I don't produce enough insulin for my weight. So losing weight is a huge help. If you/I can lose on high quantities of insulin units injected. Hence bariatric surgery.Usually it is just based on profiling.
Anyone who is overweight or obese would be assumed to be Type 2. This is because the pancreas is still able to produce HUGE amount of insulin to maintain the fat storage.
We often read that T2D does not produce sufficient insulin. That is misleading because the more accurate description is that we do not produce sufficient insulin to overcome our carbs intake. In reality we have been producing 2-3 times MORE insulin than those who are not glucose impaired. So lowering our insulin needs should be a top priority.
The difficulty of correct diagnosis then often lies with those in the normal weight range or has sudden weight loss. They have to be tested for the C-peptide levels and GAD antibodies in order to determine if they suffer from an autoimmune condition and have severely impaired insulin production. In this case, insulin therapy is necessary.
It's quite simple - they guess and I'm not joking based on the my own experience and many posts over the years. I was stick thin when diagnosed with all the symptoms and an HBa1C of around 12% but I'm still listed as T2 15 years later and on insulin now of course as I'm actually T1. My DN refused to accept I could possible be T1. Some GPs/DNs either refer you which is good if T1 is suspected or order GAD and c-peptide tests which is also good. It appears a few T1s are mis-diagnosed and actually T2 but around 15% of T2s are thin and likely to be mis-diagnosed T1s.
For me it was while i was under the knife! I'd gone in for a routine inguinal hernia repair op and they did there usual pre med checks and scratched their chins...then came back with the doctor and did some more blood pricking tests and scratched their chins again...then sat me down before my op to tell me they thought i might have diabetes. I had no symptoms whatsoever and based upon my age and physical health they concluded i was type 1 and within 5 days i was injecting insulin!
Think quite a few of the consultants do an educated guess too. I prefer your taste test, just as reliable:***:They take a blood sample and dip their finger in it if it tastes really sweet odds on your Type 1 if not so sweet maybe a Type 2
But on a more serious note from what I have seen it is all done of the HbA1c or the classic 50 Shades Of Diabetes that you sometimes see around here.
I think it is sliding scale as the information here suggests https://www.diabetes.co.uk/what-is-hba1c.html
No expert so it is an educated guess
@XxTinkerxx I get the same impression of it being rather arbitrary and there is a lot of generalisations, age, weight etc for diagnosis even before any GAD or c-peptide test. I was diagnosed as T1 before any results came in................... a turn round of 2 days!!I find it astonishing that diagnosis is so random.
Someone goes in with a reading of 23 and they are diagnosed as Type 1 despite being an adult. Surely if someone had Type 1 from childhood they would have had symptoms? Why could it not be LADA?
I go in with sugar levels that are so high even the meter said uh oh, and straight away I am diagnosed as a Type 2 despite not even being overweight.
6 years later despite my best efforts, taking the max dose of metformin and gliclizide as well as being a whole stone lighter (I am 8 St) I am now having to take insulin. It just pisses me off how arbitrary this whole diagnosis thing is.
Might be more accurate than some HCP's we have heard of...!
Sorry, you're having a tough time. You could ask to email a DN nurse. I find that they are more likely to answer. In the meantime, I recommend: https://www.bertieonline.org.uk/ETA: I had several blood tests done and they all confirmed I am a Type 1.
I don't know the exact name but the DN told me she was having my bloods tested for it as she needed the confirmation to send to my GP surgery so they can add the FreeStyle Libre to my repeat prescription.Sorry, you're having a tough time. You could ask to email a DN nurse. I find that they are more likely to answer. In the meantime, I recommend: https://www.bertieonline.org.uk/
What test results did you get to confirm type 1?
It takes time to find the right dose. The 1:10 ratio is only a starting point from where you and your consultant can start to work out your ratio's.I am struggling to come to terms with this Type 1 diagnosis as my sugars are like a Yo-yo, so I am clearly doing something wrong. The 1 unit per 10 grams of carb ratio doesn't work for me.
Thank you for reply. I agree with you that a complaint to the GP is in order, but I don't even know where to start. I am so angry right now, and I know I need to calm down before I put pen to paper as I will end up accusing them of all sorts and saying things I shouldn't. I need to figure out how to approach them, so if anyone wants to help me with that feel free!Oh dear Tinker, you really have had a very rough ride. I'm so pleased the hospital were able to bring you back from that incredibly serious and dangerous place you found yourself in.
I'm not one for making complaints. I'd much rather try to engage a person, or organisation for change, but sometimes a complaint is in order, and I do think that's the case with your surgery....snip!!
Tinker - Do you have online access to your medical records?Thank you for reply. I agree with you that a complaint to the GP is in order, but I don't even know where to start. I am so angry right now, and I know I need to calm down before I put pen to paper as I will end up accusing them of all sorts and saying things I shouldn't. I need to figure out how to approach them, so if anyone wants to help me with that feel free!
I think they are more relieved that the hospital has taken me on for now, as they were never able to help me manage this condition. All they ever said to me was:
· it will get worse
· you will end up on insulin
· take more tablets
· you don't fit the profile
· eat more carbs
When the blood HbA1C results came back (more times than not it was above 90, and a couple of times over 100), their response was "It can't continue, what shall we do?" Which used to tick me off no end. What do you mean "what shall WE do? Isn't that your job to figure this out?" I tried low carb and keto, been self-funding the freestyle libre for almost 2 years now. The only way to keep my bloods in the normal region was to not eat, and I told them this. The DN told me not to eat Egg Mayo as the mayo was high in carbs, but I should have weetabix or porridge for breakfast. *insert several eye rolling emojis here*
I am going to continue to harass the hospital. They said I could have the Freestyle Libre on the NHS, and that still hasn’t appeared on my repeat prescription list. They knew I was using it and they got me to link up to the hospital system, so right now they are getting data that I am paying £96 a month for, for free, meanwhile they do sweet ***** adams to help me. They gave me the link to the online BERTIE course, but I was stuck at the bit where you have to work out your insulin to carbohydrate ratio. After a week I skipped over it and carried on. My background insulin seems to be ok. I have a couple of lows during the night over the course of a week, but they don’t wake me up anymore. That only happens if it goes below 3.
It is a bit of a mindf* as well trying to get my head around what I am being told with regards to eating carbs. After 7 years of doing my best to avoid them, to being told I need to eat some now in order to take this insulin, is freaking me out. I feel like I am going to end up with some sort of eating disorder. Things like bread, potatoes were totally eliminated from my diet and now I am being told I should include carbs and dose accordingly. What the eck does Bolus even mean anyway???? A lot of diet programmes out there seem geared towards T2D
I have access to "Patient Access" But it gives me no details whatsoever, other than my repeat prescriptions and a list of who has accessed my records.Tinker - Do you have online access to your medical records?
I have access to "Patient Access" But it gives me no details whatsoever, other than my repeat prescriptions and a list of who has accessed my records.
Thank you. I really appreciate this.Have you asked for access to your full medical records? Theoretically, you should be able to gain access to it, although it seems not all practises have enabled that yet - despite their contracts requiring them to do so.
To gain access, I had to complete a form, and provide ID (the details of that were on the form), then wait for my User ID and Password.
My suggestion was that would allow you to make a powerful case (for example, despite 3/6/10/however many appointments, during most of which I asked for clarification on the type of diabetes I was living with, the following transpired (describe DKA).
In the meantime, you have plenty of time to make a complaint. In your shoes, my actions would be:
- request access to my full medical records. There are several layers of access they can make available, so make it clear you want your full record, for your lifetime. OK, your complaint only covers a relatively (to your life span) brief period of time. It's amazing how useful and informative our records can be.
- If your practise states they are unable to do that, I would make a subject matter request for my full record, although they could reasonably resist printing out your lifetime record. If they did, I would opt for since a couple of years prior to diagnosis
Only when I had that data would I consider building my complaint. That will also throw a bit more time into the mix, to let your emotions settle a bit.
All of that alongside trying to get my blood sugars into a better place.
Don't be too hard on yourself. You and your body have taken a real beating in recent times, and now you are left trying to work out the jigsaw without any clues.
You've had a hard time. Time to be a little kind to yourself.
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