Conflicting information. Diabetic or not?

I was diagnosed with type 2 diabetes last year. My most recent Endo visit was a couple of weeks ago. The doctor made a strange comment: "You're not insulin resistant". I replied "Oh yes I am". She then handed me 3 different insulin samples to try.

Just because I have perfect numbers due to tight control and the supplemental use of insulin, shouldn't mean I am no longer insulin resistant. I only need small doses as a supplement to help bring them down, not to rely on insulin to do all the work for me. I still control blood sugars with a modified diet and as much exercise as I can fit into a day.

I still spike into the 200's and stay there sometimes for a few hours. Especially when it's hot outside and don't take insulin.

Even with high spikes, I still managed to get an A1C of 5.2 .

When looking at the OGTT test parameters, if at any time your blood sugar is above 200, you are diabetic. My 2 hr PP came back at 294 that day, and A1c at the time was 6.8 .

Can someone tell me what is going on here?

Why would my endo say that? And then hand me more insulin?

Am I diabetic or not? If not, then how did I heal and return to normal?

Please remember that in order to be nondiabetic, you MUST be able to eat absolutely anything you want, be a couch potato, and have normal blood sugar levels.

Note: My trick at keeping a1c numbers low is to get spikes down as fast as possible or prevent them in the first place by using the DAFNE method. This means get blood sugars into the NORMAL range of <100 within 3 hours after eating. Of course keeping fasting numbers below 100 is great too.

You can be diabetic and not be insulin resistant. Usually insulin resistance is associated with type 2 diabetes, though some people with type 1 diabetes also deal with it.


You can have high blood sugar either because you are insulin resistant (but you produce enough insulin) or because you don't produce enough insulin. I am a type 1 diabetic and I am very insulin sensitive (not resistant) -- the problem is that my body doesn't produce insulin. So I have diabetes and need to replace the insulin.

Have you talked to your doctor about your insulin production? I would clarify what they meant by this as it does affect your future treatment. Also, check if you have had a c-peptide test which tells how much insulin your body produces.

As long as you CAN see high blood sugar readings, you have diabetes.

Thanks for taking the time to respond.

My C-Peptide test came back normal. I think it was 0.08 .

Every single test and number came back normal, except for blood sugar spikes and a testosterone level of around 465 (1/2 of optimal).

Some think it might be MODY or the honeymoon phase of LADA. Another doctor thought it might be one of 2 kinds of cancer.

It might even be adrenal gland related, possibly adrenal fatigue or adrenal exhaustion.

Yes, my One Touch Ultra Mini doesn't lie. It records every test I make and stores a LOT of them.

And it will show that I do have high spikes, if I don't shoot insulin (Humulog). And even sometimes when I do shoot insulin.

I have adjusted my dose from 5ui to 8ui per meal. This seems to work rather satisfactorily most of the time.

I have used Lantus, 25ui per day. This too helps a lot. My fasting blood sugars are now in the upper 70's to low 80's. Exactly where I want them. Before, I would be in the mid 90's.

Soon, I will be trying Novolog, then Apidra, and Levemir to see which works best.

I see my endo in March for another exam. I am hoping I can get my a1c under 5.0 (my goal). Last one was 5.2.

I can get any number where I choose it to be, including a1c. But it takes my being a full time slave to blood sugar levels to do it. Not the lifestyle anyone would want. Eat, exercise till eat, exercise till eat, etc, over & over every day. I did this for 9 months following my Dx. I dropped my a1c from 6.8 to 5.3, and without a single medication, insulin, or diabetes education of any kind. Just cut back carbs and exercise when eating.

I let my glucose meter be my food boss. Works every time.

There is one tiny problem though. If I don't use insulin, I begin to rapidly lose weight - from 3-5 pounds in a night.

That weight loss sounds like LADA or type 1 diabetes, but I don't know much about MODY.

An A1c of 5.2 is AWESOME! Keep it up! Sounds like you have already learned a lot about your condition, despite the uncertainty.

Note: I learned it all on my own. No classes, no CDE, nothing. This is what surprises the doctors.

They wanted my blood pressure under 100. So I gave them 80/48. Doc about had a cow. They said the bottom number, not the top number. So, I raised it back up to 102/74.

I have near absolute control over my numbers should I put forth the effort.

But it is very taxing.

How many diabetics you know that can get their a1c's that low on their own?

I had a VERY similar experience to yours!

In 1991, I had a FBG of 138, and 3 months later 131. 2 months after that, I had an A1c of 4.8. My doc told me I was hyperglycemic, NOT diabetic (the cutoff at that time was 140), but sent me to the diabetes clinic to get a meter anyway.

At the clinic, they told me I WAS diabetic, and they showed me how to test and gave me a meal plan. (I cried the whole time)

I was very concerned, so I decided to consult an endocrinologist, who tested me randomly (not after eating) and got 92, and told me I was NOT diabetic.

Then I had a coronary artery spasm (like a heart attack, but without blockages) in 1992, and my BG in the hospital was about 140, and they told me I was PROBABLY diabetic. (Everyone's BG goes up when they are severely ill or under a lot of physical stress like heart disease or pneumonia).

By this time, I was confused and frustrated, so I abandoned the meal plan, and ate what I wanted, and then in 1993, I tested at 160, and my GP sent me to an endo, who didn't question the diagnosis, but put me on pills.

The pills didn't work, so I went on insulin in May 1994, and after a long journey, here I am today.

You may or may not be insulin resistant, but that doesn't mean you are not diabetic. Type 1's and LADA's (Latent Autoimmune Diabetes in Adults) are not usually insulin resistant, but they certainly need insulin because they produce little to none. You may be producing some or even a good deal of insulin (that can be tested), but clearly not enough to satisfy your needs. If you've had BGs over 200 at least twice, that's a presumptive diagnosis, but it doesn't reveal what type you are.

What I'm saying is that you may or may not be a true Type 2 -- if you're using very small doses, that may be because you're not insulin resistant OR that you are still producing a lot of your own insulin. You could ask your doc for a c-peptide test and GAD antibody test -- that will point to whether you are an early stage LADA or a true Type 2. I don't think he's telling you you're not diabetic, but that it's unclear what type you are.

Good luck!

Thanks for sharing.

My C-Peptide test came back normal 0.08 I think.

GAD antibody test came back normal as well.

I am leaning towards adrenal fatigue causing the problems, but I don't know.

Just frustrated about it all.

I do like taking insulin because it's easy and fits my random lifestyle quite nicely.

Yes, I do get spikes into the 200's.

Go to sugarstats and look at my numbers if you wish.

(zolar1)

I do get to relax and eat almost anything I want this month. But the next 3 months I have to behave because of my next a1c test.

You also could ask your Endo to do a stress C-Pep test to see how much your pancreas is producing under stress. I have had similar symptoms to you with wild spikes at times.

My wild swings come and go. Right now they are in relapse but this fall I had a really bad time with them. I asked my Dr for a mealtime insulin but he refused. Like you I have a good A1-C but these wild swings are concerning to me.

It sounds to me you are insulin deficient and dont have the insulin to cover your needs. I am Type 2 but their are variations inside Type 2's also. I would drill down more with your Endo for additional tests at least your peace of mind.

You may want to go over to the LADA group here too as some may have experienced what has happened to you.

I don't see the conflict???

She told you you weren't insulin resistant. She was probably comparing you with other patients she has, where they need hundreds of units a day. That is the classic definition of "insulin resistant".

Some here very strongly believe that needing more than a couple units a day is "insulin resistant" but that simply isn't the broader view.

Being "not insulin resistant" has nothing to do with whether you are diabetic or not.

Diabetes in good control, is not the same as no diabetes.

You seem to worry about your numbers above 200 and all I can say is that if you are clocking in with an A1C in the low 5's, and your only out-of-target numbers are those after meals, then you are in excellent control by my standards.

If I am not insulin resistant type 2 diabetic, then what am I?

My original diagnosis was type 2 diabetes mellitus NIDDM.

Yes, I get spikes much higher than a normal person, IF I don't control them.

From my research, any spike of 40 points or more over premeal blood sugars cause cumulative tissue damage.

So, if I am say 77 before eating then jump up to 235 post meal, that surely isn't a good thing.

I usually take insulin for control of those spikes.

I can control the spikes if I want to walk for 2 hours after eating, then eat, then walk another 2 hours, then repeat every day.

That is NOT a life it is an existence.

Either I am not making enough insulin, I am insulin resistant, a combination of both, or there is another problem causing this hyperglycemia.

According to the definition of insulin resistance, you are diagnosed with insulin resistance if you need more then 200 units a day.

However, the definition does not list the division between what your pancreas produces and what you inject.

Let's assume I am making more than 200 units a day from my pancreas. I inject a total of 15-20 units a day for my bolus.

Does that make me any less insulin resistant than if I injected all 215 units a day?

All I know is that without insulin, my spikes are into the 200's. With insulin, they are generally in the normal range or close to it.

I am not a couch potato. Perhaps I should do the poor man's OGTT?

Then if at my 2 hour PP, my BS is above 200, then I am still diabetic.

My endo may very well be right. I was looking into my symptoms. They almost match perfectly those of Adrenal fatigue. I have unexplained lows from time to time and usually spikes without insulin.

Thanks Tim for the compliment on my control.

I can control ANY number I choose, but only ONE number.

If I choose to, I can make my A1c any reasonable number I want. I know my body and I know how to alter things, without a single medication or supplement.

However, I won't do that. I want legitimate data for a proper diagnosis and treatment plan. Skewing the data in any fashion doesn't do me any good.

Right now, I concentrate on my weight more than anything. If I don't take insulin, I can lose 3-5 pounds of body weight in a single night, effortlessly. With insulin, my weight is somewhat stable.

No one can explain that either.

Here are all my A1C's from time of Dx:

6.8, 5.7, 5.8, 5.3, 5.2

With the exception of the 5.2, all the others were without a single medication or diabetes class. I did it all on my own with lifestyle changes. The 5.2 is because of high spikes into the upper 200's during the summertime heat and controlled it with Humulog. I caught the problem early before the A1C could rise significantly.

Note: I have even tried Lantus. 25 units in the morning. It helps with the spikes, but doesn't do a whole lot for me.

My endo seemed unhappy with my spikes into the 200's. That's why I got humulog and the other insulins.

There is something going on in my body and I don't know what it is. But I will fix it or treat it. Somehow...

It is possible that I am LADA, MODY, or who knows what.

All I know is that I am diabetic, WELL CONTROLLED DIABETIC, and do not know the cause or even the exact type.

If I wasn't insulin resistant, then why did she give me 3 different kinds of insulin??

I am so confused here. I want to control this disease before it controls me.

And I can't do that without knowing what the cause is and a treatment plan.

Thanks for the suggestions Pauly.

Pauly, go to isletsofhope.com

You can look up your state. It will tell you if you can buy insulin OTC and if you can buy syringes OTC.

Doctors do NOT want you well. They make tons of money off your disease and any complications you may have.

My backup plan is regular insulin, and NPH insulin, should my Endo be unreasonable.

I have sufficient knowledge on how to dose.

I do not tolerate lazy or greedy or incompetent doctors.

Your doctor is a businessperson. Look at him that way. Talk $ and cents. Tell him that if he cannot give you a credible and legitimate reason why you can't have insulin, you will take your business elsewhere.

I have seen studies that now say insulin use should be the first treatment, not oral medications.

I can buy my own insulin, any kind I want, even Rx stuff without a Rx. I know how to do it and where to get it.

I can do my own A1c test. You can buy the kit in almost any pharmacy.

Note: Insulin is only a class V drug. Not hard to get.

As long as I avoid hypos and high spikes, as well as keeping all my other numbers in normal range, I don't need a doctor for my diabetes.

I really want to know the truth. What kind of Diabetes do I have?

I shot insulin on some days, only to stay high for several hours after eating.

It's a guessing game anymore. Carb counting doesn't work for me.

I can eat premeasured carbs and dose according to that.

Then all a sudden have to run out somewhere and do something (random lifestyle). I can easily go hypo to the tune of a BS of 34.

Other times, I dose according to eating and expected activity, then find out the activity was postponed or canceled, and wind up with high BS.

I won't take any kind of oral medication for diabetes. I hate pills of any kind, even vitamin pills.

You may be a LADA, and you may have multiple endocrine problems, but we here can't tell you just what it is you are up against. You need to have a detailed talk with your endo, who is the only one who can do the tests to prove or disprove your suspicions.

The fact that you can get spikes over 200 does mean you're diabetic, but doesn't tell you what kind. You need c-peptide test, antibody tests, adrenal hormones tests, and thyroid tests.

What kind of insulins did the doc give you? Any instructions on how to use them?

You shouldn't need to be walking 4 hours a day to control your BGs!

You really need appropriate medical care, and if this endo isn't giving it to you, then you could look for another endo. I would also recommend reading books about diabetes and visiting websites that are diabetes related -- there is a lot to learn.

And you still could end up like me -- Type Weird, in that I don't exactly fit into either the Type 2 or Type 1 boxes!

Every single test taken came back normal, except for blood sugar spikes.

Doc didn't give me instructions this time. She already knows I won't follow them. I know how my body works.

I start out with a small dose and work my way up until I see a problem, then back off 2 notches.

This allows a safety margin.

I have not used Novolog, Apidra, or Levemir. She said Apidra was fastest.

I am anxious to try them, but have to use up my existing humulog pen first.

Then I plan on making a detailed log book so the doctor can have more specific data.

A royal pain in the u-know-what , but I suppose she could use the information.

I am hoping the Levemir will keep fasting numbers slightly lower, and Apidra to control the spikes.

I could be LADA, Maybe. I could be one form of MODY. Or it could be adrenal exhaustion, or it could be cancer. I don't want to spend many thousands on test after test. I can't afford it.

So, I will treat it the best way I know how, until something solid is determined.

I would write more, but extremely tired right now. Drained...

> All I know is that I am diabetic, WELL CONTROLLED DIABETIC, and do not know the cause or even the exact type.

> If I wasn't insulin resistant, then why did she give me 3 different kinds of insulin??

You might be frustrated but really you're doing great. If your only problem numbers are those after meals, wow, you are so close to perfect control.

Don't confuse "not quite perfect control" with being a failure. That's an easy confusion to make, especially when you read websites populated by those with easy-to-control varieties of diabetes, or books by people who think that all diabetics should have an A1C of 4.0 or lower.

Insulin resistant has nothing to do with the number of different insulin brands or regimes tried out. They are not all identical.

Would I be "car resistant" if I test-drove Ford, GM, and Toyota cars? :-)

One thing that's certain about insulin treatment is that it always have to tweaked and sometimes one regime replacing another. And brands change, for sure.

You may yearn to be classified as "one type" or "the other type" and while those words are important to many I have to praise your endo for treating YOU, working on the exact issues YOU have, and not just treating you like all the other folks who are easily lumped as "one type" or "the other type".

Just my most of a century perspective on types: the very definitions have changed greatly over the past half century. I was diagnosed with "juvenile diabetes" back in the olden days (no blood test at all! Definition of diabetes for most of the past millenia was "sugar in urine") but I'm not juvenile anymore, as the thinning grey hairs on top of my head will prove :-).

Tim.

Oh don't mention those thinning gray hairs....LOL

My beard is nearly snow white.

I am just in a quandary over the cause of this affliction. I believe it was caused by medications I took last year, but don't know for sure. (long story).

In your opinion, am I a diabetic or not?

Also, I went hypo yesterday for no reason. I didn't even use any insulin the whole day.

56 at 345am and about 6 hours later 69.

I ate everything I could to make sure I didn't go hypo any more.

About perfect control. Yes, I can achieve it if I want to devote every minute of every day battling this disease.

I went from 6.8 at Dx to 5.3 in 9 months, without any meds or insulin.

If I knew the type, then I could zero in on the weak areas.

My endo had little to do with my treatment. I already knew ahead of time what I needed. I won't follow any diet plan except my own. Apparently it worked all this while, why fix it if it isn't broken?

She handed me the insulins with no instructions. She knew by my past usage that I start low and work up.

I adapt very quickly to many things.

Thanks for the support and compliments over my control.

My main goal is to get my a1c under 5.0. Then concentrate on spike control adjustments. Tweaks if you will.

It's hard for me to give you advice on better control, when you're better controlled than me and probably 99% of all diabetics :-).

My gut feeling is that you're having some acceptance issues, trying to decide whether well-controlled diabetes is the same as no diabetes. Some of us (e.g. me) got to side-step that issue by going into DKA coma before diagnosis and spending a couple weeks in the hospital recovering :-)

I'm very happy you and your doc seem to mesh well style-wise. You might well be LADA or not but be happy that right now your doc is helping you so much and that your numbers are so excellent.

Be wary of hypos. I've ended up with 911 calls+ambulance runs+glucagon+ER visits a couple times over the decades. You might read those with very easy to control diabetes worrying about numbers like 140 but really you don't have to sweat so hard, IMHO your numbers are excellent already, you might want to back off a little.

Oh, and instead of reading some nutcases on the web or crackpots in the bookstore saying your A1C has to be in the 4's "OR ELSE", and comparing yourself to maybe unachievable standards:

When it comes to achievable bg goals and hypo dangers when using insulin, look carefully at the DCCT results out there on the web. Your A1C is already below the lowest 1 percentile of "intensively treated" diabetics in that landmark study.

Well, I do try my best. My lowest hypo with insulin was 34.

My lowest hypo without insulin was 43.

Strange huh?

I may have caught my diabetes early enough to treat it effectively.

I am afraid that I might have adrenal problems. It could explain a lot. But my ACTH test came back normal.

You have diabetes. You always will have diabetes. What you have is well controlled diabetes.

Diagnosing the TYPE of diabetes is often very difficult. There is type 1, type 2, LADA, MODY, and some other form of "other" diabetes. We know far too little about these types, but some types of MODY are accompanied by hypoglycemia even without insulin. Click here for more information on MODY. It sounds to me that you have a good doctor if he or she recognizes that you could have adult onset diabetes WITHOUT insulin resistance. It DOES happen and many doctors don't recognize it. It may serve you well to at least listen to what your doctor has to say about what type of diabetes you may have and how the treatment options would change depending on that. If he or she recognized that you don't have insulin resistance and started you on insulin -- that seems like a wise and forward-thinking decision.

I don't know your personality type and maybe you can keep up this lifestyle forever, but I would get ready to accept an A1c over 5. NON-diabetics have A1cs over 5. If you get it below 5 by having more low blood sugars, this is not even good for you physically. The lowest A1c possible with the LOWEST variation in the blood sugars is best. You should be focused on STABLE blood sugars that are as low as possible. Dropping from 130 to 70 is NOT better than staying consistently between 100 and 110.

Meters have 15-20% error (really!), especially with lower and higher blood sugar readings. So the difference between the two lows that you posted is not that big. If you are having lows when you have NO insulin in your system (i.e. if it has been more than 24 hours since you took your last shot of long acting insulin), then you have some form of hypoglycemia, which many diabetics live with before they develop diabetes.