Could I possible be a T1?

[Jazmin ✨]

Hi there,

I’m new to the forum and slightly confused about my diagnosis.

I have just had a diabetic review with my doctor who is STILL unsure if I am a T2 or a T1 diabetic!!!

I was first diagnosed on 3 July, 2017.
I was put on Insulin straight away as my blood sugars were running at highs of around 18.
I was told to take 6 Basal and 4 Bolus units.
This did not improve my blood sugars as I later found out about carb counting and adjusting your insulin to suit your carb intake and figured out I was having more carbs so adjusted my insulin intake accordingly.
This significantly improved my blood sugars.
I was then also prescribed Metformin SR. This aided slightly in bringing my blood sugars down some more but not significantly.
I still take insulin based on my carb intake.
At my last review, I was told I am making insulin which is between the low to normal mark. (This makes things more confusing!)

I believe I had diabetes for a year before it was diagnosed as that is how long I had the symptons for. Unfortunately, I was left disappointed and neglected by my local practise and doctors as each time I went in, they failed to recognise I have diabetes. (I went in about six times over the course of a year... it is only when I moved cities and homes that I was diagnosed by my new local practise.)

I will disclose all details here;
I am considered obese. At 5’5, I weigh 16.6 stones.
I lost two stones during my year of undiagnosed diabetes and have managed to keep it off even though I do take high amounts of insulin (my doctor was surprised as he says that usually people gain weight if they are taking high amounts of insulin as the body stores the sugar as fat - something like that).
Like I said, my c-peptide measured in at a level considered between low and normal (this is what my doctor said, he hasn’t given me figures).
I tested NEGATIVE for any anti-bodies.
I am still on a basal bolus regime almost seven months later.
I am eating less carbs than I was before and dieting and exercising (I have only begun to do this in the past two months and have further lost a stone.)

I guess my question is, do I seem to fit into the category of T2 more? As I think I do and would hate to find out I have T1 diabetes... I’d rather I have done this to myself and work hard through diet and exercise and sort it out than be in a helpless situation (I honestly cannot say how much I admire the courage of T1s who go through so much every day!)

I would love to hear your thoughts on my situation.

Thank you.

 

[Jazmin ✨]

Also, T2 diabetics who were put on a Basal Bolus regime, how long did you have to stay on it after diagnosis?

Thank you.

 

[ringi]

I don’t know if you are T1 or T2. However as reducing carbs is allowing you to lose weight it is clearly a good option for you, maybe consider going “very low carb”. Provided you adjust your insulin as your BG changes it makes little difference what label you are given.

You are already on Metformin that is the standard drug for Type2 but also used for Type1 if people find it hard to lose weight or need more insulin that the doctor thinks is normal.

Normally with Type1 you would be making a very low level of your own insulin, with Type2 you would be making a very high level, way above what is normal at the time of diagnosed and for a few years after. Losing weight while undiagnosed diabetes is more common with Type1 but can happen with Type2.

Talk to your GP about SGLT2 inhibitors including the risks. (There is a risk that “diabetic ketoacidosis” may be missed by a medic if you take them and your body stops making inslin.) But they are a great drug for people with Type2, as they are the only drug that removes the sugar from your body. (Low carb reduces how much suger the food you eat gets converted into.)

Otherwise, a 10-minute walk after eating can have a big effect on BG control for little effort.

 

[paulus1]

if youve cut your carbs why are you on a high dose of insulin your basel is to keep your bg level whilst the bolus deals with the carbs you eat. you should be slowly reducing your insulin as your diet reduces the carb in put. your metformin needs to be upped if you can take it to 4 a day this reduces the insulin residence. and helps the bg be used by the body. if you can maintain a relative flat bg level slowly lower your bolus levels by a couple of clicks and see what effect this has, keep doing it until you see a slight bump in your numbers. then add back a couple of units. as you lose weight your insulin needs will fall. as you think you had it for a year and your overweight and antibody negative the odds are that your a type 2. you simply cant live for a year with active type 1 your would have been either in hospital or dead. im ina very similar situation.i had a bg of 24 and ketones my hbc1a was 106 im antibody negative. and due to the lchf diet i was able to reduce my insulin from just under 70 units a day to none. im not suggesting you stop but you should be able to lower your need.

 

[Jazmin ✨]

I’ve cut my carbs but not too much all at once as doctor said it would not be wise. So I’m doing it slowly and it’s helping So this means my insulin dose is still quite high (10-15 usually).

 

[LittleGreyCat]

I’ve cut my carbs but not too much all at once as doctor said it would not be wise. So I’m doing it slowly and it’s helping So this means my insulin dose is still quite high (10-15 usually).

I think that possibly what you have is quite high insulin resistance.

T2s on insulin are producing their own insulin but it isn't enough to effectively force the glucose out of the blood and into the tissues. Adding injected insulin gives your pancreas a hand with getting the insulin levels up so the BG levels go down, but that is still fighting the insulin resistance.

Losing weight, taking more exercise, and eating less carbohydrate can all work to reduce insulin resistance.

My favourite web page on this at the moment is https://baby.botherer.org/2018/01/sugar-sugar-baby-get-on-down-the-line-part-2/ which takes the view that IR is the main problem and if you can sort that then you don't need more insulin than your body can produce.

Although I am "normal" weight I have had a (private) test recently which shows that I still have some insulin resistance.

 

[Jazmin ✨]

Yes, I think low carb would be a very good option. Thank you for the suggestion

Hopefully I will try this and see good results.

I will ask my doctor about SGLT2. Thank you for mentioning this as I was completely unaware of
SGLT2! It’s definitely something I will be researching for myself too.

The 10 minute walk is also such a good idea! I know it sounds silly, but there is so much you don’t consider you could do for yourself, or even just remember to do, and when people point out helpful ideas and advice, it truly does help! You’ve been so helpful and I really appreciate it! THANK YOU!

I don’t know if you are T1 or T2. However as reducing carbs is allowing you to lose weight it is clearly a good option for you, maybe consider going “very low carb”. Provided you adjust your insulin as your BG changes it makes little difference what label you are given.

You are already on Metformin that is the standard drug for Type2 but also used for Type1 if people find it hard to lose weight or need more insulin that the doctor thinks is normal.

Normally with Type1 you would be making a very low level of your own insulin, with Type2 you would be making a very high level, way above what is normal at the time of diagnosed and for a few years after. Losing weight while undiagnosed diabetes is more common with Type1 but can happen with Type2.

Talk to your GP about SGLT2 inhibitors including the risks. (There is a risk that “diabetic ketoacidosis” may be missed by a medic if you take them and your body stops making inslin.) But they are a great drug for people with Type2, as they are the only drug that removes the sugar from your body. (Low carb reduces how much suger the food you eat gets converted into.)

Otherwise, a 10-minute walk after eating can have a big effect on BG control for little effort.

 

[paulus1]

you need to understand your doctor is unlikely to get low carbing. its not there standard advice. he will push more wholemeal ect ect this will not reduce your bg. if you really want to see an effect you need to be below 50 grams of carb per day. the equation isless sugar in less insulin needed to deal with it as your body loses the fat as it will your resistance should improve hence even less insulin to get the cells fuel to the right place. just poring slow release carbs in will not alter this.

 

[ringi]

But most doctors (unlike a lot of nurses) do get keeping a record of all meal and recording what meals results in good BG, while avoiding the meals that result in poor BG. Hence don't say "low carb" to a doctor, talk about how you are using the meter to learn what food your body can cope with.

 

[librarising]

Hi there,

I’m new to the forum and slightly confused about my diagnosis.

I have just had a diabetic review with my doctor who is STILL unsure if I am a T2 or a T1 diabetic!!!

At my last review, I was told I am making insulin which is between the low to normal mark. (This makes things more confusing!)

I am considered obese. At 5’5, I weigh 16.6 stones.
I lost two stones during my year of undiagnosed diabetes and have managed to keep it off even though I do take high amounts of insulin
I tested NEGATIVE for any anti-bodies.
I am still on a basal bolus regime almost seven months later.

I guess my question is, do I seem to fit into the category of T2 more? As I think I do and would hate to find out I have T1 diabetes... I’d rather I have done this to myself and work hard through diet and exercise and sort it out than be in a helpless situation (I honestly cannot say how much I admire the courage of T1s who go through so much every day!)

I would love to hear your thoughts on my situation.

Thank you.

Hi Jazmin
my twopennyworth is that you MAY well be T1.
Weight loss before diagnosis is typical for T1.
A pancreas that's still producing insulin, but at a lower level, is indicative of T1.
The presence or absence of antibodies is not definitive either way.
I lived with a declining or absent insulin production for two and a half months, with (I later discovered) bloods in the high 20s. I did not develop DKA, but did lose a stone.
I'm guessing you felt lousy during the year ?
Geoff

 

[LittleGreyCat]

Hi Jazmin
my twopennyworth is that you MAY well be T1.
Weight loss before diagnosis is typical for T1.
A pancreas that's still producing insulin, but at a lower level, is indicative of T1.
The presence or absence of antibodies is not definitive either way.
I lived with a declining or absent insulin production for two and a half months, with (I later discovered) bloods in the high 20s. I did not develop DKA, but did lose a stone.
I'm guessing you felt lousy during the year ?
Geoff

Weight loss before diagnosis is not solely a symptom of T1.

I lost half a stone very quickly just before diagnosis and had BG above 19 but 10 years on I am still classed as T2 and on Metformin only.

Sometimes it is impossible to tell in the first year or so.

 

[spaceman]

Hi there,

I’m new to the forum and slightly confused about my diagnosis.

I have just had a diabetic review with my doctor who is STILL unsure if I am a T2 or a T1 diabetic!!!

I was first diagnosed on 3 July, 2017.
I was put on Insulin straight away as my blood sugars were running at highs of around 18.
I was told to take 6 Basal and 4 Bolus units.
This did not improve my blood sugars as I later found out about carb counting and adjusting your insulin to suit your carb intake and figured out I was having more carbs so adjusted my insulin intake accordingly.
This significantly improved my blood sugars.
I was then also prescribed Metformin SR. This aided slightly in bringing my blood sugars down some more but not significantly.
I still take insulin based on my carb intake.
At my last review, I was told I am making insulin which is between the low to normal mark. (This makes things more confusing!)

I believe I had diabetes for a year before it was diagnosed as that is how long I had the symptons for. Unfortunately, I was left disappointed and neglected by my local practise and doctors as each time I went in, they failed to recognise I have diabetes. (I went in about six times over the course of a year... it is only when I moved cities and homes that I was diagnosed by my new local practise.)

I will disclose all details here;
I am considered obese. At 5’5, I weigh 16.6 stones.
I lost two stones during my year of undiagnosed diabetes and have managed to keep it off even though I do take high amounts of insulin (my doctor was surprised as he says that usually people gain weight if they are taking high amounts of insulin as the body stores the sugar as fat - something like that).
Like I said, my c-peptide measured in at a level considered between low and normal (this is what my doctor said, he hasn’t given me figures).
I tested NEGATIVE for any anti-bodies.
I am still on a basal bolus regime almost seven months later.
I am eating less carbs than I was before and dieting and exercising (I have only begun to do this in the past two months and have further lost a stone.)

I guess my question is, do I seem to fit into the category of T2 more? As I think I do and would hate to find out I have T1 diabetes... I’d rather I have done this to myself and work hard through diet and exercise and sort it out than be in a helpless situation (I honestly cannot say how much I admire the courage of T1s who go through so much every day!)

I would love to hear your thoughts on my situation.

Thank you.

youll be still in honey moon period, meaning your bodys still making its own insulin. did your GP not send you to your local hospital diabetic dept , who will keep a check on you and advise you , regarding your GPs is there a diabetic nurse there who does reviews , blood tests , urine tests ? a simple blood test confirms if you've got type 1 or type 2 diabetes. type 1 are given insulin ? my mates a type 2 hes on pills and diet . a type 1 diabetic gets a test meter in uk to do bg tests about 4 times a day. only type 2 go on insulin only if there bg levels are high and there cant get them down , trouble is that not all doctors specify on diabetes take my medical group we have 8 doctors and only one guy specifies in diabetes.

 

[SueJB]

I think that possibly what you have is quite high insulin resistance.

T2s on insulin are producing their own insulin but it isn't enough to effectively force the glucose out of the blood and into the tissues. Adding injected insulin gives your pancreas a hand with getting the insulin levels up so the BG levels go down, but that is still fighting the insulin resistance.

Losing weight, taking more exercise, and eating less carbohydrate can all work to reduce insulin resistance.

My favourite web page on this at the moment is https://baby.botherer.org/2018/01/sugar-sugar-baby-get-on-down-the-line-part-2/ which takes the view that IR is the main problem and if you can sort that then you don't need more insulin than your body can produce.

Although I am "normal" weight I have had a (private) test recently which shows that I still have some insulin resistance.

Thanks for including baby.botherer. It was an amazing read. It made me wonder again how they know I'm diabetic and how they decide on what dose of basal/bolus insulin to put me on. I thought originally it was guess work, the blog now convinces me I'm right.

 

[paulus1]

well

youll be still in honey moon period, meaning your bodys still making its own insulin. did your GP not send you to your local hospital diabetic dept , who will keep a check on you and advise you , regarding your GPs is there a diabetic nurse there who does reviews , blood tests , urine tests ? a simple blood test confirms if you've got type 1 or type 2 diabetes. type 1 are given insulin ? my mates a type 2 hes on pills and diet . a type 1 diabetic gets a test meter in uk to do bg tests about 4 times a day. only type 2 go on insulin only if there bg levels are high and there cant get them down , trouble is that not all doctors specify on diabetes take my medical group we have 8 doctors and only one guy specifies in diabetes.

not so i was put straight onto insulin/. lots of type 2 are put on insulin if there symptoms warrent it. we also in scotland get meters and strips. im type 2 and was becoming aciddotic so there is no set pattern of what a diabetic may present

 

[paulus1]

Thanks for including baby.botherer. It was an amazing read. It made me wonder again how they know I'm diabetic and how they decide on what dose of basal/bolus insulin to put me on. I thought originally it was guess work, the blog now convinces me I'm right.

for me they start low and every couple of days slowly raise the level until the ideal level of bg is reached. the bolus will eventually be dependent on what you eat.

 

[Jazmin ✨]

Yes, I also think I may be T1 as my Dad who is also a T1 LADA was told be was T2 intially... my Mum is T2 which is where it gets confusing as I have a family history of both T1 and T2!

I lost almost 3 stones before I was diagnosed, and I understand that T2’s can lose weight when there diabetes is out of control but I know a lot of T2s who mostly lost just a few pounds or maybe a stone at most. I feel like 3 stones is a ton of weight to lose in six months without trying!

I guess what’s working against me is my weight and I may well have to fight for a correct diagnosis.

Could you tell me please, if you would happen to know, are GAD antibodies seperate to the usual antibodies that doctors test for when you are newly diagnosed with diabetes and they are trying to find out which type it is? I’m still learning and don’t know if they are different as then I could request my doctor to do a test for GAD antibodies.

Yes! I felt absolutely horrid during my year of undiagnosed diabetes. Now I’m pretty sure it did not start off as crazy uncontrolled diabetes as I remember the symptons being very mild in the first 4-5 months. I was very tired all the time, hungry enough to eat an elephant at meal times and always snacking throughout the day and never gaining a pound, instead losing almost 42 pounds!

Would you also happen to know Geoff, if GAD antibodies are ALWAYS present for a T1 LADA? Or is the case similar to just T1 where antibodies are not always present?

Hi Jazmin
my twopennyworth is that you MAY well be T1.
Weight loss before diagnosis is typical for T1.
A pancreas that's still producing insulin, but at a lower level, is indicative of T1.
The presence or absence of antibodies is not definitive either way.
I lived with a declining or absent insulin production for two and a half months, with (I later discovered) bloods in the high 20s. I did not develop DKA, but did lose a stone.
I'm guessing you felt lousy during the year ?
Geoff

 

[librarising]

Could you tell me please, if you would happen to know, are GAD antibodies seperate to the usual antibodies that doctors test for when you are newly diagnosed with diabetes and they are trying to find out which type it is? I’m still learning and don’t know if they are different as then I could request my doctor to do a test for GAD antibodies.
Would you also happen to know Geoff, if GAD antibodies are ALWAYS present for a T1 LADA? Or is the case similar to just T1 where antibodies are not always present?

If doctors are testing for possible T1 they will test for GAD,so I suspect your doctor has already tested for them.
Sadly, while the presence of antibodies can confirm T1/LADA, their absence doesn't prove anything either way. One out of four T1s/LADAs won't test positive for antibodies. I didn't.
Your drastic weight loss is, I repeat, TYPICAL of T1/LADA, whilst I fully admit T2s can lose weight before diagnosis.
Your pancreas is still producing insulin, but this may be of varying quantity, so be prepared for times when your injected doses either doesn't work so well or works too well. This settles down after a honeymoon period. Good luck with everything !
Geoff

 

[paulus1]

at least your on insulin so it should not be as serious as if you were just diet controlled. you could ask for the c peptide test but its expensive so they may say no.