How do doctors decide which type of diabetes you have?

[Angelc]

Hi all

I was diagnosed with type 2 diabetes 4 years ago.

After a great deal of problems with my blood sugar over the last 6 weeks or so my consultant has put me on long acting insulin daily and is considering a short acting injection perhaps once a day. So far just my fasting sugars ie. first thing in the morning have come down, to around 7 - 9, the rest of the day they remain in the 15 - 20 bracket.

What I am curious about is how do doctors decide what type of diabetic you are? My consultant thinks that my autoimmune disease has produced type 1 diabetes and maybe I was never a type 2 at all!!!

I was just wondering what would make him think this and both him and the nurse said they would be able to tell by my bodies response to insulin.

Many Thanks

Can anyone shed any light on this? I'm still on Metformin and have been told to reduce my gliclazide to half.

 

[hanadr]

There are tests, such as the c-peptide test and some antibody tests, but to be truthful, they are rarely used. Most often, they use the situation as is and guess . Ie T1 tends to come on fast in young people and they generally have ketones as well as glucose in blood and urine. T2 tends to be more insidious and in older people, who usually don't have ketones. The next thing is the treatment. Insulin works for all kinds of diabetes. Diet control, Metformin, sulphonylureas and other oral treatment only work in T2. So if used and working, it must be T2 and if nothing but insulin works, it's T1
I suspect that most often they decide they were right if the treatment works. If it doesn't after a reasonable time, they might re-think. Since tests can be costly, they may well be the last resort.
Actually it's more important that the treatment work, than that you identify T1 or T2 or one of their subsets.

 

[Angelc]

Hi and thanks for your reply

I guess one of my concerns about this is that I am interested in Dafne, but all I read says it's only suitable for Type 1, and they haven't finally made up their minds.

Metformin never really did anything for me, neither did any of the things they have tried tablet wise over the last couple of weeks, but at least Lantus is now bringing down my fasting sugar to better levels, and I think they are going to tackle my high evening levels soon with some short acting insulin.

Ketones are a concern for me though, as time goes on I am getting a little more, first between a neg and a trace, with ocassional moderate, now mostly between small and moderate some of the time, and rarely below trace

Getting me down a bit I suppose, tired with the constant drink, loo, thirst, drink loo circles and getting insufficient sleep!

 

[Dobbs]

So far just my fasting sugars ie. first thing in the morning have come down, to around 7 - 9, the rest of the day they remain in the 15 - 20 bracket.

hi Angelc
there is a big discrepancy between these numbers you mention. A fasting measurement of 7-9 is a bit high but not disasterous and could fairly easily be improved, but 15-20 is really high and you need to get that sorted.
What sort of diet do you have? You probably know that certain eating patterns tend to make your blood sugar soar, although the details vary depending on the individual. Maybe with a modification in your diet you could bring these numbers down.

 

[phoenix]

This might help you to understand LADA, latent autoimmune diabetes in adults and it's treatment and diagnosis in the UK.http://www.locallada.swan.ac.uk/faq.html
Worth noting are that people with one autoimmune disease may also contract autoimmune diabetes. Also because in LADA the cell destruction is slower than in classic type 1 some people may be able to control their diabetes for a period with oral drugs (on average 2-6 years) but they will eventually 'stop working
Tests for various autoimmune antibodies may indicate type 1 (in LADA notably antiGAD) , a C peptide test will show how much insulin you yourself are producing, this is low in LADA but may be at the lower end of normal earlier on in the process.
Even without the tests the persons reaction to insulin is a good indicator, people with type 1 tend to take far less insulin than someone with type 2 who has exhausted their insulin production.