Type 1 or Type 2?

[loopy3112]

Hi

I'm newly diagnosed and I just wondered how the doctors know whether your type 1 or type 2?

Many Thanks

Louise

 

[Daibell]

HI. The short answer is that typically if you are in your 40s'ish, a bit overweight and your symptoms aren't that severe they will assume you are T2. If you are quite young and have high sugar readings they may think about you being a T1. Sounds vague doesn't it but due to the cost of tests and a lot of presumptions that's how it may go. There are C-Peptide and GAD tests that a GP can use to help indicate that a person is T1 or one of the T1 variants rather than T2.

 

[xyzzy]

By the symptoms you present to them.

Both Type 1 & Type 2 can initially present with similar symptoms of high blood sugars, needing to pee a lot, being very thirsty and other symptoms like regular bouts of thrush etc.

There are then specific Type 1 and Type 2 indicators.

Type 1 may present with what are called ketones in their urine. Roughly speaking these appear because in a Type 1 person their pancreas has given up and isn't producing insulin at all or very little. Type 1 may also experience rapid weight loss prior to their diagnosis. Type 1's are usually but not always children or young people and mostly normal weight.

Most adult overweight (even sightly overweight) people are correctly diagnosed Type 2 although gp's will normally do a ketone test on urine to back up the assumption as Type 2's rarely present with ketones. A Type 2 person still produces insulin in some cases in considerable amounts of insulin as part of their problem is they become resistant to the insulin they produce which ends up having the same effect on blood sugar levels as Type 1's who produce no insulin.

If it is unclear what type a person maybe there is a test called a c-peptide test that should resolve the issue.

A very few Type 2's end up being misdiagnosed as there is a third type normally called Type 1.5. Again in very simply terms this covers a range of problems such as adults who are taking a long time turning into Type 1 because their pancreas is only failing slowly.

There is a test called a GAD test that can but not with a 100% accuracy test if a person is Type 2 or 1.5

If you are an overweight adult and did not present with ketones then it's more than likely than not you are Type 2 fullstop.

If you are Type 2 (or 1.5) you will be asked to try and control your condition by diet and you will likely be asked to go on a very safe drug called Metformin. If you were Type 1.5 then you would initially be asked to do exactly the same kind of thing as very simplistically the initial treatment for both can be thought of as the same. As Type 2 and 1.5 can be treated in roughly the same way many gp's are loathed to do the tests as they cost a bit. They may hang back until making a decision about going onto more powerful drugs needs to be made. This can be months or even years.

 

[AMBrennan]

If you were Type 1.5 then you would initially be asked to do exactly the same kind of thing

Not sure that's accurate - there's some evidence to suggest that early insulin treatment is beneficial in 1.5/LADA, and there's little reason to think Metformin would be efficient (2nd/3rd line oral drugs that stimulate insulin production would work though).

Further, cases of T2 in kids are not unheard of (any more)

 

[xyzzy]

If you were Type 1.5 then you would initially be asked to do exactly the same kind of thing

Not sure that's accurate - there's some evidence to suggest that early insulin treatment is beneficial in 1.5/LADA, and there's little reason to think Metformin would be efficient (2nd/3rd line oral drugs that stimulate insulin production would work though).

Further, cases of T2 in kids are not unheard of (any more)

Thanks I'll mention that to my diabetic nurse when I see her next month as it was her who told me the treatment is roughly the same.

 

[Sarah69]

When I asked my consultant I was told type 1 you need insulin immediately and type 2 you start with diet to try and control it.

 

[sweetLea]

Are there any other T1.5's on here?
I was put straight on to insulin and metformin together and for the most part, along with low carbing, it has worked well. However, I am now insulin resistant which is a real nuisance. Any other T1.5's dealing with that?

 

[phoenix]

Thanks I'll mention that to my diabetic nurse when I see her next month as it was her who told me the treatment is roughly the same

Cochrane review: Interventions for LADA
http://onlinelibrary.wiley.com/doi/10.1 ... 513.d01t02

I just ignored it for 3 years, lost a lot of weight, started to get DKA symptoms, had a fasting glucose in the 20s so got sent to hospital and started straight on insulin ....probably not the recommended way but at least I didn't get misdiagnosed :lol:

Sweetlea: I've been diagnosed for 7 years, at that time my c peptide levels were very low . My insulin dose at diagnosis was a total of 32u. It has gone down since then but I use a pump. It varies according to exercise/carb levels and is between about 22 and 27 units a day , so I think I'm still fairly insulin senstive.

 

[Sanober]

Are there any other T1.5's on here?

:wave:

I'm nearly 35 and was diagnosed in November 2011 (after much faffing about trying to determine what type I actually was - as you may see from signature below, I was initially a T2 but with a ? Both my parents are T2 so easy to stick me in that bracket I suppose).

I was put on Gliclazide after I was kept overnight in the hospital after feeling particularly nauseaous and generally ill that afternoon (and the GP referred me down) they did loads of tests and they couldn't figure out why I had high blood sugars but I had no ketones then (early stages though I suspect).

I gave the Glic a couple of weeks and it worked for two days or so and then glucose was going back up again (it stopped the constnt peeing /thirst though ) I mentioned it to the Diabetes consultant who insisted I gave it 3 months...as I was about to leave I asked for an anti-GAD. It came back positive, I got a letter telling me to stop taking the Glic (I already had) and to consider insulin.

I have been on insulin since and what a difference. It was a relief to start with, people commented how much better I looked and I had my personality back - I could also eat more normally without fear of feeling symptomatic and sleeping better.

However, during the last fortnight I've been battling with the 'honeymoon period' so a bit frustrating at the moment.