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Confused!! T1 or t2

lou258

lou258

Well-Known Member
Messages
73
Type of diabetes
Type 1
Treatment type
Insulin
Hi guys wonder if you can help.

I was diagnosed t1 in August. I had acute dka and was in hospital for a week, half of which in icu.

it was a shock and tbh when they said diabetes I assumed t2 before they said - I’m 37 and overweight (Bmi was around 42). I have tested negative for antibodies but doc seemed happy I was t1.

I am on Lantus (24 units daily) and novorapid.

For meals I am on breakfast/lunch 2units per 10g carbs, dinner 1.5units per 10g. On this my BG has been pretty good, avg 6.5 and around 1 hypo a week.

Today out of curiosity i didn’t take my novorapid with brekkie or lunch, results below. I don’t understand these. How has my BG dropped back without my bolus??!

Breakfast - 36g carbs. Pre 5.3 1hr 10.5 3hrs 5.4
Lunch - 38g carbs. Pre 4.5 1hr 7.2 2hr 7.9 3hrs 7.2

Sorry for massive post I’m just really confused. I have even just booked a private c peptide test. Any ideas? Is it possible I’m really t2?!
 
lou258 said:
Hi guys wonder if you can help.

I was diagnosed t1 in August. I had acute dka and was in hospital for a week, half of which in icu.

it was a shock and tbh when they said diabetes I assumed t2 before they said - I’m 37 and overweight (Bmi was around 42). I have tested negative for antibodies but doc seemed happy I was t1.

I am on Lantus (24 units daily) and novorapid.

For meals I am on breakfast/lunch 2units per 10g carbs, dinner 1.5units per 10g. On this my BG has been pretty good, avg 6.5 and around 1 hypo a week.

Today out of curiosity i didn’t take my novorapid with brekkie or lunch, results below. I don’t understand these. How has my BG dropped back without my bolus??!

Breakfast - 36g carbs. Pre 5.3 1hr 10.5 3hrs 5.4
Lunch - 38g carbs. Pre 4.5 1hr 7.2 2hr 7.9 3hrs 7.2

Sorry for massive post I’m just really confused. I have even just booked a private c peptide test. Any ideas? Is it possible I’m really t2?!
Click to expand...

In the early days, many T1s have what they call a honeymoon period, where their pancreas splutters a bit, some still producing a bit of insulin all the time, and some with period producing insulin, then not for a time, and round the loop again, however, it looks like @himtoo is online, I'm sure he'll have some T1 wisdom for you..
 
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DCUKMod said:
In the early days, many T2s have what they call a honeymoon period, where their pancreas splutters a bit, some still producing a bit of insulin all the time, and some with period producing insulin, then not for a time, and round the loop again, however, it looks like @himtoo is online, I'm sure he'll have some T1 wisdom for you..
Click to expand...

Thank you. Maybe I’m grasping at straws ;)
 
1) it's really very uncommon for type 2 diabetics to have dka.

2) 25% of type 1 diabetics are antibody negative

3) your BG has dropped without a bolus either because you are honeymooning or because 24 units of lantus is too much

4) a private cpeptide test will likely just tell you you are honeymooning. It won't tell you what type of diabetes you have the only test that can do that is an antibody test which if positive means definitely type 1, but if negative simply means we don't know.
 
DCUKMod said:
In the early days, many T2s have what they call a honeymoon period, where their pancreas splutters a bit, some still producing a bit of insulin all the time, and some with period producing insulin, then not for a time, and round the loop again, however, it looks like @himtoo is online, I'm sure he'll have some T1 wisdom for you..
Click to expand...

I think you mean many T1s have a honeymoon period? At least I've not heard that in reference to type 2 before
 
catapillar said:
1) it's really very uncommon for type 2 diabetics to have dka.

2) 25% of type 1 diabetics are antibody negative

3) your BG has dropped without a bolus either because you are honeymooning or because 24 units of lantus is too much

4) a private cpeptide test will likely just tell you you are honeymooning. It won't tell you what type of diabetes you have the only test that can do that is an antibody test which if positive means definitely type 1, but if negative simply means we don't know.
Click to expand...

Thanks :) I guess I’m just grasping at straws, I’m a very data driven person and I struggle with the somewhat lack of definitive yes/no answers!

on 3 if lantus was too high would I be hypo-ing more? Or need less basal more bolus and stay at reasonable BG? Does that make any sense?!
 
What I notice around there is they throw the term "DKA" around pretty loosely. Sounds to me like if they find any ketones in your urine they diagnose you with "DKA". Which I don't think is correct. Remembering that it's been many years since I treated it, but as I remember DKA stands for Diabetic KetoAcidosis. The ketones form as a consequence of not being able to use glucose for cellular energy (because there's no insulin to allow it into cells). And ketone bodies are an acidic substance so your blood becomes more acidic the longer it goes on. And we used to measure acidity with an arterial blood gas (using a radial artery stick, not the common venous blood sample used for most chemistry lab tests). That not only tells the pH (acid-base status) of blood but also the oxygen and carbon dioxide content of the blood. Because when it gets more acidic the body wants to "blow off" carbon dioxide to help compensate and bring the pH back up toward normal which is 7.0. So you need to know the pH and the pCO2 on the blood test. There's way to correct the acidity for any CO2 value below normal (which is 40). So see if they did a blood gas when you were admitted to the hospital right in the emergency room. Also the serum electrolytes would be useful too, particularly the serum bicarbonate ("bicarb").
 
TheBigNewt said:
What I notice around there is they throw the term "DKA" around pretty loosely. Sounds to me like if they find any ketones in your urine they diagnose you with "DKA". Which I don't think is correct. Remembering that it's been many years since I treated it, but as I remember DKA stands for Diabetic KetoAcidosis. The ketones form as a consequence of not being able to use glucose for cellular energy (because there's no insulin to allow it into cells). And ketone bodies are an acidic substance so your blood becomes more acidic the longer it goes on. And we used to measure acidity with an arterial blood gas (using a radial artery stick, not the common venous blood sample used for most chemistry lab tests). That not only tells the pH (acid-base status) of blood but also the oxygen and carbon dioxide content of the blood. Because when it gets more acidic the body wants to "blow off" carbon dioxide to help compensate and bring the pH back up toward normal which is 7.0. So you need to know the pH and the pCO2 on the blood test. So see if they did a blood gas when you were admitted to the hospital right in the emergency room. Also the serum electrolytes would be useful too, particularly the serum bicarbonate ("bicarb").
Click to expand...

At admission pH was 6.8 and bicarbonate 3.7
 
TheBigNewt said:
Cool, how about the pCO2? I forget how to convert bicarb to our numbers sorry.
Click to expand...

Don’t have that sorry, limited info on my discharge note. I don’t actually know what my BG were like at admission.
 
lou258 said:
Don’t have that sorry, limited info on my discharge note. I don’t actually know what my BG were like at admission.
Click to expand...
If they knew the pH the other stuff should be part of that blood gas test. You can call the hospital and they'll fax you anything you want of your own records. Sometimes they'll fax you a release of info form for you to sign before they'll do that though. What you more or less want are the lab tests and the discharge summary.
 
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Hi @lou258
sorry for being late to too your topic -- oops !! :)

I think the advice on the honeymoon period fits pretty well --- being aware of our blood sugar levels is a critical tool in long term management -- so my advice is to keep testing often and at the point you see changes to these sort of numbers -- talk to your DSN about making changes to your regime ( adjusting doses )

also -- look into a carb counting course if you have not already been on one -- invaluable for us type 1's !!!!!!!!!
 
I suggest you keep the carbs down and adjust your insulins accordingly to avoid a hypo; do all of this gradually. If you have insulin resistance this should gradually fade as your weight reduces. As you reach a 'normal' BMI if you still need to have insulin then the T1 is indicated. If you find you can stop the insulin and retain good blood sugar then T2 is indicated. This is only a rough guide and might take some time but reducing the weight is the best way to sort out the diagnosis and lowering the carbs is the normally the best way to do that
 
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