MODA - Mature Onset Diabetes in Adults

the usual Alphabets for these so called T1.5s is LADA or MODY.
You seem to have got both. Have you remembered it wrong? What tests did they do to get this diagnosis. jusst guessing isn't good enough.
How are you controlling your condition?
. If you can control BG on diet or Metformin or sulphonylureas or a combination of some/all of these, you are essentially a T2 and if insulin is essential, you would need a test called c-peptide to be sure whether you are insulin resistant or not producing any, which is the functional difference between T2 and T1 MODY and LADA are both metabolically like T1 in that insulin production stops.
As to Testing
this is very much a sore point for many of us here. You have a right to self-test until you, at least, learn what to do. There's no other way. If it gets left for a whole year, there can be much damage done. Look up your local PCT protocols. they will be somewhere on-line. You should be offered
firstly 3 monhs of education and lifestyle change and then a check, then Metformin for 3 months then again a check and then further treatments until your condition is stable. that's for T2. T1s need urgent treatment by a specialist.
What should not happen is that you are sent away an left to get by on your own. You have stumbled on one of the best resources for diabetics here. What we don't know between us, we can point you to somewhere else.
If you have been left to cope with just the advice not to eat too many grapes, Just go to your health centre and make a HUGE fuss. What are they there for if not to treat you? the GP is not simply a diagnosis service.
That's not to say that the most likely dietary advice that you will get is actually going to help.
" Eat loads of complex carbohydrates with every meal," will only push your BG up higher.

That's good! ask her how you should learn what to eat without a meter and why should you eat carbs if you can't procees them.
If she has an answer that makes sense then let us know.

Dizzy foggy spell without taking insulin or something to stimulate insulin isn't likely to be hypo, especially in T1 diabetes.
MODY sometime comes on quickly. and is metabolically
like T1. It stands for Maturity Onset Diabetes of the Young. In other words T1 which comes on in adulthood instead of the more usual child. It's often called T1.5, especially by Americans.
Is this what your nurse meant?

Not all T1s have BGs in the 20+ range, especially if it's caught early. It's perfectly possible for T2s to be in that range. When I was in hospital,( following the stoke and when the diabetes was found) the T2 lady in the next bed regularly had readings close on to that despite taking insulin. She was eating high carb including biscuits with her tea each morning. She got quite upset when my readings were always betterr than hers. I didn't know much then, but was already leaving out the biscuits.

Never heard of MODA, but MODY is like Hana has said maturity onset diabetes of the young. Maturity onset diabetes in Adults is just that, diabetes in adulthood.

LADA is Latent autoimmune diabetes in adulthood - which is, simplistically put, type I developed during adulthood (it usually happens in adulthood).

MODY is usually diagnosed before the age of 25. There are at least six known types of MODY (or monogenetic diabetes) which are known to exist (and more suspected). MODY is sometimes mistaken for type I or type II diabetes dependent on age of diagnosis and symptoms.

Basically, type I diabetes is usually due to an autoimmune reaction whereby the beta cells of the islets of langerhans in the pancreas are attacked by the own body. Type II diabetes - the beta cells still produce insulin, however, there can be some degree of insulin resistance (bodily cells don't accept the insulin) and the production for whatever reason has been compromised (usually polygenic = more than one gene that causes it).

So, the question is. Are you producing any insulin at all? With the BG levels that you've recorded, it's more than likely that you are - and it's most likely that you've developed type II diabetes.

With regards to classification of diabetes, there seems to be a lot of confusion over what type people have. Type 1.5 is a term that is used for LADA or MODY. However, a more correct term of usage would be insulin dependent diabetes mellitus (IDDM) or non-insulin dependent diabetes mellitus (NIDDM).

In your case, you've been diagnosed with NIDDM (without a test to check for an autoimmune reaction).

And, you've already said that you've experienced hypos - without medication for diabetes, this would be a very rare occurance.

Hypoglycaemia is caused when your insulin/glucagon feedback mechanism is disturbed.

Basically, insulin reduces BG levels. Glucagon is the opposite and acts to convert stored glycogen in the liver to glucose which is released into the blood stream.

So, in a non-diabetic (or NIDDM diabetic to a certain extent), insulin will be released when there is too much glucose, then the glucagon mechanism will be activated to combat hypoglycaemia.

In most people, including IDDM diabetics, the glucagon mechanism still functions, it's just a balancing act on how much insulin is taken.

So, unless on a hypoglycaemic causing agent, as you can see, it's very, very unlikely that you'd have a hypo.

It's more likely that the fogginess you experienced is due to high glucose levels.

Sorry for the essay!

Fiona

If you try low carb, you should see a weight loss and an improvement in Hb A1c. If that sounds intimidating, you could try the GI diet. It would improve your numbers and probably help with the weight. Whatever you do don't expect the standard dietary advice and medication to do anything other than make you gain weight. Metformin alone doesn't cause weight gain. It and Byetta are the only meds I know of that don't.
I wouldn't think you were a candidate for Byetta anyway, It costs a lot and they're mean with it.
THe NICE protocol recommends a 3 month trial of lifestyle change before going to medication.
Your nurse has guessed T2 and the odds are she's right It's the most common It isn't called MODA.
If treatment for T2 works and continues to work long term, she'll be proved right.
BY the way don't forget exercise in the equation.
Vest of luck
Hana

Hi Karynn,

There are a few things that worry me about what you have said and I think that it is quite likely that you are going to need insulin sooner rather than later.

1. You developed clear symptoms associated with high blood sugars such as weight loss and thirst over a relatively short time of six weeks.

2. Your hbaic is high but not massively so, perhaps suggesting you've not had diabetes that long.

3. You already have an autoimmune disease ie Crohns. Having one autoimmune disease makes you more likely to get another. In addition the steroids used to treat Crohns can sometimes precipitate diabetes.

4. Your brother is a type one and it is a genetic condition.

5. You are saying you need to lose a stone. How many women say that ? I certainly do. What this means to me is that you are not that overweight. This is also a hint that you could have insulin deficiency diabetes and not insulin resistant diabetes. You are probably a LADA rather than a MODY or a type two.

I do think you need to keep an eye on your blood sugars because the usual drug treatments for type two diabetes don't work if what you really need is insulin.

It is certainly worth cutting down your sugars and starches so that your pancreas has as little to do as possible.

If your blood sugars start to climb despite your efforts (you don't need to wait till you are getting readings of 20+) you need to see the doctor. Hopefully you will get a less intimidating response. Nurses can be very good at following procedures but you need someone to look at the big picture here.

Metformin is a treatment for T2 diabetes. It enables the insulin you produce to work more effectively plus a few other things. it's a great medicine, but can upset the digestion until you adapt to it. That might be what your DSN meant. It's of NO use to T1s unless they are also on insulin.
there's a natural assumption that if someone of "Middleyears" presents with diabetes symptoms, They MUST be T2.
Katharine is a GP with a special interest in diabetes and I'm sure would look more carefully at her patients. She's what might be called a "rara avis"
In the end, it doesn't much matter if they get the most accurate diagnosis, as long as the treatment is right.
As you say you are very short and very overweight. It might be most helpful to you and your future health if you go to a much reduced carbohydrate eating plan. that would help with your BG numbers, very quickly and with the weight. If your digestion is so sensitive, you need to find out what you can eat safely and check how you can reduce the carbs within that.
Try reading Bernstein. You might find some help there.