Doctors say different things...

Covichuela said:

Hello everybody. This is the first time I write a post in a Diabetes forum… I wonder if someone could help me… I have been diagnosed almost one year ago with Diabetes.
I am a 29 years old girl, skinny, apparently healthy and with really good cholesterol levels..

Last year in May I did a blood test, due to an anaemia and a low vitamin D levels. I forgot to go for the results and I come back home for holidays (Spain).

When I come back in September my doctor wanted to repeat that blood test because I had Pre-Diabetes...

The results confirm I had diabetes, but they didn´t know which type. I mean, they said I was Type 2 but they ordered an antibody test to see if I was LADA.

on February I come back to my GP to see the results and he didn´t understand them… It took me weeks to book an appointment with a doctor specialized in Diabetes. Finally in April I was told I had Diabetes type 2. The antibody test were negative. They gave me a copy with the numbers but I am not a doctor! I didn´t have any clue about them.

Anyway, in June I had an appointment with the nurse and she was very shock when I told her I was type 2. She insisted I should be LADA, my weight is 49 kgs.

Last week I went to see a doctor in the hospital, after almost one year of my diagnosed. She told me I had Gad antibodies positive. I am LADA.

I am confused. Why two different doctors say different things with the same results???

I checked online, but it´s a bit confused to interpreter the numbers. I know there are probably people like me here, and If I am lucky enough, maybe someone got the same results than me and can explain which type I am. I am a bit desperate…
So, there it is:


C-Peptide: 312 pmol/
Insulin: 4.7 mu/L
Islett Cell antibodies: Negative
Anti-GAD antibodies: 308 kU/L


Thank you very much. I appreciate all the feedback.

Kind regards,

Cova

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Hi Cova,
Welcome to the forums.

C-peptide results would be interpreted in conjunction with your blood glucose level. Low peptide with high glucose tends to indicate Type-1. High peptide levels with low blood glucose might be interpreted as Type 2 but could also mean other things.

So maybe you were a bit borderline at the time of the first test? You don't give your glucose figures so it's difficult to say.

Take a look at this page for more information...?
http://www.diabetes.co.uk/c-peptide-test.html

Hi and welcome!

Unfortunately, many Doctors know very little about diabetes, and some just refer all their d patients to the practice nurse.

I suggest having a good read of the LADA section of the forum (they are a great bunch, and incredibly helpful). And if you have any doubt at all about the advice and care you are getting at your doctor's, then ask for a referral to you nearest endocrinology/diabetic clinic. They, at least, should be experts!

Hi. Both GAD and c-peptide results are not always reliable and different labs I gather can give different results. Basically if you are thin at diagnosis and have difficulty controlling your blood sugar even with low-carbing and some of the tablets then you will be a LADA. I've been down the same route and my diabetes GP(s) didn't have a clue. Sadly the diabetes training for many in the NHS and no doubt overseas is lacking which is why this forum can help so many. In addition to this the tests can be inconclusive. Fortunately the latest DEC 2014 NICE pathways document says to assume the possibility of T1 if you are slim at diagnosis.

Covichuela said:

Thank you very much for the answers! I also checked the Peptide-C levels, I think they are high, but I am not sure. My Hba1c was 8% at the moment of diagnosed. Two months later with pills was 6.4. Now I am happily in 6.3.

At the moment I am taking 1.500 metformin per day and 100mg of Staglipina.

What really confusing me is the GAD antibodies...

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"What will the GAD test results show?
Presence of the GAD antibodies is observed in 75% of people with type 1 diabetes at diagnosis.

If the test shows GAD antibodies are present, this indicates that the patient has type 1 diabetes. If no GAD antibodies are present, however, the test cannot be conclusive in saying that the patient does not have type 1 diabetes."

So as you do actually have GAD antibodies it tends to point towards T1 I think.
http://www.diabetes.co.uk/gad-antibody-test.html

Hi Cova,

Don't be too fazed by the semantics. If you have a positive GAD result, it means you have auto-immune diabetes. That means, some of your immune system cells have been attacking your own body's insulin-producing cells (the beta-cells). That means diabetes Type 1 or Type 1.5 (which is a subset of Type 1 that comes on slowly with adults).

(Whereas Type 2 is the result of insulin resistance and thus too much insulin .)

Either way, Type 1 or Type 1.5, that means your body can't manufacture enough insulin for your metabolism to function properly. So you'll need to inject it.

That 's not awful.

Edit: adding this part repeat from an earlier post because it says all I have to add:

Here is my advice on what to do next, based on my own experience (you have to judge how well that fits you). I think it's better to start with insulin now rather than pussyfoot around with other drugs, because only insulin will arrest/reverse the decline and ensure that you can keep your daily insulin dose low into the long term, perhaps even permanently. That’s important, because insulin should be kept as low as possible, for two reasons: 1) you will preserve your residual basal insulin capacity and this means you will have enviably stable BG levels and will avoid the horrible lows that full T1s undergo; 2) low levels of insulin (i.e. insulin sensitivity) is associated with longer life expectancy. No other drugs can prevent diabetes progressing and keep insulin needs low, except possibly metformin, which can be taken alongside insulin for Type 1s and is an incredibly benign drug with other protective effects, if your stomach can tolerate it. I would agitate strongly to avoid any other kind of drug like sitagliptin etc: they may stimulate the pancreas, but will also burn it out quicker.

Your consultant may suggest one of these three alternatives.

1) Basal insulin only. I tried this; for me it was a waste of time, because the issue with me was post-meal spikes. I was incredibly good, ate less and less, exercised more and got more and more miserable, and my BG levels just continued to rise slowly. Once I took bolus, end of problem. My fasting levels went right down again.

2) Mixed insulin, on the grounds that you are new to all this and you need something simple. Here you are given a 70:30 mix of basal and bolus insulin, and you have to take it twice a day and match your meals to it. You may like this; I wouldn’t. It’s rigid, and you will have to eat to your insulin.

3) Full basal/bolus (or MDI, multiple daily injections). This is what I would recommend. Contrary to what you might think, it’s not difficult. Usually you have two basal injections (night and morning), or sometimes one only. Then you inject bolus 30 mins before each meal. You have to carb count for this. No problem – we are adults and this can be quickly learnt. I use the Carbs & Cals app, and you’ll need to weigh stuff for the first few weeks. Then you’ll know it.

4) They may suggest tablets which stimulate Insulin production in the pancreas. These will work for a time but will hasten your descent into full diabetes, with a high TDD and attendant risk of hypos. Personally, I think these drugs should be avoided at all cost.

I would also recommend getting the Abbott Freestyle Libre, a continuous blood glucose monitor system that you stick on your arm. The point here is that it tells you what is actually going on in real time, so you can adjust (food, timings, insulin doses). It costs about £130 for the reader and the first two sensors, thereafter £50 for a two-week sensor. But it will teach you more than anything, and you don’t need to run one all the time. I run one every month or so.

So there you are, for what it's worth. I would also read up all the posts on the 1.5 forum.

Good luck!

Lucy

Hi Covi, I´m with Lucy on this one. It´s better starting insulin early to preserve betacells! Metformin is for type 2. Maybe you can take metformin at bedtime for better fasting sugars just maybe. It´s seems weird your doctor says no, then he want´s your pancreas to burn out before starting you on insulin which is weird in my opinion. As for the hypo´s Im only currently taking 8 units of Lantus once daily. And a hypo is very rare!

This is your decision, it´s your pancreas . But when I came on this forum I got advised to read Richard K Bernstein Diabetes Solution. I would rather believe him than your doctor. He´s points out if you get your sugars in normal range you can extend your honeymoon for probably years. He also point´s out doing this with "Law of small numbers" Which basically means no more than 30g of carbs each day. Hence when your in the honeymoon you need to take very little insulin. But all this you must decide for your self. Take care...

Covichuela said:

I know, right?? I don´t have another appointment till next year…. So I can´t discuss that with her for now… however, she told me they have to look closely to me (I guess in case my pancreas dies forever…)

The only recommendation she told me was "to avoid the stress because stress can kill the cells quicker…". I am a freelance journalist, a Drama student and I work in the mornings in a busy kitchen… Stress is part of my life!!

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I would be changing doctors. 5 months+ is too long to wait to get your health sorted out. Your doctor's approach to your condition does not sound right. I think a second opinion is warranted.

Covichuela said:

That´s what I think… but she is the doctor at the hospital… at my diagnosed I had a nurse, but she moved to another clinic. Then, I have been seen a GP with Diabetic knowledge but he decided to refer me to the hospital, where I am seeing my actual doctor and a nurse as well… I feel like a guinea pig sometimes!

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Sorry to hear that. Can you ask the hospital if you can see a different specialist? Your GP might be able to help with this, perhaps by writing a letter to them.