type 1 or 2?

No idea, but type 1 diabetes can be differentiated from type 2 by blood tests if there is doubt, I don't know how accurate the tests are in the early stages though. In the early stages of type 1 when only a few cells have been killed off I imagine there could be a smaller rise in a GTT, so I don't know if it would be possible to tell the difference based on just that.

Is this a real patient or hypatheticaly speaking?
I wouldn't want (spiked like that either way) :shock: :shock: :shock: :shock:
I trust theres a consultant involved?

A pretend one I assumed, hence the ' '.

:lol: You never know what cuts the goverment have lately :lol:

i was recently diagnosed

they are classing me as type 2 at the moment, however the doctor says he wouldnt be suprised if i turn out to be type 1.. something about the blood tests leaving him uncertain

so maybe its difficult in the early stages??

If it was a real patient we would advise them to ask their doctor as only a doctor can do the proper tests to tell whether the patient is type 1 or 2. An oral glucose test isn't sufficient to distinguish between the two types - it can only diagnose diabetes, not the type. There are also more types than just 1 or 2.

I think you need to look at the other aspects of your patient, as Daisy says the glucose tolerance test only shows that he is diabetic.
Is there a record of recent unexplained weight loss, polyuria/dipsia? Has his blood been tested for the presence of ketones etc. Even without those though the person may still have T1
see http://diabetes.diabetesjournals.org/co ... l.pdf+html

Can you order C Peptide and antibody tests?
It really isn't easy. It's no wonder people are often misdiagnosed.

If it's for an assignment and you have made the points about ordering further blood tests, and mention that you need to investigate for MODY as well because diabetes isn't just 2 types, and point out that an undiagnosed type 2 could have had diabetes for some time, perhaps progressively getting worse and now have really severe insulin resistance... if you put all that in, you ought to get an A+ in my opinion.
Good luck!

An undiagnosed patient would have HYPERglycemia not HYPOglycemia the two can cause the same type of symptoms but of course are different , Hypoglycemia is only suffered if too much insulin is used, or blood sugar lowering drugs, and will cause low blood sugars , of course if its for an assignment it will be important not to mix the two as they both require completely different treatments. They diagnosed my type 1 with an antibody test as i was so ill and i was started on insulin sraight away I had only been feeling ill for 2 weeks and lost a lot of weight and was excesivly tired to the point where i couldnt even fold up a basket of washing also had ++++ketones and ++++sugar in urine symptoms came on very quickly , they are slower in type 2s

I've seen people without diabetes get hypoglycaemic, but only after very extended periods (several hours) of extreme exercise eg fell running, mountain biking, typically part of an adventure race.

I wouldn't think it was possible, and not at all possible in type 1s as undiagnosed type 1 diabetics will always be running high, thats what makes you so ill, as they have no or very limited islet cells left to produce insulin which usually makes the illness more severe before diagnosis, my mum has type 1 too and was ill and bedbound for a week or two before diagnoses and ended up in a diabetic coma for 2 weeks as she was being taken to hospital , with type 2s they still produce some insulin just not enugh for their needs and sometimes in normal amounts but due to resistance cant use it properly so can go sometime with little or no symptoms, even years as the symptoms aren't as severe, now i inject insulin even i can go days with higher than usual BGs and unless i tested would have no idea i was running high apart from a bit more tiredness , its when you have little or no insulin at all in your system that the serious short term symptoms start, with type 2s the serious damage is caused over a longer period of time . i have only really good knowlege of type 1s and a little less of type 2s but like i said i would be rather surprised if an undiagnosed diabetic would run too low BGs as they wouldnt really be diabetic if their bodys could lower their blood sugars that much by themselves. Also as said in previous posts the only way you would really find out for sure whether type 1 or 2 is by a antibody teast or similar, as evn type 1s can have a honeymoon period where they still produce some insulin for a while ... it really depends on how soon the diabetes is discovered . Also even though type 1 is more usual in younger people dont rely on that alone, both my mum and I was diagnosed at 36 years of age and I have seen some locum doctors who atomatically assume i am type 2 needing insulin because i got it late, and have had to argue the fact that my antibody test comfirmed type 1, the first doctor i saw when i crawled ( as i could hardly walk) to see him was ignorant to this which ended up with me very seriously ill due to his incompetence and the slowness of his diagnoses, as he sent me home again and resulted in the other doctor at the practice phoning me and sending me straight to hospital after seeing my ketone results and amount of sugar in my urine, I wasn't long off ending up like my mum in a coma

Non-diabetics can get hypos - for instance, from too much alcohol - but they don't have comas because the liver kicks in.

Undiagnosed Type 2s can get hypos if the pancreas pushes out too much insulin - being on overdrive to cope with the insulin resistance - and lowers the BG too much. Again, no coma because the liver copes.

So you might get some symptoms - eg sweats, pounding heart etc - but not realise what the cause was. I've had that long before I was diagnosed Type 2, when all my fasting blood glucose tests were coming back well within the normal range. I only realised what it was when I was diagnosed and started reading round.

As far as I know - still learning!

Viv

Hi Viv thats real interesting as my friend has been getting these sypmtoms for a while, she has been to doctors quite a few times for tests and i have even tested her blood for her but her levels have been normal at the time of testing, as I said in my previous post i only really have good knowlege of type 1s and a little less on type 2s especially before diagnoses. What i wanted to ask was how many times did you have to repeatedly go to the doctors before they dicovered it as I would have thought it would be hard to diagnose if you were running low as well as high and what tests did they do for you?, as I really don't want my friend ending up with problems later on if she has indeed got type 2, I really haven't much faith in my surgery after what happened to me and am worried for my friend so any advice i can pass on would be great

viviennem said:

Non-diabetics can get hypos - for instance, from too much alcohol - but they don't have comas because the liver kicks in.

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A long time before I was diabetic I used to get a hypo every morning before lunch. Nothing to do with alcohol though. I think they were caused by a rebound from a large carby breakfast. Before I felt well enough to drive I had to eat something - the trouble is that I used to eat far too much as I had this irrestible urge to eat carby food. I was never near a coma though so you are right about that. It wasn't until I became a member here after I was diagnosed T2 that I realised what it was.

As far as I know at that time I wasn't having highs, just nocturnal hypos after too much alcohol. I'm afraid I did go through a rather heavy drinking phase, but no more! With the symptoms I was getting I was more afraid of heart disease, but that's been okay so far. Maybe your friend should ask the doctor straight out if it could be a hypo and get him/her to discuss it? Maybe the doctor doesn't know that non-diabetics get hypos? They can't know everything.

I used to have my blood glucose tested regularly - at least once a year - because I've been a prime candidate for Type 2 for at least 12 years, if you go by the book re obesity, but I only went out of 'normal' range last April, during the most horrendous house move I've ever done! Went straight back on low carb, got back into the NICE guideline range, then went on metformin to see if it would help the weight loss.

I don't think you necessarily have to swing back too high after a hypo.

by jonesma10 » Mon Feb 07, 2011 11:27 pm

thanks stabatha, it makes sense.. but could he get hypo after exercise even though he's not diagnosed? :s

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Unlikely if he's T1. it's more likely to produce hyperglycaemia and very possibly DKA.
When blood glucose and insulin levels are normal the cells are able to obtain sufficient to fuel exercise. In fact most of the insulin is 'shut off' as there are glucose transport pathways that function during exercise without insulin.
When insulin levels are too low AND glucose levels are high (as would be the case in a nearly diagnosed T1) these non insulin pathways aren't suffcient and glucose isn't able to be taken into the muscle cells quickly enough. As the exercising muscles can't access the glucose to provide energy, signals are 'sent' to the liver to provide some. The liver pours out more glucose and blood glucose levels rise even further. The cells still can't access this extra glucose so the body turns to it's next resource, by breaking down body fat. This produces ketones and with it the danger of diabetic ketoacidosis.
In fact that's exactly what happened to me when I went for a bike ride before diagnosis, the next day I was in hospital.