When a patient has newly diagnosed type 1 or type 2 diabetes, C-peptide can be used to help determine how much insulin the patient’s pancreas is still producing.
In type 2 diabetes, there is insulin resistance and a compensatory increase in insulin production and release that can also lead to beta cell damage. Type 2 diabetics usually are treated with oral drugs to stimulate their body to make more insulin and/or to cause their cells to be more sensitive to the insulin that is already being made. Eventually, because of the beta cell damage, type 2 diabetics may make very little insulin and require injections. Any insulin that the body does make will be reflected in their C-peptide level; therefore, the C-peptide test can be used to monitor beta cell activity and capability over time and to help your doctor determine when to begin insulin treatment.
High levels of C-peptide generally indicate high levels of endogenous insulin production. This may be a response to high levels of blood glucose caused by glucose intake and/or insulin resistance. (With insulin resistance, the body’s cells do not use insulin normally to transport glucose inside the cell. The cells become “starved for glucose,” interpret that as a lack of insulin, and signal the body to make more.) High levels of C-peptide also are seen with insulinomas (insulin-producing tumors) and may be seen with hypokalemia, pregnancy, Cushing’s syndrome, and renal failure.
Low levels of C-peptide are associated with low levels of insulin production. This can occur when insufficient insulin is being produced by the beta cells or when production is suppressed by exogenous insulin or with suppression tests that involve substances such as somatostatin.
Even though they are produced at the same rate, C-peptide and insulin leave the body by different routes. Insulin is processed and eliminated mostly by the liver, while C-peptide is removed by the kidneys. Since the half-life of C-peptide is about 30 minutes to insulin’s 5 minutes, normally there will be about 5 times as much C-peptide in the bloodstream as insulin.