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Nurses querying type 1

A

Amyjane_

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So back in April I had an emergency admission as my ketones was +4, sugars between 17-HI & urinating and drinking a lot, loosing weight and generally feeling like ****...
I have a family history of both type 1 and 2...
the nurses are now considering if I could be type 2. I am 20 years old 8st 5lbs and healthy. My hba1c was 114 in April now it’s roughly 52 (libre)
I’m on both long and fast acting insulin.
What do you guys think?
 
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Hi and welcome to the forum.

Have you been tested specifically for type 1?
 
Hi @amyjane

Welcome to the forum.

Did they give any reason why the change of mind regarding your recent diagnosis?
 

Hi there, I think even allowing for the fact that many Nurses are simply not experts on this subject, there MUST be another reason why they are thinking type 2, anything is possible but based on what you have told us I can't imagine why they would now be thinking type 2. Have they done any specific tests that you know of (C Peptide or antibody tests?). Your hb1ac may have gone down quickly (so did mine within one month), my very first jab jab of insulin in hospital and my first glucose level after diagnosis went from 'Hi' to 2.8!!! It would wouldn't it, when you're on insulin!!! I think you are going to have to pin them down on the whys as the last thing you want is them 'guessing'. What test are you waiting for by the way?, all of my specific tests were done over the 3 months following going on insulin but my C Peptide showed low and my GAD antibody test showed positive. x
 
Yeah after they said that they’re not quite sure about wether it’s type 1 on the phone. I didn’t think about anything else. I thought why would they change it. I will ask. I am waiting for the antibody test to confirm it
 
Make sure they run an Antibody test and a C-Peptide test.Your symptoms are more a type 1 thing than a type 2 thing. Loss of weight is a biggy for a type 1 as they can't utilize the food they eat when they aren't taking insulin. rarely even on meds do type 2's get DKA because they still make insulin.

The first test to see if you are a type 1is an antibody test. Type 1 is an autoimmune disease that means your own body attacks your beta cells that make insulin. The antibody tests tell you whether your body is destroying the cells. A few very rare cases people don't have the antibodies but still don't make insulin.

The next test is a c-peptide test. This will tell how much insulin you are making. A type 1 will test at a low normal level or a low level and keep decreasing over time. A type 2 will test at a high normal or high level because they are making enough insulin or even more than a "normal" person they just can't use it properly, they are actually insulin resistant. C-peptide is only made by your body to match the insulin your body makes and has nothing to do with using insulin. It will still tell you how much insulin you are actually making, which will slowly decrease over time if you are a T1.

As a type 1/LADA especially when you get it as an adult you still make some insulin for a while until it slowly stops, that can actually take a few years to complete and it also is one of the causes that so many type 1's are misdiagnosed at first as a type 2. That is the honeymoon period. But you are 20 years old and the process is usually faster when you are younger.

There are some people that get both type 1 and type 2. Both are inherited diseases and type 2 is even more an inherited disease. Most type 1's don't have a problem with insulin resistance that a type 2 has. It is a little rarer to have both. But a type 1 feasibly could not be producing insulin and not use the insulin very well that they take. So you can end up with both. But that just seems so unlikely at the age of 20 but who knows, especially with a family history of type 2.
 
I battled for 10 years being told T2 this year to be told I’m T1. Trouble was I had slow onset T1 so was producing insulin enough that cpeptide tests indicated I was T2

If you are on insulin the actual type doesn’t matter so much it more of an issue if you want to get off insulin

Or if you want insulin pump or libre these are normally only available to T1
 
Thats horrendous! I’ve already got the libre‍
 
Amyjane_ said:
Thats horrendous! I’ve already got the libre‍
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I'm amazed that even having a Libre the nurse is considering T2. From what you say you are almost certainly T1 and not T2. I hope they are doing the C-Peptide and GAD tests. The former should show low insulin.
 
Daibell said:
I'm amazed that even having a Libre the nurse is considering T2. From what you say you are almost certainly T1 and not T2. I hope they are doing the C-Peptide and GAD tests. The former should show low insulin.
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I’ve got everything on repeat prescription too. They’re only doing the GAD test at the moment.
 
It's possible to have both type1 and type2.

It may be the inslin requirements are closer to what the nurce expect from someone with type2.

The details of the emergency admission makes me think type1, but all these symptoms are possible (but uncommon in combination) with type2. The question is how does it change the management plan of the type is changed in the medical records?
 
It’s not possible to have both type 1 and type 2. You can be type 1 with insulin resistance but we really shouldn’t call it having ‘both types’ as they are very different conditions
 
Amyjane_ said:
I’ve got everything on repeat prescription too. They’re only doing the GAD test at the moment.
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Hi again. If the GAD test is negative you will need to ask for the C-Peptide. GAD can be negative if tested quite a long time after diagnosis or pancreatic damage can be caused by viruses as well as antibodies which GPs don't always realise.
 
Emily95 said:
It’s not possible to have both type 1 and type 2. You can be type 1 with insulin resistance but we really shouldn’t call it having ‘both types’ as they are very different conditions
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There is nothing that the biology that stops someone with type2 developing type1, however clearly once all the beta cells have been kill by the autoimmune process it is no longer type2.
 
I never had gad antibodies they didn’t do cpeptide tests in the early stages of diagnosis. I had cpeptide done about a year ago the results were 630 which put e just outside the T1 category although my DVLA consultant said if it was upto him he would classify me T1 right away.. a few months ago was retested and can back at 60 which is extremely low and made me definitely T1.. now got libre and a pump appointment next month
 
Hello. I’m type 2 and just come out of hospital with a dka. So it is possible type 2 can have them. I’m in going more tests now to investigate why it happened. Hope you get answers soon. It’s very frightening sometimes. X
 
Mummybear3 said:
Hello. I’m type 2 and just come out of hospital with a dka. So it is possible type 2 can have them. I’m in going more tests now to investigate why it happened. Hope you get answers soon. It’s very frightening sometimes. X
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Yes T2 can get dka it’s a lot rarer but if very insulin resistant and un/poorly controlled the body still doesn’t get enough nutrition therefore dka can happen

Me as a slow onset T1 would go sky high in numbers if I stopped insulin but because I’m not very resistant and was still producing some insulin I never had any keytones.. it’s the lack of keystones that my consultant always said I was T2

However my stepdad only found out he was diabetic when he was admitted with dka

In short every case is different and there is always exceptions to the norm
 
What are your c-peptide units for the figure 630 you quoted? pmol/L? That would put you above the higher end of the reference range for normal fasting 260-620 pmol/L.
 
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