Are you sure you are really not a Type 1?


#1

Today waiting in a long line at the grocery store…
I had put a new energy type Bar in my basket and realized that I did not have my reading glasses (no large print on any bars).
So I asked the woman in front of me if she would read the number of carbs for me since I was I diabetic and needed to check that out. (I have no shame I talk with everyone)… well she read the label, too many i said. Then she asked me If I was a T1 or T2. I replied T2. She looked at me a bit befuddled and said “but your are thin”. I said that my fasting numbers were way over 300 if she knew what that meant. Still looking befuddled, but did they take your A1c? I said of course and it was 12.0 at diagnosis.
Oh my she said, you must get that question a lot, Lauaghing I said yes, but at least she seem to understand diabetes. It seems that her husband was diagnosed T1 at age 41.

The point, all T2’s are not fat and lazy, nor are all T1 diagnoses as children.


#2

Nor are all LADAs thin. Actually, having fasting BGs over 300 or A1C of 12.0 only confirms some form of diabetes, and does not differentiate between T1 and T2. Doctors are notoriously bad at misdiagnosing LADAs as T2, particularly in this forum, so how do you know that you are T2? Antibody tests are definitive if they come back positive, but I would think a correctly done C-Peptide test would determine whether your body is producing too much vs too little insulin at diagnosis, which has the advantage of differentiating insulin-resistant diabetes from the various pancreas-impaired versions of diabetes.

So, are you sure you are T2? Seeing that T2 meds don’t particularly work for T1, it’s an important question.


#3

FYI anti body negative, Cpeptide at DX was very high, with high BG, later when BG was managed, Cpeptide was solid mid range. 10 years now since dx 9 years off of medformin, A1c less than 6, diet and exercise only.

Definitely not T1.

I do like your insulin resistant definition, rather than the catch all T2.
I might not get so many questions with that.

It is not really important to me to have a catagory to fit in, I am please too be fortunate enough to be able to control it with diet and exercise only. )


#4

You’ve touched on a sore point that feeds the myth that sloth and gluttony are the root sources of type 2 diabetes. Did you know that some medical research suggests that type 2 diabetes comes first, followed by an unhealthy appetite and out of control weight gain? These events all precede an actual diagnosis. The conditions of T2D come first, followed by weight gain, not the other way around.

The belief that people with T2D brought this condition onto themselves is an insidious one. It isolates people, makes them feel shame, and prevents successfully treating this disease.

There may be some T2Ds who are fat and lazy, but fat and lazy exists in people without T2D, too. The implication that fat and lazy are the root cause of T2D is ignorant, hurtful, and ineffective at moving toward an appropriate solution.

Over the years, many of us in the T1D community have unwisely used blame and shame to try to separate us from the T2D community. We tell our friends and neighbors that T1D is an autoimmune disease and we have innocently suffered at the hands of fate while the T2D community, enabled by poor lifestyle choices, more or less volunteered for their fate.

This stance by some T1Ds is in itself wrong and shameful. It doesn’t help; it only hurts. I hope that you are able to adjust your perspective on this important social point.


#5

I also hate when I get the “but you’re too thin to have diabetes” line. I hate that everyone gets thrown into one group. As we all know, each one of us with our diabetes is so very different. And i’m sorry but if weight and lack of exercise was the reason for type 2, there would be a lot more people with diabetes. The weight of the average human has gone up dramatically! And they don’t all have diabetes.
It would be great if we can get away from the blame/shame game we play with people who have diabetes and the people who think they know diabetes.


#6

I also get people, including doctors, that think I can’t be type 2 because I’m thin, but I’m auto-antibody neagtive so :woman_shrugging:.


#7

Gee, maybe that woman should do some research on all the thin T2’s in India and China.

There is a theory that we all have different ways we handle fat. Some people’s genetics just put in under the skin, no matter how much they have. Other’s start putting it around the organs right from the start. Most do a blend. The theory is that where you put the fat will determine if/when insulin resistance develops. Fat around organs leads to the resistance and does not require you to be over weight. Then again, some people can have huge amounts of fat under their skin and never become resistant. Bottom line, we are all different and stereotypes hurt everyone.


#8

Broadly likewise: I am a T1, but my wife (HbA1c 5.6%) has, I guess on and off, been diagnosed as pre-diabetic T2. Her mother certainly is a T2D, she is taking metformin, she is thin, always has been, exercises regularly, always has. Her HbA1c is about 7% and she does have the side effects - loss of eyesight and a somewhat acrimonious disposition that suggests high blood sugar.

In this case there is a very clear family disposition to T2D; mother, one son (out of three) clearly diagnosed and one daughter semi-diagnosed who being married to a T1 is somewhat aware of many of the issues.

While the familial disposition is clear there may still be some dietary factor - throughout their life they have eaten rice and/or noodles as their primary food source. That isn’t a conscious choice, there was no choice, just what is available. Nevertheless it isn’t obviously diet; father-in-law is fine, well, grumpy, but fine, despite the same diet.

As Kailee56 points out, there is more that one factor, though that doesn’t incline me to be sympathetic towards gross over eating, I am a T1D after all.

John Bowler jbowler@acm.org


#9

I have T1D to, unquestionably (diagnosed at age 9 in DKA, have developed other autoimmune conditions). Yet as an adult I’ve become overweight and have taken T2 drugs. All of the T2s I know weigh less than I do.

Weight should just be disconnected from diabetes. Sure, some people do become morbidly obese and that leads to diabetes. And for some people, it’s even due primarily to overeating or to eating fast-food for every meal. But at this point, with two-thirds of the population overweight, it goes way beyond individual choice. Clearly there’s wider issues at play that need to be dealt with, other than blaming individuals for something they may have little to no control over.


#10

I did not connect weight and diabetes; I didn’t even connect weight and “gross over eating”.

I’ve seen it; “gross over eating”, it may, indeed, cause excess weight, I don’t know.

I do know it annoys me and that comes from being a T1D and knowing if I down a half of a half of a slice of pizza, let alone the beer (I love beer) I will be 200+ to the wall.

Somewhere out there people think that “sympathy” absolves an individual of understanding. It does not; understanding comes first, most of the time afterwards sympathy is superfluous.

John Bowler jbowler@acm.org


#11

I would never feel annoyed at another person’s medical circumstances. I used to sharply define T1 and T2 and was always adamant that I had T1D. That was 10+ years ago, before I knew much about diabetes. These days think T1D and T2D share many of the same struggles, and I rarely feel the need to specify unless I’m talking to a doctor (and sometimes i do specify when I want to emphasize why I monitor my BG so closely and why it fluctuates so much).

I don’t know about pizza or beer first-hand. I can’t have either due to serious food allergies. But I do know plenty of people with T1D who have learned to manage these things in moderation with insulin, if they choose to. It might take some work and mistakes up-front to come to a final dose.

I know many people with T2D who can’t eat these things because they don’t take insulin. If they go high, they’re stuck with that high until their pancreas deals with it.


#12

I have diabetes on both sides of family (T1 and T2 on both) and there is no correlation with weight, diet, or activity level for my family.


#13

Eating is not a medical circumstance. Neither is exceeding the speed limit or cutting up someone else on the highway or swearing someone out or just telling someone to shut up.

Neither is liking, or disliking, Brahms, or Black Sabbath, or Pink.

Neither is shooting a gun, or not shooting a gun, or not being permitted to carry a gun, or a knife.

Annoyance just is.

John Bowler jbowler@acm.org


#14

I never thought of it that way.
But it makes sense.

My experience is T1 so I don’t get the exposure to the T2 aspect.


#15

Thanks Jen. Since my life is just controlling diabetes is by what and how much i

Ieat. And then heading to the gym

Not complaining it works well for me. I am really good at counting carbs and limiting what and how much I eat

After dinner BG 99 (I did have two glasses of wine.)


#16

^One of the reasons why I decided to start on insulin. A1C in Dec 2015 was 13.0 and now it is 5.9.


#17

As I mention I do use a low carb way of eating, to control my BG.
But the need to add insulin could always be in my future. Could I ask how did you structure your insulin intake? Asssuming that you were still producing insulin, how do you balance the added insulin. like a T1 or different.
I really follow this site to keep up on insulin issues, so if it is needed, I will have some back ground.


#18

I have the opposite happen. I’m definitely type 1, diagnosed at 11, but I have always been overweight. I even had a doctor try to take me off insulin because he was convinced I was type 2 and could do without it. If my pump gets disconnected, I’m 300 within 3 hours, I definitely need insulin, but I’m fat so I must be type 2 lol.


#19

But overeating can be a sequela of Type 2 diabetes. If the cells are insulin resistant - fuel (glucose) can’t get in. So it hangs around in the blood stream and results in hyperglycemia. But those cells are starving. Insufficient cellular fuel gives the brain the message more food is needed. A starving person is hungry and craves food. More willpower isn’t the answer for many. Rather, it’s the right diagnosis and treatment and normalizing blood glucose levels.


#20

@T2Tom I started off with basal insulin (Tresiba) which helped somewhat in reducing A1C from 13.0 to 11.0 and that was eating pretty judiciously. So my doctor and I decided to add Humalog using the Rule of 500 to get the initial carb coverage ratio and Rule of 1800 to for the initial correction factor. And then fine tuned the Tresiba and Humalog dosing from there. Keep in mind that I did the following as well:

  1. Started using the mySugr app religiously.
  2. Tested upon wakeup, before meals/snack, two hours after meals/snack, anytime I felt “off”, and at bedtime.
  3. I didn’t eat anything that I did not have an accurate carb count for during the first 4 weeks of insulin therapy. I also did eat high carbs or low/no carb aiming for about 100-120 which seems to be most realistic for me personally.
  4. The basal insulin was adjusted upward 2 units every 4 days until my fasting blood sugar was consistently below 120 without any hypos.
  5. The bolus was adjusted to achieve 140 or less 2 hours post meal/snack.
  6. The correction factor was adjusted to bring a high down to 120 within 3 hours along with no additional eating or insulin to avoid stacking effects.

Thankfully because I had done this when my formulary changed this summer it only took 3-4 weeks to get stabilized on the new combination of insulins.