Hello all
Recently ( one month ago ) I have been diagnosed type 1 diabetes .
My blood sugar level before and after eating was 368 and 646 mg/dL .
C-Peptide level - 0.82 ng/ml
HbA1c - 10.20 %
Ketons in urine 40 mg/dL
My age is 28 .
After the results doctor said that there is no need for the GAD antibodies test because its definitely type 1 diabetes . So i had to start insulin therapy .
Do you think that with that results I can be sure that its type 1 diabetes ? or It will be good to do the GAD antibodies test anyway ? Thing is that i already started insulin therapy , so do you think it is still possible to do GAD test ?What do you recommend me ?
Thank you very much in advance .
With best regards
Gato
Especially if those lab results were after fairly sudden-onset of symptoms, it definitely sounds like Type 1. That being said, you can certainly ask for antibody testing to confirm the diagnosis. However, with BG and A1c that high, insulin therapy will be the recommended (and even required) treatment regardless of results.
As for the antibody tests, there are actually five tests commonly used, of which anti-GAD is one. Insulin Auto Antibody (IAA) is the only one no longer relevant to you (because you started insulin therapy). The gold standard for diagnosing Type 1 is:
presence of one auto-antibody (GADA, ICA, IAA, IA-2A, and ZnT8) and symptoms of diabetes mellitus (elevated BG, neuropathy, excessive urination, low fasting insulin, low C-Peptide score, etc.)
presence of two auto-antibodies (GADA, ICA, IAA, IA-2A, and ZnT8) and no (or mild) symptoms of DM
Since you are symptomatic, presence of one or more of the four antibodies you can still be tested for would confirm a diagnosis of Type 1 DM. If you test negative, that does not mean you are not Type 1, but rather than you didn’t test positive. It could mean you are in an “advanced” stage of Type 2, you are “idiopathic Type 1” or “T1b” or “T1.5” or “DKA-prone Type 2” or… any number of other things. There are also genetic versions of DM, including MODY and MIDD, which are super-rare.
In the long run, the goal of treatment is to lower your BG to safe levels, avoid hypoglycemia, and reduce or mitigate the severity of complications (including micro- and macro-vascular effects of hyperglycemia). What the antibody tests can help with is understanding the likelihood of long-term treatment options. Although insulin therapy is normal for someone with your lab results, in some Type 2s they eventually transition to oral medications after their BG normalizes from intensive insulin therapy. For almost all Type 1s, once exogenous insulin is necessary, it remains necessary for life. Some MODY and MIDD and Type 1b cases have intermittent insulin use throughout life, but they’re vanishingly rare.
Hi Gato.
You can do the anti-body testing at anytime regardless of taking insulin, there is only the one test that may be impacted and it’s not a critical one (IAA or something). FROM YOUR results in my opinion , regardless of type you likely need to be on insulin, which is your first priority to regain control. The research does recommend insulin, at least as a short term (for type 2) with numbers like yours and it may last longer (life time like me). I was even higher at presentation and got to see a great diabetesologist who explained that to me… we tested several years after my diagnosis only because I had no control and we needed to understand why
At some point, after you get control you may want to pursue the testing, it should not in my opinion be the focus
I agree with your doc. If a young person shows up with those bg levels, C-Peptide level, and Ketones, it is certainly T1 diabetes. I am going to guess that you had all the classic non-lab-test symptoms of ketoacidosis and diabetes too.
I don’t want to go all old-grandpa-guy on you, back back in my youth, my doc diagnosed me without a blood test at all, and the urine test (in addition to smelling of ketones) instantly turned the urine test tablet jet-black was just to confirm the obvious diagnosis. “So I tied an onion on my belt, which was the style at the time” (that’s Grandpa Simpson coming through with talk about the old days.)
I’m not fundamentally opposed to running a GAD or other antibody tests (there’s actually a whole battery of antibody tests including ICA, IAA, and IA-2A) if it’ll help clear anything up. But I don’t think there will be any value gained. GAD Antibodies are only found in 80% of T1’s at time of diagnosis. The other antibodies are even less likely to turn up in a T1. So if you don’t turn up positive for GAD antitobodies that doesn’t mean you don’t have T1 diabetes and there really isn’t any value added.
