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Diagnose type 1 as safer choice?

rmz80

rmz80

Well-Known Member
Messages
332
Location
Leeds
Type of diabetes
Type 1
Treatment type
I do not have diabetes
It just dawned on me why a diagnosis of type 1 is much more preferable to a diagnosis of type 2.

It’s the consequences of getting the diagnosis the wrong way round.

Type 1 is treated with insulin. A type 2 can also be treated with insulin but this could be considered a bit over the top as Metformin would usually work.

Whereas a type 1 treated with Metformin would probably die.

If I were a making the diagnosis I would choose type 1 as the safer option. Blood tests for autoimmune disease as could be wrong.

Below is an extract from Nice Pathway which is used to diagnose.

Adult with suspected type 1 diabetes

Diagnose type 1 diabetes on clinical grounds in adults presenting with hyperglycaemia, bearing in mind that people with type 1 diabetes typically (but not always) have one or more of:
Ketosis
rapid weight loss
age of onset below 50 years
BMI below 25 kg/m2
Personal and/or family history of autoimmune disease.

Do not discount a diagnosis of type 1 diabetes if an adult presents with a BMI of 25 kg/m2 or above or is aged 50 years or above.
Do not measure C-peptide and/or diabetes-specific autoantibody titres routinely to confirm type.
 
rmz80 said:
It just dawned on me why a diagnosis of type 1 is much more preferable to a diagnosis of type 2.

It’s the consequences of getting the diagnosis the wrong way round.

Type 1 is treated with insulin. A type 2 can also be treated with insulin but this could be considered a bit over the top as Metformin would usually work.

Whereas a type 1 treated with Metformin would probably die.

If I were a making the diagnosis I would choose type 1 as the safer option. Blood tests for autoimmune disease as could be wrong.

Below is an extract from Nice Pathway which is used to diagnose.

Adult with suspected type 1 diabetes

Diagnose type 1 diabetes on clinical grounds in adults presenting with hyperglycaemia, bearing in mind that people with type 1 diabetes typically (but not always) have one or more of:
Ketosis
rapid weight loss
age of onset below 50 years
BMI below 25 kg/m2
Personal and/or family history of autoimmune disease.

Do not discount a diagnosis of type 1 diabetes if an adult presents with a BMI of 25 kg/m2 or above or is aged 50 years or above.
Do not measure C-peptide and/or diabetes-specific autoantibody titres routinely to confirm type.
Click to expand...
Id prefer to not have diabetes full stop
 
With the decades of injecting, finger pricking, working out carbs, exercise, stress, illness, school, puberty, work, family life, pregnancy in women, time of month etc etc....................... I'm with @karen8967 ( a bit of wishful thinking on my part):rolleyes:
 
A T1 treated with metformin would definitely die - lack of insulin is the problem, metformin may improve their blood sugars but it isn't treating the underlying cause. That being said, many T1s with insulin resistance take metformin as an additional method of dealing with their blood sugars.

Yes, a T1 diagnosis is "safer". Fortunately it is often pretty obvious when somebody is T1 vs T2 (although there are some other types as well), and if there is any doubt then testing antibodies will confirm it. Also after seeing how somebody responds to treatment the doctor could adjust - a misdiagnosed T1 not responding to metformin should (but isn't always) raise suspicions of misdiagnosis.


Agreeing with everyone above, not being diabetic is the safest of all!!
 
A few other points to add. Metformin is not a problem with T1. I take Metformin as it improves my blood sugar slightly and helps with other aspects of health - it also keeps my DN happy! Note that metformin never has much effect for anyone; it's overrated by GPs and DNs. There are other causes of 'T1' besides antibodies and this includes viruses. The ends result is identical to T1 thru antibodies so the c-peptide test is more useful than GAD as it shows the actual level of insulin whereas GAD may show negative despite there being beta cell death. Note that treating T2 with insulin can be debateable. If there has been beta cell death thru long-term T2 damage then it makes sense but as many T2s will already have too much insulin, then adding to that isn't helpful.
 
I can understand erring on the side of caution. I'm still not 100% convinced I'm type 1. Going from that list, I'm 40, presented after a 1 month of symptoms setting in, had reasonably high BG (fasting 26-28 mmol/l, A1C of 152) and ketone level 1.1 and had lost a little weight.
However, I was a little overweight and GAD was negative and there is no family history. I have asked about trying Metformin instead of insulin (as I'd rather not use it in perpetuity), but the consultants take was that "it works, so why risk changing it?"
 
Daibell said:
Note that metformin never has much effect for anyone; it's overrated by GPs and DNs.
Click to expand...

Should that say everyone? At the end of last year I stopped taking Metformin for two months, for some reason I started to have the awful side effects again while traveling which I couldn't put down to food, a bug etc. Having the luxury of a FreeStyle Libre I saw that at the end of two months, there was a difference. Technically that could have been for other reasons, as we all know, there's all sort of things affecting BG.

It's a topic that's been discussed on the net for well over ten years and although there doesn't seem to be much empirical evidence one way or the other, there's some research reported athttps://www.webmd.com/diabetes/news/20141028/metformin-beats-other-type-2-diabetes-drugs-for-first-treatment-study#1.

As always, no matter what the research says, we will all have different experiences.
 
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