Confused about my doctors/consultants advice, am I type 1.5?

Ian DP

Well-Known Member
Messages
712
Type of diabetes
LADA
Treatment type
Insulin
Dislikes
Chips
Just out of interest, what kind of fats make up your 80%?. Do you eat much meat, fish, cheese, coconut oil nuts etc.
 
  • Like
Reactions: 2 people

mrbondsbody

Member
Messages
23
Just out of interest, what kind of fats make up your 80%?. Do you eat much meat, fish, cheese, coconut oil nuts etc.

I eat a lot of saturated fat (heavy cream, whipped cream, Greek yoghurt, fatty cuts of meat such as pork, cheese), I don't really eat coconut oil as its too expensive. I limit the amount of cheese I eat to stay in the protein limits of 15%.

I have decided to cut the saturated fat down and increase monounsaturated such as olive oil and oily fish. My diet ratio is Increased protein to 25% and carbs to 10%. Fat at 65%.

It tough as my blood sugar has risen when I did this. My average was 5-6 and now its 6-8 on average.

Its going to have to be a choice or either hoping my high cholesterol doesn't get me, but having excellent blood glucose levels or compromise and starting taking a small does of medicine with a low carb diet that is low enough in saturated fat to bring my LDL down.
 
Last edited by a moderator:

Ian DP

Well-Known Member
Messages
712
Type of diabetes
LADA
Treatment type
Insulin
Dislikes
Chips
Try KTC 100% pure coconut oil. It is not expensive (around £2.50 for a large 500ml tub from larger Tesco and sainsburys or on eBay - I often buy 6 tubs from eBay if I can't get to a large Tesco). This oil does not taste or smell of coconut, so I use it for all my cooking (fried eggs etc.). Many say it helps promote HDL (good cholesterol). It certainly has with me, since eating it I now have a higher HDL than LDL.
 
  • Like
Reactions: 4 people

rosserk

Well-Known Member
Messages
288
Type of diabetes
Prediabetes
Treatment type
Diet only
Hi apologies if the answer to my question is contained in the thread and I've missed it but... I thought if C-Peptide results were above the normal range that would rule out LADA? C Peptide is released by the pancrease in equal quantities to insulin produced naturally so injected insulin would not effect the results, or have I got confused?? If that's the case a simple test for C Peptide can rule out Type 1 and Lada, if the results of the C Peptide are low then further tests would be required...
 
Last edited by a moderator:

Daibell

Master
Messages
12,642
Type of diabetes
LADA
Treatment type
Insulin
Hi apologies if the answer to my question is contained in the thread and I've missed it but... I thought if C-Peptide results were above the normal range that would rule out LADA? C Peptide is released by the pancrease in equal quantities to insulin produced naturally so injected insulin would not effect the results, or have I got confused?? If that's the case a simple test for C Peptide can rule out Type 1 and Lada, if the results of the C Peptide are low then further tests would be required...
Hi, Yes, you're right, a high c-peptide implies T2 and the reverse for T1.
 

christi99

Well-Known Member
Messages
57
Type of diabetes
Type 2
Treatment type
Tablets (oral)
I recently was referred the hospital because they find it strange that I am so thin for a type 2 diabetic. I have been tested for type 1 by two antibodies and its negative. She said there is an 80% chance I am not type 1, however there might be a 20% chance that I am a slow burn type1 diabetic. I am on the VLCD (5% carbs, 15% protein, 80% fat).

I had my ketones measured at the clinic and they were 2.5. Which is not surprising as its a ketogenic diet. However the doctor wants to put me back on a carb diet, just to see if I produce ketones.

The funny thing is that there is a test that can be done (a total of 4 antibodies) instead of going back to carbs but its not offered on the NHS only in research studies. I might go private, however the doctor advised against it. I checked it out and it cost about £600!

My blood glucose are a consistent 5-6 mmol even after eating. But they are worried I could just sky rocket into ketoacidosis.

Any advice?

Thanks,

James
I think the clinical importance with regard to establishing what type (2 or 1.5) is perhaps simply an academic one. Either type usually presents with insulin insufficiency and/or insulin resistance, and tends to worsen with age and or lifestyle factors. Type 1.5 is usually associated with autoimmunity whereas Type 2 commonly r/t obesity- but not always so!! A type 2 or 1.5 does not necessarily need oral or injectable medication- it all depends on how your body responds to behavioral modifications such as low carb diet and exercise regimen. (Even 10 minutes of sustained cardiovascular exercise decreases insulin resistance for a while). Exercise helps move insulin into the cell, therefore the body requires less circulating insulin to get the job done. The same is true for ingested carbs - requires significantly more insulin to metabolize than protein and so sends a message to pump out lots of insulin (if you have any type of diabetes, carb counting is essential for blood glucose control.) If you are type 1, a VLCD is more difficult as hypoglycemic events can be a problem - because one injected insulin- it needs to be fed, so to speak. However, every body is different.

As for VLC diets- my son has been on one for 1 month (he needs to lose about 35 lbs but he is 6'5''- type 2 for 2 yrs) and he is also on medication. He has been able to reduce is oral meds in half, BS has improved dramatically AND he feels great. Also lost 15 lbs. There is clearly a metabolic principle at work here. This dietary concept works even as it presents a dilemma for clinicians- ketones in the urine! Your doctor wants you to go back to having more carbs so HE/SHE knows how to manage your disease (or merely to see if the ketones disappear, which is likely if you add more carbs to metabolize- shifting out of the true benefit of a VLCD!) I really doubt he /she is trying to see if your ketones skyrocket with a dietary change that adds carbs as that just has no medical basis unless you happen to simultaneously morph into a type 1 at the same time (and produce no insulin). They are taught a pretty narrow treatment /monitoring protocol making it difficult for MDs or other clinicians to interpret data when someone is on a VLCD. I understand their dilemma and he/she's does have a responsibility to monitor and respond to your findings- which is difficult when they find ketones, even if it can be explained by diet. The medical profession really doesn't provide much in the way of creative or out of the box thinking for them to safely practice! Too much liability and they need to cover themselves by establishing that they really did look into the ketone issue in case there is a problem in the future. With that said, I don't think YOU should have to challenge your body so he can see how you respond (unless you want to and you consider it temporary)! If they monitored you based on BG, you would be a success. Ketoacidosis (DKA) is extremely rare in Type 2's. While ketosis is a state that happens when we burn high amounts of fats resulting in ketone production, DKA is a very, very different metabolic dysregulation that rarely is triggered by dietary intake but a serious lack of indogenous insulin. Our bodies normally have a great ability to maintain blood Ph due to the many buffers that respond to changing acid/base metabolic byproducts and within respiration- the acidosis in DKA is a catastrophic failure of our buffer system due to hyperglycemia and subsequent complications of this in the body. That is just medical fact. There are negative side effects to every treatment- including meds, and ketone production (or ketosis) is not ketoacidosis! If there are any negatives to ketosis, is it worse than the negatives of the other oral agents? Depends who you ask I guess. Important to keep well hydrated though. To me it seems the benefits of a VLCD outweigh the risks, when you look at the negative impact of poorly controlled blood glucose.
 
Last edited by a moderator:
  • Like
Reactions: 2 people

Eurobuff

Well-Known Member
Messages
356
Type of diabetes
Type 2
Treatment type
Diet only
I was in the same boat a year ago when I was diagnosed.i was 42 and I wasn't overweight and I put myself on a low carb diet. I had ketones in my urine (the highest level). The DN was concerned and asked me to test my urine and my BG 2 hours after I'd eaten twice a day for a week and go back. The results showed my ketones as high but my BG between 7-9 at the time. She was happy that this proved it was the lack of carbs that was doing it,many that it was ketosis and not ketoacidosis.
 
Last edited by a moderator:

Spiker

Well-Known Member
Messages
4,685
Type of diabetes
Type 1
Treatment type
Pump
Our bodies normally have a great ability to maintain blood Ph due to the many buffers that respond to changing acid/base metabolic byproducts and within respiration- the acidosis in DKA is a catastrophic failure of our buffer system due to hyperinsulinemia and subsequent complications of this in the body. That is just medical fact.

Hyperinsulinemia? Really? What's the mechanism?
 

christi99

Well-Known Member
Messages
57
Type of diabetes
Type 2
Treatment type
Tablets (oral)
I have a question for you all with regard to how they use the information they get from your blood tests in the U.K. I have read many posts here that discuss or explain the different forms (LADA, MODY etc.) In the U.S. th
Hyperinsulinemia? Really? What's the mechanism?
Oops, I didn't mean to write insulinemia but hyperglycemia. Sorry about that! I actually had written something something additionally and changed it never noticed the words- thanks for noticing!
 
Last edited by a moderator:
  • Like
Reactions: 2 people

christi99

Well-Known Member
Messages
57
Type of diabetes
Type 2
Treatment type
Tablets (oral)
I do have a question for any of you after following this thread. It seems in the UK, or at least on this forum there seems to be much discussion regarding the etiology of specific forms of diabetes- I don't mean just Type 1 or Type 2 but subtypes LADA, MODY etc. In the U.S., very rarely is anyone ever sent for any labs to determine this (and I realize while the treatment may be relatively the same, there may be a benefit to knowing). They just say ok, your blood sugars are now high - you have DM - here's meds, diet, monitoring etc. You are only considered type 1 here when your body does not produce any insulin and therefore- treatment for this etc etc.
Anyway...Being diagnosed as an atypical Type 2 and a family of the same- none of us meeting any of the risk factors for this (like obesity etc) it is very enlightening to me that you are all discussing this work-up - especially since you have a socialized medical system- We actually pay large premiums monthly for insurance to cover us, and we don't get the same in-depth work up. (I am sure somewhere they might, but not in standard primary care. So... is this true or just a random impression I am getting? I actually have an appointment with my endocrinologist today and will inquire about this too.
 

Spiker

Well-Known Member
Messages
4,685
Type of diabetes
Type 1
Treatment type
Pump
No our medical professionals are much the same as the US they rarely investigate beyond Type 1 vs 2 and often don't investigate that properly. We have a lot of activist people on these forums who push hard to get a more fine grained diagnosis.
 

christi99

Well-Known Member
Messages
57
Type of diabetes
Type 2
Treatment type
Tablets (oral)
No our medical professionals are much the same as the US they rarely investigate beyond Type 1 vs 2 and often don't investigate that properly. We have a lot of activist people on these forums who push hard to get a more fine grained diagnosis.
Oh OK thanks for the clarification. I was intrigued by the in depth discussion of such matters. I now am interested in finding out more on this on my own, but i am pretty certain no one is going to order me these tests unless I pay out of pocket- which I am not willing to do.
 

Spiker

Well-Known Member
Messages
4,685
Type of diabetes
Type 1
Treatment type
Pump
i am pretty certain no one is going to order me these tests unless I pay out of pocket- which I am not willing to do.
Some of the tests are not that expensive so it might be worth considering, just for your own benefit.
 

christi99

Well-Known Member
Messages
57
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Some of the tests are not that expensive so it might be worth considering, just for your own benefit.
I definitely am going to ask about it today. Do you ever notice that when you ask for these kind of things, or even go on anything but a mainsteam diet (like the VLCD) and adopt a certain vigor in learning about a disease process, even when the medical community isn't offering any great remedies (not necessarily diabetes but even with DM), they treat you like a lunatic or neurotic ? That compliance is the only norm they want to see and not interdependent participation? I know I have gotten this before and frankly it makes me want to just not discuss anything with them for fear of this. And I am a pretty rational and conservative person i general. I understand them not wanting to actually pay for things that don't fall within accepted diagnostic or treatment guidelines, but there is another underlying paradigm going on ...
 

mrbondsbody

Member
Messages
23
Hi guys,

Its been awhile since I last posted so I wanted to update you on my progress.

To help you remember I had gone VLCD to treat my diabetes which still at the moment is unknown (85% fat, 10% protein, 5% carbs) and this had a dramatic effect on my cholesterol. I saw a dietician who gave me some advice.

I modified by diet to 65% fat, 20% protein, 15% carbs, increase my fiber to >25 g a day, reduced my satuared fat to <40g and started to eat a little fruit again. Eliminated cheese and replaced a lot of butter with extra virgin olive oil.

At first my blood sugar was high but as my body adapted it normalised.

My recent cholesterol results and H1ac results are amazing (see picture).

In addition I have gone for genetic testing (for MODY). I get the results back in October.

jITnHfx.png
 
Last edited by a moderator:
  • Like
Reactions: 2 people

christi99

Well-Known Member
Messages
57
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Hi guys,

Its been awhile since I last posted so I wanted to update you on my progress.

To help you remember I had gone VLCD to treat my diabetes which still at the moment is unknown (85% fat, 10% protein, 5% carbs) and this had a dramatic effect on my cholesterol. I saw a dietician who gave me some advice.

I modified by diet to 65% fat, 20% protein, 15% carbs, increase my fiber to >25 g a day, reduced my satuared fat to <40% and started to eat a little fruit again.

At first my blood sugar was high but as my body adapted it normalised.

My recent cholesterol results and H1ac results are amazing (see picture).

In addition I have gone for genetic testing (for MODY). I get the results back in October.

jITnHfx.png


Wow... that is amazing. Ok I am also in a dilemma here re: choesterol/lipids. I had an annual cholesterol/lipid panel done ( I have been doing the VLCD but had recently increase carbs a bit (but high quality, high fiber like quinoa, brown rice etc). I don't need to lose weight, I have increased my exercise a lot more, eat little to no red meat, have very little saturated fat in general, no processed foods, etc.etc. and have avoided gluten (I have another autoimmune disease I am trying to impact). Just to keep it simple - my cholesterol yearly is around 140's. Well just got it back and it is 300!!!!! ( I am not sure what scale is used in the UK -but it should be less than 200). Ya, I have high HDL's but also high LDL! As well ,my H1AC was high, my fasting blood glucose was high, and now my doc wants to put me on metformin and a statin!! I am shocked!!! Usually I am controlled with diet alone. I realise it may be coincidental, but that seems unlikely. I am so disappointed. I will not go on a statin but frankly I am so angry I have had these results from this diet. I am not going to add more carbs but I will add more fiber and exercise even more (Blah...) I just wonder if anyone else had a spike in cholesterol following change to this diet? And I was hoping for better BS control not worse...
 

mrbondsbody

Member
Messages
23
Hi Christi, Sorry to hear about your cholesterol profile. Sounds like potentially your high blood glucose has caused the rise. Could be temporary increase due to insulin resistance swapping from VLCD to a more carb diet. I have noticed if I eat too much my blood sugar rise a lot so I eat smaller meals to avoid this.


Was your triglycerides high aswell?

Do they know what type of diabetes you have?

Many thanks,

James

:
 

Daibell

Master
Messages
12,642
Type of diabetes
LADA
Treatment type
Insulin
I do have a question for any of you after following this thread. It seems in the UK, or at least on this forum there seems to be much discussion regarding the etiology of specific forms of diabetes- I don't mean just Type 1 or Type 2 but subtypes LADA, MODY etc. In the U.S., very rarely is anyone ever sent for any labs to determine this (and I realize while the treatment may be relatively the same, there may be a benefit to knowing). They just say ok, your blood sugars are now high - you have DM - here's meds, diet, monitoring etc. You are only considered type 1 here when your body does not produce any insulin and therefore- treatment for this etc etc.
Anyway...Being diagnosed as an atypical Type 2 and a family of the same- none of us meeting any of the risk factors for this (like obesity etc) it is very enlightening to me that you are all discussing this work-up - especially since you have a socialized medical system- We actually pay large premiums monthly for insurance to cover us, and we don't get the same in-depth work up. (I am sure somewhere they might, but not in standard primary care. So... is this true or just a random impression I am getting? I actually have an appointment with my endocrinologist today and will inquire about this too.
Hi. As Spiker says, our UK system is really no better. I think some of our GPs (medics) can be quite ignorant about diabetes even after the NHS training course and don't know about LADA or Late onset T1 or the associated GAD or c-peptide tests. Some want to avoid the cost or hassle. I'm listed as a T2 but know that I'm a Late onset T1. I had my one GAD and c-peptide tests done privately as I gave up with our NHS and my c-peptide was very low. My GAD was negative which can be due to two things either the long time after diagnosis (a know feature of GAD testing) or that my islet cell failure is due to a virus, pancreatitis or whatever. So, the value of this site globally is that we can share our knowledge or diabetes in the real world and be able to challenge the 'experts' who may not be that expert or avoid the high costs of private tests of consultations. One thing that does surprise me is the diference between UK and USA diabetes drug pricing. In general they are much cheaper in the UK and I'd like to understand why?
 
  • Like
Reactions: 2 people

christi99

Well-Known Member
Messages
57
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Hi Christi, Sorry to hear about your cholesterol profile. Sounds like potentially your high blood glucose has caused the rise. Could be temporary increase due to insulin resistance swapping from VLCD to a more carb diet. I have noticed if I eat too much my blood sugar rise a lot so I eat smaller meals to avoid this.


Was your triglycerides high aswell?

Do they know what type of diabetes you have?

Many thanks,

James

:

No, in my country they really don't give a **** about determining etiology of "types" except for T1 and T2 (too cheap/they don't care/management is the same). I don't fit the profile of a typical T2, so I suspect it is what I have seen here referred to as 1.5. Because I am thin (BMI of 20) and I get a good amount of exercise, there wasn't much I could do except try the VLCD as well as eliminate gluten (for reasons having to do with 2 other diagnosed autoimmune diseases i have). Yes my triglycerides were high as well and they simply NEVER have been. While my blood sugar has been higher than normal since my 20's and I have managed to not require meds, and I ate a really high carb diet proportionally, not calorically (healthy carbs but still carbs...) I really don't like the taste of animal proteins so I struggle to get enough protein in general. i thought by doing this VLCD it would help (even though it would be very, very tough for me to follow) I thought I would try it based on what I have read here. But OMG- never did I expect this!! Yes, it may actually also be related to a very underactive thyoid they have been trying to manage (Hashimoto's) and this can cause elevated lipid profile but this was the biggest (and only ) spike ever- even though thyroid problem has been a 2 year debacle. I just wonder if my elimination of so many sources of fiber (while still having many veggies with fiber) concurrently with increasing fat and protein sources are to blame- funny thing is though... I was feeling really energetic and healthy- only added a little extra carbs because I always felt like I was starving to death. (I even lost weight despite eating way more calories). Oh and had eliminated wine, and any alcohol even though I didn't have much (due to ? sugar, carbs etc) I expected GREAT results. :( Maybe it was coincidental but boy, this is very disappointing... I am afraid to stay on it for fear I will have a cardiac event!! (Many in my family have had early heart disease, attacks, stokes etc- probably due to the diabetic thing. My doctor won't help because they don't believe in the VLCD- just in throwing meds at me. So discouraged...
 

christi99

Well-Known Member
Messages
57
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Hi. As Spiker says, our UK system is really no better. I think some of our GPs (medics) can be quite ignorant about diabetes even after the NHS training course and don't know about LADA or Late onset T1 or the associated GAD or c-peptide tests. Some want to avoid the cost or hassle. I'm listed as a T2 but know that I'm a Late onset T1. I had my one GAD and c-peptide tests done privately as I gave up with our NHS and my c-peptide was very low. My GAD was negative which can be due to two things either the long time after diagnosis (a know feature of GAD testing) or that my islet cell failure is due to a virus, pancreatitis or whatever. So, the value of this site globally is that we can share our knowledge or diabetes in the real world and be able to challenge the 'experts' who may not be that expert or avoid the high costs of private tests of consultations. One thing that does surprise me is the diference between UK and USA diabetes drug pricing. In general they are much cheaper in the UK and I'd like to understand why?

One word. Insurance. Example, I had an elective cosmetic procedure done, paid out of pocket and was charged 6,000 dollars . It was mistakenly (? or on purpose) sent to my insurance, who also paid it. Except they billed insurance almost $25,000 (so 4 X times what I was charged!!! ) I called my insurance to explain that it was elective (technically cosmetic- but did have medical component- but my doctor did not deem it to be medical necessary- therefore not covered , just comfort and appearance related.), My insurance carrier said "well, your doctor must have thought it was medically necessary!!) So... hospital committed fraud, insurance company didn't care AND I paid all for nothing, They would not reimburse me after several calls. So yeah, hospitals fraudulently using billing codes they know they will be reimbursed for at a high rate. Drugs- Charge more for drugs because insurance companies will pay for it- and indirectly the consumer does- through high monthly premiums and co-pays. That is why I wish we had socialized medicine or I lived in Europe ( my family is english/scottish and I went to college there)! Yeah, pros and cons to both- but if I ever ask my doctors to tests for things based on my review of current studies (I am a researcher!) or other treatment options- they just have NOOOO interest in humoring me! No critical thinking goes on except in limited diagnostics and narrow treatment options (treatment of choice). And their treatments are not working so it is so frustrating. I pay thousands a year for medical , dental and insurance out of pocket and still can't get done what I ask for... Doctors can't either- they have to make a case to insurance based on insurance co. set guidelines, and they frequently deny it! Profit rules our world of medical care.
 
  • Like
Reactions: 2 people