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CPEP Test

D

Duncan_Scott

Member
Messages
22
Type of diabetes
Type 2
Hi Everyone,
After being diagnosed for the past 14 years as type 2, I had a lengthy spell in hospital with DKA brought on by sepsis. The endocrinologist treating me at the hospital felt I was more type 1 than type 2 based on how my body was responding to treatment. He has been treating me as type 1 for the last 5 months when I asked for a c pep test. I just got the results back and they indicate 1.66 ng/ml, this was based on 12 hours fasting and 12 hours without insulin (basal or bolas). If i'm reading this correctly the results seems to be in the normal range but I don't know what this means for me with regards to being a diabetic (type 1 or type 2?) and what it means in terms of treatment...Can anyone help me to understand the numbers and what it might indicate/mean to me.

Thanks


Kind Regards


Duncan
 
Type 2. You've had diabetes for 14 years. Clinically, Type 1's will deteriorate onto insulin within 3 years (LADA 6 years) and have trace levels of c-peptide.
Type 2's, if they have uncontrolled blood sugars out of the normal ranges, will require insulin a lot by 10 years as their beta cells fatigue due to insulin resistance. Your c-peptide is normal. Type 2's don't become Type 1's. Type 1 is an autoimmune condition.

On diagnosis, I had a c-peptide of 0.17 ng/ml (normal 0.5 to 2.7). Less than 0.2 ng/ml (on diagnosis - not 14 years later) is type 1.
 
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Hi Ert, Thanks for coming back to me. what you are saying makes perfect sense and thats why I requested the Cpep test as I couldn't understand the logic f what I was being told.
Currently I'm on 14 units of Lantus per day and an A1C of 5.8. The consultant also had me on Novo Rapid but with a low carb diet, I've managed to get off of that now. I'm trying to get off insulin as my weight is rising ...don't know whether the cpep test result gives me some wriggle room to reduce the Lantus a bit even at the expense of my sugar going up a little.

Thanks for coming back to me. I really appreciate it.

Kind Regards


Duncan
 
I put on 20 kg when starting insulin. It's really difficult to keep the weight off.
 
ert said:
Clinically, Type 1's will deteriorate onto insulin within 3 years (LADA 6 years)
Click to expand...

Hi @ert is there a link or source you can share for those figures? Wanting to learn a bit more.
 

Your C-peptide is quite good. I wouldn’t want to question a doctor’s professionalism but I think he/she was wrong to assume anything and diagnose you before doing a test. It’s good that you requested the C-peptide.

As iterated by others, type 1s will progress onto insulin quite quickly, within weeks and months rather than years. A type 1 also has a higher HbA1c at diagnosis because of insulin deficiency.

It is a bit of an enigma as to why your C-peptide is good yet you still went into DKA. Perhaps request another C-peptide (not sure if the doctor would agree to this though).

At the end of the day it doesn’t change your treatment plan. If you need insulin, you need insulin.
 
I agree it doesn't look much like T1 in your case, @Duncan_Scott .
The next bit isn't very relevant to you, I think, but I still wanted to add some more information in reply to Type Zero's post to prevent confusion in others who may read this thread.

Hope you'll find a treatment plan which works well for you, regardless of type!
TypeZero. said:
As iterated by others, type 1s will progress onto insulin quite quickly, within weeks and months rather than years. A type 1 also has a higher HbA1c at diagnosis because of insulin deficiency.
Click to expand...

T1's, which includes LADA's, sometimes do go for years without needing insulin after a diagnosis based on high BG's and positive antibodies. It can take a long time before you're not producing enough insulin yourself, especially when eating low carb.
Not needing insulin within a year does not rule out T1.

The same goes for hba1c: it's not a diagnostic tool to determine type. If caught early, or if someone happened to already eat low carb, you can be diagnosed with T1 even with prediabetic numbers.
Not having a very high hba1c does not rule out T1.
 
My experience as a t1/lada is that I had normal cpetide levels after 7 years and it quickly tailed off after that

A lot of t2's will over produce insulin in an effort to keep bg down so will often have high cpetide

In 'my' opinion based on 'my' experience normal cpetide does not rule out t1/LADA

So if you need insulin to prevent dka then insulin you need

I had many chats with consultants about coming off insulin and it was only when they started adding other meds and my insulin need didn’t drop that they said it won’t be possible

But up until 6 years after diagnosis I could stop insulin for many weeks before my bg started to get really out of control..

Now if I disconnect my pump I know it within hours
 
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Well in my defence I put type 1s and 1.5s into different categories. T1 is rapid onset and anything that is autoimmune and takes long is generally considered T1.5
 
TypeZero. said:
Well in my defence I put type 1s and 1.5s into different categories. T1 is rapid onset and anything that is autoimmune and takes long is generally considered T1.5
Click to expand...

Not according to my consultants or genetic nurse.. they have blatantly stated I’m T1.. I’ve badged myself as LADA due to the time that it too to come on.. the reason I was referred to a genetic nurse was to check for LADA and in my last consultant appointment she said no I’m T1


So I think it’s more reasonable to say in ‘most cases’. There will always be someone falling outside of the ‘normal’
 
TypeZero. said:
Well in my defence I put type 1s and 1.5s into different categories. T1 is rapid onset and anything that is autoimmune and takes long is generally considered T1.5
Click to expand...
Officially autoimmune is listed as T1, there is no separate official way to put LADA or 1.5 in medical records. LADA's are T1's in their records. T1 is officially defined as autoimmune diabetes, nothing about speed of onset in the definition.
You didn't mention your personal choice to use different categories than the official ones which is very confusing and not helpful in this thread.
 

Actually I don’t think there is an “official” definition, T1, T1.5/LADA and T2 all exist - it’s just the matter of a CCG including it into their protocol which is highly specific to your location. The term LADA is clearly not a made up term by me, it has a scientific basis marked by lower titre of antibodies and a more gradual progression onto insulin compared to T1s.

Anyways the thread has been derailed hugely, apologies Duncan
 
Hi Everyone,
No worries I'm really interested in the information its really helping me. My consultant now thinks I'm type 2 following the cpep results but thinks I should take another test in a few weeks. I'm starting to feel more comfortable now in part due to the test and in part due to everyones help on this forum. My bloods are averaging 6.8 over the last week ...my Lantus is 14 units split 2x day and I have not required a shot of the Novo Rapid for 8 days. I have a 1.2 shot of Victoza per day and metformin and I'm finding i'm eating a good healthy diet and I'm not hungry. I would like to adjust my Lantus little by little to get down to 10 units per day but overall right now apart from the weight gain I think i'm doing ok. thank you all for your help.
 
Goonergal said:
Hi @ert is there a link or source you can share for those figures? Wanting to learn a bit more.
Click to expand...

The 3 years to insulin with a c-peptide below 0.2 nmol/l (6 years for LADA with above 0.2 nmol/l readings but below the normal range) figures came from my specialist treating me for type 1 diabetes on diagnosis at the Churchill OCDEM Oxford.

There is a reference to the same process for time to insulin for type 2 (relevant to the question asked) diabetics that follow the same timeline once their c-peptide ends up as low after 10 of more years with type 2 diabetes:

Time to insulin treatment may also be associated with c-peptide response [40]. In a retrospective study of insulin-treated individuals with T2DM, time to insulin prescription in individuals with an MMTT c-peptide of at most 0.2 nmol/l (suggesting absolute insulin deficiency) was 2.5 (1.5–3) years compared to 6 (3–10.75) years for those with a mixed meal stimulated c-peptide of greater than 0.2 nmol/l (p = 0.005).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5446389/
 
Low CPEP and no antibodies on diagnosis.
Generally diagnosed as T1 but lacking any evidence of autoimmune disease.
Where does that fit into the great scheme of things?
 
Hi, can a type 2 also be (become) type 1 and visa versa? Sure why not, Are all type 1’s the same? 2’s? 3’s? 1.5’s? But we do love a box, it makes us feel better. I think you could be an unusual type, maybe type 47? I hope you find some answers.
 
LittleGreyCat said:
Low CPEP and no antibodies on diagnosis.
Generally diagnosed as T1 but lacking any evidence of autoimmune disease.
Where does that fit into the great scheme of things?
Click to expand...
Low C-peptide (below the normal range) will result in a rapid deterioration onto insulin, which supports type 1. Sometimes beta cells are killed by a virus.
 

I don't love a box, I just love a proper diagnosis so I know what I am dealing with. That's what makes me feel better. Imagine being in the type 2 'box' when you are actually a type 1, as many people have been and dangerously so, or in a type 1 box on insulin when in actual fact you were a type 2 and could have done it on diet alone maybe or a type 3c and boxed up as a type 2, the diagnosis matters as does the different treatments. You are right in that we are all individuals with varying physiology and thresholds etc, but type 1s are 'all the same' in terms of their diagnosis and eventual insulin requirements but that's not to say their numbers in relation to glucose levels or blood tests or C Peptide levels or reactions to food or amounts of insulin are all the same (same for type 2). I'll be honest, I find your post a little flippant considering it is a serious disease we are all coping with. Besides which you are wrong and your post may confuse people.
 
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ert said:
Type 2 is caused by insulin resistance. Type 1 is autoimmune.
Click to expand...
So it’s impossible for a person with type one to be or become insulin resistant, therefore be or becoming type two also? Using your definition of type two.
 
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