance he may do a fasting blood plasma test, but this needs to be followed up with an HbA1c unless it is clearly non-diabetic, in which case he may not bother with an HbA1c and send her on her way. If that happens, she may wish to push for the HbA1c.

 

[Claire007]

Thank you squire & bluetit, that’s hugely helpful, it was the fact it was returning to normal and she didn’t have any other symptoms that pointed me towards T2.
Another question! What causes t2 in people who are not overweight? She’s only 8st and while Im fully aware t2 isn’t only diagnosed in patients who are overweight, apologies if I come across as ignorant!, I don’t know why someone with a lowish being might be at risk.
I have spent a lot of time in the last two years trying to get my head round my own t1 & I don’t know want her to get fobbed off by her GP.

 

[Rachox]

I had two HbA1c tests about a week apart to diagnose my type 2. GP said they wouldn’t diagnose on just one incase there was an error of some sort on the first.

 

[Grateful]

Another question! What causes t2 in people who are not overweight?

Nobody knows! There is some "association" with sedentary lifestyle (edited to add: and stress, and lack of sleep) and some suspicions about the carb-heavy Western diet, but that's about it. Also, genetic factors. I am Type 2 and have a first cousin with Type 2. Both of us have always been active and never overweight. Genetics? Or just coincidence??

Edited to add: In America, something like 10 percent of Type 2 diabetics are neither overweight nor obese. That may sound like a low proportion, but multiplied by the total number of T2s out there, it is many millions of people.

 

[Daibell]

Hi. There isn't really a test for T2 other than the c-peptide which can help distinguish between T1 & T2 (former shows low insulin and the latter high insulin). The HBa1C is the best test to diagnose diabetes - both T1 & T2. In my opinion anyone diagnosed and with low weight should be suspected of being T1 and not T2 (per recent NICE Guidelines update). This means having the c-peptide test. The GAD test may also indicate whether anti-bodies have caused the T1. Arguments continue on whether T2 should be used by default for 'anything' other than T1 confirmed by the GAD test. So, with a low weight and a low-carb diet if the BS keeps going up then suspect LADA and get the right medication along the way.

 

[Claire007]

This friend of mine is so active she sends me dizzzy! She literally is always on the go and doesn’t understand how anyone can slob about on the sofa! Amazed she’s my friend as I’m more on the slob side of a weekend!
Well she can’t get an appointment until middle of November so I can keep testing her in the mean time if she wants me to and get her to keep a record.
I really hope it’s just a blip, but my if I forgot to give my fast acting and ate a small sandwich and an Apple, mine would only go a tad higher than hers did (still honeymooning) so I am worried for her.
Thank you all very much for your advice.

 

[Bluetit1802]

Another question! What causes t2 in people who are not overweight? She’s only 8st and while Im fully aware t2 isn’t only diagnosed in patients who are overweight, apologies if I come across as ignorant!, I don’t know why someone with a lowish being might be at risk.

Taking away some known causes such as genetics or certain medications, we are left with insulin.

Type 2 diabetes is the last in a chain of events. It starts with either insulin resistance or too much circulating insulin. I am not sure which of these comes first. Chicken and egg situation.

The most current thoughts on this are too much insulin production is a major factor. We all know that insulin production is driven by too many carbs and consequently a lot of glucose in the bloodstream. The cells (and that includes the liver) become IR which means the insulin can't do its job properly. So more and more insulin is produced to try and counteract this. We end up with high levels of circulating insulin, and this makes the IR worse.
Meanwhile, the glucose isn't getting cleared effectively and remains in our blood stream. Somewhere down the line, Type 2 diabetes rears its head. It is associated with obesity, but the hyperinsinaemia comes first, and the fat deposits caused by the high insulin don't always materialise on the outside - they materialise round the liver and pancreas, and other cells and organs making us even more IR.

Does that make sense? It isn't an easy concept to grasp, never mind explain!

http://bjgp.org/content/67/657/158.3

 

[Claire007]

It does, great explanation thanks, I can remember being told the differences between T1 and T2 when I was diagnosed but I think I had enough on trying to get my head round injecting/ carb counting and didn’t take much notice! Thanks.

 

[Bluetit1802]

It does, great explanation thanks, I can remember being told the differences between T1 and T2 when I was diagnosed but I think I had enough on trying to get my head round injecting/ carb counting and didn’t take much notice! Thanks.

Can I say, you are doing a wonderful job looking out for your friend, and how refreshing it is to see a T1 trying to learn about T2.

 

[NewTD2]

Hi. There isn't really a test for T2 other than the c-peptide which can help distinguish between T1 & T2 (former shows low insulin and the latter high insulin). The HBa1C is the best test to diagnose diabetes - both T1 & T2. In my opinion anyone diagnosed and with low weight should be suspected of being T1 and not T2 (per recent NICE Guidelines update). This means having the c-peptide test. The GAD test may also indicate whether anti-bodies have caused the T1. Arguments continue on whether T2 should be used by default for 'anything' other than T1 confirmed by the GAD test. So, with a low weight and a low-carb diet if the BS keeps going up then suspect LADA and get the right medication along the way.

I might be LADA and I am scared.

Please advice.