Type 1 diagnosis Vs. GAD test results?

Daibell said:

Hi. I agree that a c-peptide would help. My GAD was negative but the c-peptide showed I had low insulin and my continued use of insulin proves I need it. In many ways if the two insulins help and work it proves that you are a LADA and not all T1s have the same degree of islet cell degradation. I would go along with the medics as you are lucky that they seem clued-up. My GP refused to say I was LADA and initially refused insulin thru ignorance. If thru a lower carb diet you get the weight into the right BMI area (perhaps it is already) and you still need the insulin the T1 is sort-of proved.

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Andy-Sev said:

Your case sounds similar to mine as I was sent to hospital with high blood glucose and high ketones at the age of 42 where a consultant said I was Type 1 even though my brother and father both have type 2. But when my GAD results came back and I was told they were negative, don't know the actual values, I found myself in this situation of depending who I spoke to I got a different answer; the diabetic specialist nurse says I am most likely type 2, a consultant says ketones are more indictive of type 1, a regular GP says most likely Type LADA and my last consultant admitted he hadn't got a clue.

Sadly there are quite a few of us around who on presentation don't fit neatly into the standard diabetic type boxes and it seems current practice we are left in limbo to see how things play out over time, that can be a long time in the case of LADA which is a slow progressing form of Type 1.

Having gone through the confusion, the frustration and anger of an uncertain diagnosis I know exactly how you feel and all I can say is that whilst pushing for answers you need to read up yourself so that when you get to see a consultant you go in there with the knowledge to ask the right questions. Although don't be shocked if you find yourself coming away even more frustrated as most consultants struggle to deal with those who don't fit the types perfectly.

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TorqPenderloin said:

I think you certainly deserve a definitive diagnosis, but I'd consider it a good thing that they're treating you as a T1 patient.

The worst thing that can happen is that they misdiagnose a T1 and treat them as a T2. If your pancreas no longer produces insulin, metformin and sulfonylureas (like Gliclazide) are going to be useless.

Unfortunately, your numbers fall into a bit of a "Grey area" in that 18 mmol/L is definitely high, but it's not astronomically high. When someone has levels nearing 30 mmol/L, their response to artificial insulin paints a much clearer picture about their insulin resistance. Of course, that doesn't mean it's an effective way to diagnose someone, but it does help. To explain, someone with very low insulin resistance might need less than 10 units to drop from 30 mmol/L. However, someone with very severe insulin resistance might need more than 100 units to drop from that level.

The people who are very difficult to diagnose are often those with type 1.5/LADA and people with type 2 who don't produce much natural insulin (have c-peptide levels that are considered on the low end of "Normal").

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