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Type 2 or Type 1??

M

Meg2009Arm

Well-Known Member
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60
I just wondered how doctors decide which type you are. I'm classed as Type 2 (but was classed as Type 1 during pregnancy when I was diagnosed) I'm 37 (was 34 at the time of diagnosis) not overweight and now even approaching being underweight because of the strict diet I'm on. I'm farely active although no exercise routine as such. Both my father and his father are diabetic (type 2 but both overweight and it developed in their 60's).
I'm on Metformin and Sitagliptin and until recently when I started an even stricter diet my BS would be a bit up and down. I had a retinopathy exam which showed slight damage starting in one eye, hence me trying to be extra good. The problem is that my energy levels have fallen and I'm finding it really hard to manage through the day on the food I'm eating. My BS levels in the last week or so seem to be better but not sure I can cope with this. The other thing is various consultants and even the retinopathy nurse said it was weird that I'm type 2 becasue my profile is of a type 1. Should I be getting a second opinion?

Thanks
Meg
 
Although people can generally be classed as type 1 or type 2 there are those that fall into the grey area in the middle...

At present I would say you sound like you are type 2 as type 1 diabetics have very low or no beta cell function and hence produce no insulin. Therefore the drugs that they give to type 2 diabetics to increase insulin output / decrease resistance have no or limited effect on type 1's... for instance metformin in a type 1 would slow carbohydrate absorption but wouldn't help to increase insulin production.

Long term poor control of type 2 diabetes can cause beta cell damage and therefore can start to show reduced beta cell function as high sugars damage these cells. To diagnose type 1 you would normally have a couple of tests to see if you have the anti-bodies responsible or a c-peptide test to see what your beta cell output is like.

If you are unhappy with your diagnoses I would discuss with your HCP...
 
People with type 1.5 or LADA (latent autoimmune diabetes in adults) can originally present as type 2 and are commonly 'normal' weight but can also be overweight, and often seem to respond quite well initially on diet / metformin as they still have residual beta cell function but they will all require insulin at some point, usually with a few years.

The standard tests for diabetes type are c-peptide (measures your endogenous insulin production, i.e. how much your pancreas is producing itself) and GAD antibodies. The presence of GAD antibodies means that your diabetes is autoimmune, i.e. T1 type, as your body is attacking the beta cells. However, lack of GAD antibodies doesn't necessarily rule out T1. There are some other tests looking for specific antibodies but these are expensive and not that common.

I was diagnosed T2 at 34 and reclassified as T1 after two years.

I would ask for a referral to an endocrinology clinic if you haven't had one already and get them to do type tests.
 
Hiya Meg!

Sorry I didn't see your post earlier, but I've been away.

With two close relatives diagnosed as Type 2, it is possible you are Type 2. However, your profile screams LADA. You will not be able to sustain yourself on the amount and types of food you will need to eat to control your BGs if you are LADA. You will need insulin and there is growing evidence to suggest the earlier you go on it the better as it can help to preserve your remaining beta cells. Go back to your HCP and explain you think you might be LADA and ask for a GAD antibody test. As Russ explained, the lack of these antibodies is inconclusive, but the presence of them gives you a Type 1 (LADA) diagnosis. The treatment for that should be insulin.

Are you testing your BG regularly? LADA sufferers generally see a much higher spike 2 hours afer their food than Type 2s. If you regularly spike into double figures on relatively low amounts of carb, you might well be suffering from LADA. For example, 10g carb could put me into double figures without my insulin. However, a fasting BG could be pretty normal or even low - this confuses the medical profession as they see good fasting BGs and good HbA1cs and think you are well-controlled, but the spikes after food are very damaging and you will need insulin to control them.

I produce good levels of basal insulin and my HbA1cs have been consistently in the 5.1 to 5.8 region, but I cannot eat without my BG rising high. A bowl of porrige put me up to 26 while I was misdiagnosed as Type 2 and told I was very well controlled. I was losing weight rapidly and I didn't have any weight to lose!

You must go and discuss your concerns with your HCP and get the GAD test done.

Let us know how you get on.

Smidge
 
Thanks for the info Smidge. You said your BG went to 26 after a bowl of porridge, were you on medication then? I regularly have porridge in the morning with my metformin and Sitagliptin and usually it's between 5-7 afterwards so thats good isn't it? Although I'm struggling with energy levels seem to have my levels under control 4-7 before meals and about 5-7 after. Since havng the retinopathy test I have been keeping a diary of all the food I'm eatng and my BG levels before and after so far I've only had two readings that were between 8-10. I'm sure my doctor is going to tell me I'm doing the right thing with my diet, I'm just not sure it's enough to stop the problem with my eyes. When the results come through and I see my doctor I will mention what you said about LADA though. Thanks very much.
 
Hiya Meg!

My 26 reading was without any medication - they thought I should be able to control it with diet only as my HbA1cs were so good :roll: Your 5 - 7 after porridge sounds excellent - I can't even manage that with insulin! In fact, all your results sound good. I guess the difficulty is whether you can get enough calories with the diet you're on. I couldn't even though I was eating avocado, nuts, cream, olive oil etc - the weight just kept dropping off without the carb. Once I went onto insulin I was able to add a bit more carb into my diet (although I still keep it at about 40g a day) and I've managed to put on half a stone - a bit worried I might not be able to stop now :lol:

The consultant told me that Metformin can be very effective for LADA in its early stages, but that the effectiveness wears off as the condition progresses, whereas it can remain effective for Type 2 for many years. Your BGs do look more like Type 2, but given that you're slim and in your 30s, I'd definitely ask for the GAD antibody test - it's the only way to differentiate between LADA and Type 2 and as you already have complications with your eyes, it's vital that you make sure you get the most appropriate treatment for your condition - and that means getting an accurate diagnosis. Certainly I felt so much better as soon as I went onto insulin - as soon as I started on the insulin I realised how weak and lethargic I'd been feeling while trying in vain to manage my condition with diet and exercise.

Good luck. I hope you've managed to catch the retinopathy in time.

Smidge
 
Hi Meg, Hi all

I'm curious as to when they determine an GAD antibody test? What was your last Hba1c Meg and has it been stable/falling or rising? Did any of you have obvious symptoms? Quick weight loss/excessive thirst/hunger etc?

What was everyone else's at the time they ran the GAD test? I've had c-peptide so far and it's normal. I am seeing a Diabetologist and he suggested I can't be insulin resistant becaise I'm not overweight.
They've put me in the T2 bracket initially because both parents have T2 - (overweight and in their 50s).

I feel as if they're basically waiting for my Hba1c to move up (I'm getting tested 3mthly). I'm not on any medications but the Diabetologist has mentioned poss Glipizide/insulin but they will keep monitoring me for now.

I am 34, slim (BMI 22.5) lost some weight but not drastically I would say - a stone in 6mths? No debilitating symptoms and yet they've mentioned possible 1.5 - what triggers the GAD test?

As you can see from my HBa1cs below they rose a little but has levelled out (not for the lack of trying I must add!)
 
Hi Smidge and Sanober

I rang my doctors today to see if my retinopathy test results had been received by them yet and they aren't so will try again next week. I need them to have the report before I go and ask for the GAD test, but I will definately do that, thanks Smidge. I thought I was doing OK, energy levels still rather low at times but I'm getting used to less carbs, not really hungry most of the time but I am starting to worry about my weight. I've just done my BMI and it was 19 for a 37 year old female 5'11'' weighng 61.8kg.

To answer your questions Sanober, my last HBa1C was 6.7 think the one before was around 7 so lttle difference. I've not had any obvious symptoms, thirst etc.
I thought I was doing OK with my new reduced carbs diet too but today I had a wholemeal cheese and tomato sandwhich which made me 9.9! My eyes went watery and I felt abit weird. Last week I had similar sandwiches with levels of 5-6. It's really disheartening when ths happens, you think you've got things under control and then.... you haven't.
I am only tested for my Hba1c every 12 months and was told by the nurse who did my last retinopathy exam that I would only need testng again in 12 months! I said surely if there's a problem even if only small should be tested sooner and she said there was no need for that but should just talk to my doctor if have any concerns.
Thanks for your advice. Wll let you know what the doc says.
 
Meg,

Sory, can't advise on teh T1/1.5 or 2 issue, but from what you have said your control is excellent.

Your point aboutteh 12 months check is quite a reasonable question to ask...but I have heard it said that most people who have been diabetic have soem changes to teh back oftheir eyes. Alas, I can not quote you a study or other evidence, as it was a passing comment by my optician a few years back. I guess, it is becasue of this they don't check more regularly. It will all depend on the amount of change...how small is small?

Sorry for waffling, I was trying to reassure you, though obviously it is very scary, and not good news, it does not mean that your diabetes is out of control...it is more likely a sign of damage done in your "undiagnosed" years, and now, with good control, thos small changes may even reverse, or certainly get no worse.
take care
 
Thanks sugar2, know I shouldn't worry until I see my doctor. You have been reassuring, the advice on here is really helpful and helps you to realise your not the only one in this boat!
 
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