How Do They Diagnose What Type Of Diabetes You Have?

[XxTinkerxx]

Just been reading @Shilts post in the newly diagnosed forum and it made me wonder.

How do Dr's determine what type of Diabetes you have? When I was diagnosed my readings were off the scale. The meter said Hi.

Is there a special test that determines between Type 1 and Type 2?

Just curious

 

[Knikki]

They take a blood sample and dip their finger in it if it tastes really sweet odds on your Type 1 if not so sweet maybe a Type 2

But on a more serious note from what I have seen it is all done of the HbA1c or the classic 50 Shades Of Diabetes that you sometimes see around here.

I think it is sliding scale as the information here suggests https://www.diabetes.co.uk/what-is-hba1c.html

No expert so it is an educated guess

 

[pollensa]

Just been reading @Shilts post in the newly diagnosed forum and it made me wonder.

How do Dr's determine what type of Diabetes you have? When I was diagnosed my readings were off the scale. The meter said Hi.

Is there a special test that determines between Type 1 and Type 2?

Just curious

I am still curious too, firstly refer to Type 2 diabetes, after A1C showing high, but turned out error finally, and only pre, putting that aside, good question, who diagnoses takes place generally, I refer, each country seems to differ re cut off values, thresholds of how to diagnose Diabetes two, some countries, use finger testing with A1C testing, some only one or the other or both, only one country I know off, may be wrong? NZ they do what I call pragmatic sensible approach, before labelling anyone, they always do two tests of A1C and finger testing, especially if a person has no symptoms, generally two tests are taken if an A1C is showing diabetic range, same day or day after 2nd test conducted and if shows on par or over and 2 tests reveal diabetic range, they then label accordingly. Two tests I feel is an essential system to be 100% sure. others may not feel the need of this.

As within, it seems different countries, follow their own countries strict rule of proceedures, to obtain final diagnosis I refer to Diabetes 2, as I understand,

Question re special test between type 1 and Type 2 sorry I cannot comment on personal knowledge known, as I am not sure at all, for this, perhaps ask your doc direct or medical team to explain in depth, if there is a set regulated test or other that determines the differences??? may answer your quetion a good one I have to say for peace of mind.

Have a nice day.

 

[ickihun]

Yes. C-peptide blood test. This tests your insulin level at the time of blood taken.

Mine should have been tested before I was started on insulin therapy but it wasn't. I will be requesting it but it's going to be very difficult to decifine on my huge insulin units injected. I don't envy him the job.

Its thought that if no insulin or low insulin then high and difficult to treat bg levels but I've always avoided sugary foods so even as a teenager I've eaten a lowercarb diet to my family due to taste choices. I preferred meat and fish to chips or mash. My treat was mackerel in a tin but sisters got boiled sweets.
I need mine checked.

 

[XxTinkerxx]

Thanks for the replies guys. @Knikki - your reply did make me chuckle

 

[JohnEGreen]

When I was diagnosed my readings were off the scale. The meter said Hi.

When my meter said Hi I just thought it was being friendly.

I think diagnosis is down to a lot of factors HbA1c fasting blood sugars if your lucky the doctor may spring to a GAD or C-Pep test then there's family history general health have you had serious weight loss and some times the doctor just takes one look at you and says T2 or T1 based on assumptions.

 

[Jaylee]

and some times the doctor just takes one look at you and says T2 or T1 based on assumptions.

Yep, I can vouch for that. I normaly just say I'm a diabetic. The nurse then looks round me like a "tire kicker" at a car auction & says "you don't look type 2." (Especially since I hit a certain age.)
I alway wonder what they thought of my T2 dad. He had a small frame too!

Mostly, assumed by age, BMI, how high the BG, that sort of thing... Regarding an initial diagnosis I believe. Some HCPs still prefer sun dials as a measurement of time over a digital watch..

 

[Ann1982]

Just been reading @Shilts post in the newly diagnosed forum and it made me wonder.

How do Dr's determine what type of Diabetes you have? When I was diagnosed my readings were off the scale. The meter said Hi.

Is there a special test that determines between Type 1 and Type 2?

Just curious

I have the feeling my doc looked at me and said oh she is overweight must be type 2! Regardless of the fact that I had all the type 1 symptoms. I was put on insulin very shortly thereafter but am still defined as type 2!

 

[XxTinkerxx]

I find it astonishing that diagnosis is so random.

Someone goes in with a reading of 23 and they are diagnosed as Type 1 despite being an adult. Surely if someone had Type 1 from childhood they would have had symptoms? Why could it not be LADA?

I go in with sugar levels that are so high even the meter said uh oh, and straight away I am diagnosed as a Type 2 despite not even being overweight.

6 years later despite my best efforts, taking the max dose of metformin and gliclizide as well as being a whole stone lighter (I am 8 St) I am now having to take insulin. It just pisses me off how arbitrary this whole diagnosis thing is.

 

[EllieM]

Well, when I was diagnosed, 48 years ago, it was really simple. I woke up thirsty in the middle of the night, my T1 mother did a urine test (contained sugar), and my family doctor sent me for a blood test. As I was a child, I was automatically T1, as was (then) anyone who became diabetic under the age of about 30. (My older non-diabetic brother had a life-threatening head injury when he was 25 and I remember being told that given the family history he was then at risk of this triggering T1). All the T2s were (much) older and were overweight, and there were a few unlucky women who got gestational diabetes which became permanent if they had too many pregnancies (3?).

Things are very different now, not sure whether it's diet (supermarkets put sugar in everything) or environment (lots more pollution?), but there are many many more T2s than there used to be. And doctors do tend to make assumptions based on age and weight. I get the impression that there are just so many diabetics out there that they just hand out some metformin as a band aid approach, and gradually escalate the drugs if that doesn't work.

6 years later despite my best efforts and taking the max dose of metformin and gliclizide I am now having to take insulin. It just pisses me off how arbitrary this whole diagnosis thing is.

On the plus side, if you end up on insulin because you're LADA rather than T2, it should mean you're not insulin resistant, so you don't need to worry so much about the low carb, and you should end up on a reasonable dose of insulin rather than the mega doses that some poor T2s have to suffer under.

 

[XxTinkerxx]

Well, when I was diagnosed, 48 years ago, it was really simple. I woke up thirsty in the middle of the night, my T1 mother did a urine test (contained sugar), and my family doctor sent me for a blood test. As I was a child, I was automatically T1, as was (then) anyone who became diabetic under the age of about 30. (My older non-diabetic brother had a life-threatening head injury when he was 25 and I remember being told that given the family history he was then at risk of this triggering T1). All the T2s were (much) older and were overweight, and there were a few unlucky women who got gestational diabetes which became permanent if they had too many pregnancies (3?).

Things are very different now, not sure whether it's diet (supermarkets put sugar in everything) or environment (lots more pollution?), but there are many many more T2s than there used to be. And doctors do tend to make assumptions based on age and weight. I get the impression that there are just so many diabetics out there that they just hand out some metformin as a band aid approach, and gradually escalate the drugs if that doesn't work.


On the plus side, if you end up on insulin because you're LADA rather than T2, it should mean you're not insulin resistant, so you don't need to worry so much about the low carb, and you should end up on a reasonable dose of insulin rather than the mega doses that some poor T2s have to suffer under.

Thanks for that. All very informative.
I'm on 10u at night and that seems to be working.

Keeping the levels in single figures throughout the day is still a struggle though but I am determined to find a way to deal with that as the last thing I want to do is end up having to inject at mealtimes.

 

[kokhongw]

Usually it is just based on profiling.

Anyone who is overweight or obese would be assumed to be Type 2. This is because the pancreas is still able to produce HUGE amount of insulin to maintain the fat storage.

We often read that T2D does not produce sufficient insulin. That is misleading because the more accurate description is that we do not produce sufficient insulin to overcome our carbs intake. In reality we have been producing 2-3 times MORE insulin than those who are not glucose impaired. So lowering our insulin needs should be a top priority.

The difficulty of correct diagnosis then often lies with those in the normal weight range or has sudden weight loss. They have to be tested for the C-peptide levels and GAD antibodies in order to determine if they suffer from an autoimmune condition and have severely impaired insulin production. In this case, insulin therapy is necessary.

 

[EllieM]

Keeping the levels in single figures throughout the day is still a struggle though but I am determined to find a way to deal with that as the last thing I want to do is end up having to inject at mealtimes.

Honestly, injections are one of the least annoying things about being T1. Matching insulin to blood sugars and food intake is annoying, and hypos are my least favourite part of the illness. My guess is that if you eventually stop producing insulin altogether you will have to take some bolus insulin (I assume you're just having basal now). If you're happy staying very low carb then I guess you may be able to get away without it, but if you're not insulin resistant there's no need to fear injecting insulin, as you're just replacing something that you're no longer producing, rather than giving your body extra of a compound that it can't use properly...

 

[XxTinkerxx]

Honestly, injections are one of the least annoying things about being T1. Matching insulin to blood sugars and food intake is annoying, and hypos are my least favourite part of the illness. My guess is that if you eventually stop producing insulin altogether you will have to take some bolus insulin (I assume you're just having basal now). If you're happy staying very low carb then I guess you may be able to get away without it, but if you're not insulin resistant there's no need to fear injecting insulin, as you're just replacing something that you're no longer producing, rather than giving your body extra of a compound that it can't use properly...

Yes I was told that I am being given insulin to "top up" though I did note that the consultant (who's second opinion I sought) had written in his letter that I should be monitored and may be prescribed further insulin to take at mealtimes

To be honest I don't mind the odd hypo. My sugars have been high for so long I feel relieved it's not that high! Crazy I know

 

[Grateful]

For what it's worth, my unscientific impression is that doctors who find a high HbA1c rely heavily on two things: the patient's age, and whether they are overweight. If the patient is middle-aged and overweight, they will assume T2 and start treating you for it. If you are a child or in early adulthood, they are much more likely to assume a high likelihood that it is T1, or at least, they will be more proactive in trying to figure out what type you have.

In my case I was middle-aged, but not overweight, and with no symptoms -- just a high HbA1c -- when diagnosed 1.5 years ago in the United States. T2 was assumed (with no further tests) and I have no reason to doubt that assumption, especially since I have been able to deal with the condition solely with diet.

When I moved to the UK four months ago and had the first consultation with my new English GP, she looked at me with some surprise (my BMI is now on the edge of the "underweight" scale) but accepted that I have diabetes, judging from the test result that I had at diagnosis.

Diabetes is a very common disease. While the general approach used by the doctors seems to make sense "on average", the numbers of patients is so large that it is inevitable many people's diabetes type will be misdiagnosed if these simple "average" assumptions are used. That's a problem!

 

[XxTinkerxx]

I totally hear that!

One of the things that I kept being told over and over again by the DN and my Dr was that I did not "fit the profile". Even the consultant alluded to that in his letter.

So frustrating.

 

[Circuspony]

I was diagnosed T1 at 43. Two antibody blood tests came back positive and a c-peptide test showed low levels of insulin being produced.

 

[XxTinkerxx]

I was diagnosed T1 at 43. Two antibody blood tests came back positive and a c-peptide test showed low levels of insulin being produced.

I will ask about this c-peptide test next time I see them!

 

[JohnEGreen]

When I asked my GP he laughed and said no more blood tests for you John, I wish he had been correct about the no more blood tests.

Needless to say I have had a ton of blood tests since but no c-pep included.

 

[Daibell]

It's quite simple - they guess and I'm not joking based on the my own experience and many posts over the years. I was stick thin when diagnosed with all the symptoms and an HBa1C of around 12% but I'm still listed as T2 15 years later and on insulin now of course as I'm actually T1. My DN refused to accept I could possible be T1. Some GPs/DNs either refer you which is good if T1 is suspected or order GAD and c-peptide tests which is also good. It appears a few T1s are mis-diagnosed and actually T2 but around 15% of T2s are thin and likely to be mis-diagnosed T1s.