Please suggest way forward!

[HSSS]

You're right in that if the GP's aren't recommending testing blood sugars to see what carbs the patient can tolerate, then that only option is more medication, which includes insulin. However, insulin resistance and beta cell function can be measured easily and accurately using the HOMA formula which specialist tend to do with a simple blood test of fasting glucose and insulin. C-peptide is only useful if it's off the scale low (less than 0.2 ng/mL on diagnosis which was me) which is type 1 or on diagnosis above the lab range supports insulin resistance. The normal range is not conclusive. In the lower normal range could indicate you are fasting or have eaten a lower carb meal.

My point is if not managed well most type 2's will exhaust their pancreas' beta cells, killing them, by spiking their blood sugars and running their blood sugars high. It happens over a longer period of time and many will eventually require insulin. This doesn't mean they have turned into type 1's. The HOMA formula results would be more useful here. Most will still need a specialist to calculate the results and interpret these tests. https://www.dtu.ox.ac.uk/homacalculator/

Type 1's immune system kill off most of their beta cells on diagnosis and the remaining cells don't linger for very long in a honeymoon. I had a bet with my consultant who diagnosed me as type 1 in the first week that if I could stay off insulin for 6 years, he might consider he was wrong. Two years later, I lost the bet.

In terms of insulin, Dr Bernstein puts most of his patients on small doses of insulin on diagnosis, no matter the type, as he says it's the best treatment for elevated blood sugars. I'm no longer scared of insulin as I was initially. It certainly helped normalise my blood sugars when extreme diet and exercise had no effect. I still choose to eat LCHF.

We kind of agree of quite a few points. The c peptide isn’t, necessarily, to see what carbs can be dealt with. It’s to see if the patient has any hope of coping with carbs unassisted by insulin. Because if they have no or minimal insulin production then insulin is absolutely required. If it’s high they quite probably can find alternatives if they want to. Agreed a mid range result isn’t conclusive but just because some results are inconclusive doesn’t mean no test should be done. Obviously the conditions the test is done under (fasted, low carb etc) is relevant. I linked to an insulin resistance test above which provides similar insight. A lack of insulin resistance in the face of high bgl (therefore necessarily low insulin) would suggest the same as a low c peptide result would it not?
Im not arguing the fact that long term high levels may damage and burn out the beta cells, in fact I agree over many years this probably does occur in some cases and results in insulin requirement. I just think too many drs assume this has happened far too quickly without confirmation. As a result they miss high and increasing IR -as a result of continuing high carb diets and insulin stimulating medications that flog a dying horse - by putting it down to pancreatic burnout incorrectly. And totally agree this burnout is not the same as type 1, even if treatment is apparently the same. LADA seems to take elements from both in the early years and progress more slowly than classic type 1 from all the things I’ve read (but not experienced personally).

 

[ert]

We kind of agree of quite a few points. The c peptide isn’t, necessarily, to see what carbs can be dealt with. It’s to see if the patient has any hope of coping with carbs unassisted by insulin. Because if they have no or minimal insulin production then insulin is absolutely required. If it’s high they quite probably can find alternatives if they want to. Agreed a mid range result isn’t conclusive but just because some results are inconclusive doesn’t mean no test should be done. Obviously the conditions the test is done under (fasted, low carb etc) is relevant. I linked to an insulin resistance test above which provides similar insight. A lack of insulin resistance in the face of high bgl (therefore necessarily low insulin) would suggest the same as a low c peptide result would it not?
Im not arguing the fact that long term high levels may damage and burn out the beta cells, in fact I agree over many years this probably does occur in some cases and results in insulin requirement. I just think too many drs assume this has happened far too quickly without confirmation. As a result they miss high and increasing IR -as a result of continuing high carb diets and insulin stimulating medications that flog a dying horse - by putting it down to pancreatic burnout incorrectly. And totally agree this burnout is not the same as type 1, even if treatment is apparently the same. LADA seems to take elements from both in the early years and progress more slowly than classic type 1 from all the things I’ve read (but not experienced personally).

Yes, there is a longer period for Lada. My specialist argued with me that 6 years cut-off for type 1 Lada for needing insulin, where after that, I could change my diagnosis to thin type 2 (which I wanted to be so I could reverse it.) He said because of my low insulin (less than 0.2 ng/ml, a clear type 1) on diagnosis it would be 3 years for me. The clinical notes I researched supported his views and unfortunately for me, within 2 years, he was right.