This past weekend I was rushed to the hospital with a case of DKA and was newly diagnosed with diabetes. The Doctor said I recovered very well and I left the hospital on Tuesday prescribed Metformin, Novolog(base 20 units per meal), and Lantus(30 units at night). However they’ve been unclear on whether it’s T1 or T2 and I’d like to hear your opinions on what you think it is. For awhile I’ve had symptoms such as frequent urination, dry mouth, hair thinning, weight loss, thirst, etc. that I pretty much ignored until my DKA incident, so once again I ask in your opinion which type of diabetes do you believe I have?
Welcome to the club that you didn’t ask to join! Sounds like classic type 1 but could be LADA which is type one but your beta cells die off slowly over a period of years rather than months. The good news is you most likely don’t have to guess. Your Dr.s can run autoimmune antibody tests to see if you are producing antibodies as well as checking your C-peptide level. While some type 1’s don’t produce antibodies most do. One of our members @Melitta has written extensively on diagnosing type 1 in adulthood you should look her up and research the tests she recommends.
Welcome and you would be most likely best off to not even think about what type you have and only concentrate on what you need to do to keep your numbers in a control range that you and your doctor are comfortable with. I was diagnosed diabetic more than 30 years ago and am treated at Joslin, Boston which is considered the foremost clinic in the world and after all these decades, they are still scratching their heads as to what type I have, but who cares. I take fast acting Humalog MDI (multiple daily injections) and am able to flatline my blood glucose near perfection so that is all that counts.
When people ask me what type I am, I just tell them I am insulin dependent.
Did they put you on a CGM (Continuous glucose monitor)? 20 units of novolog seems like a scary dose to me, unless you are type 2/insulin resistant. Or still in those younger years where a meal equals everything in the kitchen. If you don’t have a CGM, make sure you’re testing OFTEN after a bolus that big. That’s the sort of number that scares me being thrown around with a potential Type 1, who still might be making their own insulin.
Do you have plans to follow up with an endocrinologist? It’s the endocrinologist that will help you figure out how to effectively for your insulin and can do lab tests to confirm what type you have. The ER is mostly concerned with getting you stable and getting you back out of the ER to free the bed for another emergency.
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Presenting with DKA almost certainly means you have T1D. Your doctors can confirm that with antibody tests and a c-peptide test as @Firenza says above.
A T1D diagnosis, if you are a T1D, is important for practical reasons. Many insurance companies will drag their feet in paying for an insulin pump or continuous glucose monitor, CGM, without the formal T1D diagnosis.
I consider a CGM as the best tool available for you to educate yourself quickly about how food, exercise, stress, sleep and a whole host of other factors affect your glucose metabolism. Without a CGM, you are flying blind about how your glucose metabolism works.
Fingerstick glucose checks can help, but they are like single point-in-time snapshots whereas a CGM is like a video. With a CGM you can detect trends and take timely counter-measures to manage your glucose in real-time.
I understand that some cases of diabetes are more difficult to diagnose but those are exceptions, not the rule. You deserve a proper diagnosis. This is important.
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Hi and welcome: The unexplained weight loss, DKA, and need for immediate exogenous insulin all point to Type 1 diabetes. It is actually important to get a correct diagnosis, and especially to have a correct diagnosis in your medical records. Here is a link to an excellent Diabetes Forecast article that explains the tests that your doctor should request. Also, JDRF’s T1detect offers low-cost autoantibody testing, although they do not perform the full suite of autoantibody tests. Best of luck to you!
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