Being Told By An Experienced Diabetic Ward Nurse "i Think You're A Type1".

[ickihun]

How often do these experienced nurses get such things right?

I was having a procedure done last month when the nurse in the none diabetic related unit declared out of the blue that she believes I'm a type 1 not type2.
I told her about how long I'd been diagnosed and that how bad my insulin resistance is. She told me again she feels I'm type1 not a type2.
Why?

Is it because most type2 drugs don't work on me except metformin and canagliflozin? Well work but side affects drive me to distraction.

 

[Seacrow]

If you have massive insulin resistance, you are a type two. Your 'experienced diabetic ward nurse' needs to go back to school.
You may be type one or type lada as well, but this is pretty much irrelevant when it comes to insulin treatment, except that drugs which encourage the pancreas to function won't work for you.

And no, experienced nurses do get things wrong. I got admitted onto a ward with severe dehydration, bg of 5,1. The nurse in charge told me to drink lots and lots of water. I had to get a doctor to explain this would make me hypo, because she didn't believe me and kept trying to get me to drink. I complained, and accidentally got all the nurses on the ward sent on a diabetes aware course. Bet my name is mud on that ward now (haven't been back yet).

 

[Alexandra100]

I was having a procedure done last month when the nurse in the none diabetic related unit declared out of the blue that she believes I'm a type 1 not type2.

Could you be a double diabetic - both 1 and 2?

 

[ickihun]

Could you be a double diabetic - both 1 and 2?

I'm confident I have severe insulin resistance and had diabetic symptoms at 6yrs old but not diagnosed til I was 31yrs old. With burst appendix and bells palsy in hormonal years top off with underactive thyroid I knew PCOS diagnosis also was not the end of my health conditions being brought to light. Diabetes diagnosis wasnt a shock but work needed for maintaining it for life was.
Ive never had a health problem free decade.

I don't know a life without diabetes. It's been there from the start.

How does it feel not being diabetic then diabetic?

 

[sbnz]

Hi ickihun, you have had your fair share of difficult and painful illnesses - I feel for you - I am type 1 and have had some other illnesses too - irritable bowell/gastroparesis - never been properly diagnosed as one or the other but improving (less painful symptoms) as I limit my flour intake and cheap fats (hot chips...) and consciously (mindfully?) focus on relaxing and dissipating tension. Also have periods of depression and anxiety - again improving with support and care. It is possible this nurse is correct - or at least partially correct - lately it has been recognised that there are several types of diabetes - more than just the straight type 1, straight type 2, gestational and the forms caused by injury to or removal of the pancreas. It is possible for someone diagnosed as type 1 to also have insulin resistance and be given meds usually associated with type 2 diabetes for example...and then there is MODY too and others I've prob not mentioned as well...?. When you think about how genetically diverse we can be one from another (although sharing many general similarities too - one head, two eyes, two arms and two legs etc) - there can also be people born with different features...or who develop different features as a result of their environment and it's influences on our health and physicality...including things such as our early emotional care and sense of safety. So you could have certain features/physicality which are quite different from the general categories (in terms of diabetes) and also include other features ...Bells palsy etc. I suppose you didn't ask the nurse why she thought this - or you would have mentioned that? Perhaps because you have a number of other conditions - she may think you have an autoimmune thing going on (as in type 1 diabetes) and you may have mentioned to her that you think you first experienced diabetes when you were quite young? --> [I'm confident I have severe insulin resistance and had diabetic symptoms at 6yrs old but not diagnosed til I was 31yrs old.] which she may by default read as having type 1. My personal take on diabetes is that there are probably many ways/causes by which we can end up with diabetes - whether type1 or 2 or gestational...as we all have quiet diverse DNA possibilities and diverse environments from which we were raised/exposed/socialised/taught....

 

[sbnz]

Hi ickihun, you have had your fair share of difficult and painful illnesses - I feel for you .......as we all have quiet diverse DNA possibilities and diverse environments from which we were raised/exposed/socialised/taught....

correction....oops ..I meant quite diverse not quiet diverse...

 

[ickihun]

Hi ickihun, you have had your fair share of difficult and painful illnesses - I feel for you - I am type 1 and have had some other illnesses too - irritable bowell/gastroparesis - never been properly diagnosed as one or the other but improving (less painful symptoms) as I limit my flour intake and cheap fats (hot chips...) and consciously (mindfully?) focus on relaxing and dissipating tension. Also have periods of depression and anxiety - again improving with support and care. It is possible this nurse is correct - or at least partially correct - lately it has been recognised that there are several types of diabetes - more than just the straight type 1, straight type 2, gestational and the forms caused by injury to or removal of the pancreas. It is possible for someone diagnosed as type 1 to also have insulin resistance and be given meds usually associated with type 2 diabetes for example...and then there is MODY too and others I've prob not mentioned as well...?. When you think about how genetically diverse we can be one from another (although sharing many general similarities too - one head, two eyes, two arms and two legs etc) - there can also be people born with different features...or who develop different features as a result of their environment and it's influences on our health and physicality...including things such as our early emotional care and sense of safety. So you could have certain features/physicality which are quite different from the general categories (in terms of diabetes) and also include other features ...Bells palsy etc. I suppose you didn't ask the nurse why she thought this - or you would have mentioned that? Perhaps because you have a number of other conditions - she may think you have an autoimmune thing going on (as in type 1 diabetes) and you may have mentioned to her that you think you first experienced diabetes when you were quite young? --> [I'm confident I have severe insulin resistance and had diabetic symptoms at 6yrs old but not diagnosed til I was 31yrs old.] which she may by default read as having type 1. My personal take on diabetes is that there are probably many ways/causes by which we can end up with diabetes - whether type1 or 2 or gestational...as we all have quiet diverse DNA possibilities and diverse environments from which we were raised/exposed/socialised/taught....

I also told her I'm the only diabetic in the family and was born premature then ill very very young with pneumonia and chest infection which the antibiotic wasn't happy to resolve and left allergic symptoms on its administration.
I wasn't breast fed so powdered milk was encouraged from day one. (sugary)

 

[EllieM]

And no, experienced nurses do get things wrong. I got admitted onto a ward with severe dehydration, bg of 5,1. The nurse in charge told me to drink lots and lots of water. I had to get a doctor to explain this would make me hypo, because she didn't believe me and kept trying to get me to drink.

How does that work? I thought water only flushed out sugar if you were running at very high levels?????

 

[DavidGrahamJones]

. . . . . . the nurse in the none diabetic related unit declared out of the blue that she believes I'm a type 1 not type2.

I didn't realise that crystal balls had become part and parcel of medical diagnosis. Or did she have to hand the tests that are done to confirm a particular diagnosis.

The W.H.O. document, Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia, (http://apps.who.int/iris/bitstream/...d=E8178B5ECF233C74442F84655487B0EA?sequence=1), is an interesting read, maybe she should be told to go away and "Read and Digest".

It's a shame that doctors are so reluctant to even consider asking for a c-peptide test or an insulin resistance test. It certainly answers two important questions. Does my pancreas make any insulin at all? How insulin resistant am I? I think in my case being told that I didn't need to know by my old GP was a guarantee that I wanted to know and eventually I paid for the tests myself. Probably not essential, but I now know exactly what I'm dealing with.

 

[JohnEGreen]

Lady next door coming up to her 80th birthday was told a couple of weeks ago she was T1 but now her diagnosis has been changed to T2 she is as thin as a rake in fact has lost 3 stone over a few months going from 9 St to 6 Stone she is feeling a little confused about it all. And she has also now been diagnosed with COPD as well never rains but it pours.

 

[Alexandra100]

Diabetes diagnosis wasnt a shock but work needed for maintaining it for life was.

Very well put! I think you may be speaking for all of us here, as regards the hard work.

 

[ickihun]

Lady next door coming up to her 80th birthday was told a couple of weeks ago she was T1 but now her diagnosis has been changed to T2 she is as thin as a rake in fact has lost 3 stone over a few months going from 9 St to 6 Stone she is feeling a little confused about it all. And she has also now been diagnosed with COPD as well never rains but it pours.

Bless her. I'd get her iron levels checked as my asthma I feel is from insuffient iron and betablockers side affects.
My lungs are clear on x-rays and oxygen levels on finger tester is always good. Even when it's clear I cannot breathe.

 

[ickihun]

How does that work? I thought water only flushed out sugar if you were running at very high levels?????

I'm not sure. I've heard of too much water causing havoc as it flushed out hormones in urine.
Maybe she's right?

 

[ickihun]

I'm finding nurses are at so much variant level of knowledge. Shouldn't they all be equal unless a sister or none specialist?
I've heard there's a shortage but I'd rather have quality rather than quantity.
My dn is fantastic and she has a huge depth of knowledge.

I must add this ex-diabetic ward nurse is no longer on that ward. Maybe that is why?

I must add blood tests do get subject to human error, just like everything else.
I would need to see 3 blood test results to accept a serious life hanging diagnosis.
Hence I only started stressing after a few months after diagnosis but because I keep being told the get type wrong, it makes me wonder.
If I'm going to be on insulin, for life I'd prefer to know then I can stop thinking I'm not doing enough to get off it.
After my bariatric op I may still be on insulin. Specialist is hoping only basal and metformin but metformin has let me down now so.......

I see endo on Tuesday and I'll ask him again what I'm looking at after op, his best hopes.
I'll keep low carb eating as a more optimistic outlook on top. Surgeon knows I won't lose as much as none insulin takers. He was hugely impressed with nearly 4st loss on diet change though.

I'm wondering why my insulin was changed when I was losing nicely but had a few hypos and a 48 hba1c. If I was just overweight I'd understand but I'm morbidly obese. He was one who referred me for op.
I'm guessing NICE jumps in to protect against too much weight loss on insulin, even type2s.
I only lose running in 5s no matter how much insulin I need.
My insulin need isn't decreasing currently. Basal is just barely holding its own but on huge amounts. I was taking 72units but now on 129units in metformin's absence.

Maybe I could try liquid metformin to customise my help which should be far cheaper than the extra insulin? Then after op no IBS or GERD so tablet metformin will be tolerated again, maybe???

 

[Alexandra100]

I'm wondering why my insulin was changed when I was losing nicely but had a few hypos

Hypos can kill, and then the diabetes team would be blamed. They would not be blamed if your life was shortened by hypers and /or obesity. This would be considered either the normal progression of diabetes or your fault! Both Dr Bernstein and Jenny Ruhl point this out.

 

[Alexandra100]

@ickihun what an amazingly strong person you are (and have always been). You not only survived so many severe health problems continuing from childhood, you have surmounted all that to build a family! We can all take inspiration from your story.

 

[Seacrow]

How does that work? I thought water only flushed out sugar if you were running at very high levels?????

BG is measured as (amount of sugar)/(amount of fluid) - mmol/ml. If I increase the fluid in my body, I.e. by rehydration with pure water, without also increasing the amount of sugar my BG will fall.

So, a severely dehydrated diabetic with low bg will get even lower bg if rehydrated with pure water. This is what Hartmann's solution is for, since it contains glucose and other electrolytes. Hartmann's is what nurses are told to use to rehydrate diabetic patients.

 

[Seacrow]

I have to say, WOW ickihun , on the 4st weight loss. Well done and congratulations. I know just how hard it is to lose weight when you're really exercise limited (bmi firmly stuck at 36 ).

Do they make liquid metformin? Or are you thinking of putting the tablets in a blender and liquidising.

 

[EllieM]

BG is measured as (amount of sugar)/(amount of fluid) - mmol/ml. If I increase the fluid in my body, I.e. by rehydration with pure water, without also increasing the amount of sugar my BG will fall.

So, a severely dehydrated diabetic with low bg will get even lower bg if rehydrated with pure water. This is what Hartmann's solution is for, since it contains glucose and other electrolytes. Hartmann's is what nurses are told to use to rehydrate diabetic patients.

Thanks, that makes perfect sense.

 

[tim2000s]

@ickihun - it's fair to say that if you had traditionally presenting type 1 diabetes that had remained untreated since six years old, then you'd not be on the forum making posts. OF the other options, there are various factors that make you having a form of diabetes other than Type 2 quite unlikely as well. The key one that you mention is that you're the only one in your family, and most other forms have a genetic component that has usually shown up in previous generations.