Type 1 to Type 2 transformation?

[RichardWB]

Hello,

In May 2014 I presented to the doctors with a fasting BGL of 20mmol/l (360mg/dl) and a BMI of about 22. Blurred vision, extreme thirst and the usual suspects initially had me quickly labeled as having diabetes and type 2 (I was 46yrs old) and given the usual metformin medication. After tests and a specialist appointment a week later, the endocrinologist told me to throw the tablets away and immediately commenced me on Novo rapid and Lantus. I tested negative for GAD antibodies.

Fast forward about 6 months and I had I think about a weeks worth of the 'honeymoon' period, which I've read is considerably very short. Since 2014 I have had a couple of C-peptide tests and they have indicated just trace levels of insulin production.

I recently had another C-test about 4 months ago which indicated significant insulin production levels. Under guidance from the endocrinologist, three months ago I stopped the Novo rapid meal injections and halved my Lantus injections and commenced taking Gliclazide (60mg in the morning). Then about a month ago I stopped the lantus and in addition to the gliclazide am now taking diaformin XR (2000mg at night), Hence after 4.5 years of 4 daily injections, I'm now taking type 2 medication. Incidentally since moving away from the insulin my BGL stats are currently summarized as follows

Average BGL = 6.35mmol/l (114mg/dl)
2Stadnard Deviations = 3.7mmol/l (66mg/dl)

after taking the usual 4 BGL readings per day.

The specialist questioned himself as to whether he had misdiagnosed me, and he is unsure of whether the current production of insulin by the pancreas is only temporary or not. Needless to say this journey has required me to change my diet substantially (typically I am limiting carbs in my diet) and have increased my vegetable intake. I have exercised vigorously throughout my life.

I have searched the archives within this forum and can only see traces of discussions in which people have come off insulin, but it is very few. I suppose my questions are

1. Is this a temporary reprieve based on any evidence that others may have experienced?
2. Is it possible I can recover from type 2 with my continued lifestyle choices?
3. Did I really ever have type 1 or do I have a dual; type diabetes, where type 1 was masking the type 2?

regards
Rich

 

[SimonCrox]

Could be something called Ketosis Prone Type 2 diabetes; in some people with T2DM, when their glucose levels go high, their pancreas stops making insulin (so treatment with insulin is needed). After a while with good control, the pancreatic beta cells wake up and make insulin again, so can manage with tablets.

My favourite article on the subject is :-
http://annals.org/aim/article-abstr...s?doi=10.7326/0003-4819-144-5-200603070-00011

This was first described in African AMericans in a suburb called flatbush, so sometimes known as Flatbush diabetes; but it ocurs in all ethnic groups.

Once the glucose levels have been controled, folk can often manage on tablets for a while eg 3 to 10 years, which I think varies by country - short control USA, long control Africa (OK Africa is a continent)

Best wishes

 

[RichardWB]

Hello,

Thank you Simon for the thread and information. The link to Flatbush diabetes is very interesting, and I notice it has been identified in other cultures outside the USA, which is good as I am in Australia (I was born in the UK). There are some differences however as no other direct family members (parents, brother & sisters) have had any history of diabetes, and I didn't present as mentioned overweight at my initial diagnosis. Additionally the stopping of the insulin is often within the first year of being diagnosed. Perhaps not all symptoms or conditions are always consistent. I did however recently notice in the past month a medical specialist in the UK was advising that all type 1's should be periodically checked as to whether C-peptide and hence pancreatic function returns.

I still continue to take the Type 2 medication and not a great deal has changed with my BSL levels in the 6 months from ceasing injections. The only marked difference is loosing about 5kg since stopping the insulin. It's difficult to know whether this is a result of taking oral medication (I believe Diaformin can cause weight loss) or whether any spiked BSL increases could be the cause. My periods of high BSL have not generally increased as I have tracked my BSL randomly on a daily basis.

regards
Rich

 

[LittleGreyCat]

There was some excitement at the Diabetes UK Professional Conference this year about recent research which showed some regeneration of Beta cells in T1s.
So there seems to be a possibility that Beta cells can regenerate under certain circumstances, and some debate about the possibility that some T1s are constantly regenerating Beta cells then killing them off again with their autoimmune system.

There was no explanation as to why T2s didn't regenerate Beta cells.

There was also no obvious suggestion that you treated T1 with immunosupressants (anti-rejection drugs used after transplants) to suppress the immune system and allow the Beta cells to regenerate.

Still, interesting times!

 

[Caeseji]

There was some excitement at the Diabetes UK Professional Conference this year about recent research which showed some regeneration of Beta cells in T1s.
So there seems to be a possibility that Beta cells can regenerate under certain circumstances, and some debate about the possibility that some T1s are constantly regenerating Beta cells then killing them off again with their autoimmune system.

There was no explanation as to why T2s didn't regenerate Beta cells.

There was also no obvious suggestion that you treated T1 with immunosupressants (anti-rejection drugs used after transplants) to suppress the immune system and allow the Beta cells to regenerate.

Still, interesting times!

Bears mentioning the research we were discussing in this thread before: https://www.diabetes.co.uk/forum/threads/a-curious-bit-of-research.164359/

It could be they don't need to regenerate but merely have optimal conditions to shift back to their natural state but I do delight in that recent research on T1! It would make sense honestly because the body is constantly producing and regenerating cells.

 

[ert]

I believe being negative for GAD antibodies would indicate you were thin type 2. Thin type 2's display more type 1 like symptoms, including normal BMI, very low c-peptide on diagnosis which results in very high blood sugars after eating carbohydrate and GAD and IA2 negative. I may say this as I've had a diagnosis of type 1 under the same circumstances - BMI 22, very low c-peptide and very high blood sugars and have managed with intermittent fasting, interval running and low carbohydrates with enormous effort. I was told to go onto insulin immediately but didn't after following my blood sugars with a glucometer for a couple of days. My specialist is just coming around to thinking that I must be thin type 2 after a honeymoon period of 2 years. Dr Jason Fung is my answer to managing this and hopefully reversing it. But you appear to have kept your sugar levels low enough for your beta cells to regenerate, which is something that doesn't happen in type 1's after their immune system kills off their islet cells.