Does this person have Type 1 diabetes?

Type 1 and LADA
#1

First off, I’m Type 1 myself but only for a relatively small amount of time-- I know quite a bit about the disease but nowhere near what some of you guys know. So I need your help with this one.

I’m trying to figure out if my 40 year old uncle (who is a bit ‘heavy’) has diabetes-- particularly if it’s Type 1. His doctor informed him he had very high blood sugars, and I recently tested him with my own meter and he scored over 400.

Judging by his age and his heavier disposition, you’d immediately think that he was Type 2 diabetes. But there are other factors that complicate it: First, he isn’t even close to ‘sedentary’. He’s always doing things when he’s not at work, he’s one of those hands-on types. I’m not even sure if he watches any TV.

Second, 7 months ago he was 50lbs heavier than he was today and when they tested his fasting blood sugars then, it was abnormally low (50-something). He was heavier, with low blood sugar. Since then, he’s LOST weight but GAINED blood sugars. I think he thinks his weight loss is due to perserverance but he seems impulsive and I can’t imagine him being able to legitamately lose 50lbs in 7 months.

So what do you guys think? He’s older and heavier than normal (but not sedentary), but he’s losing weight and his blood sugars are rising. Type 1?

#2

Well he could be a Type 1.5 and between both worlds, both insulin deficient and insulin resistant. This can be confirmed with more testing from his doctor. If he is many are misdiagnosed as a 1.5 and not given proper treatments.

I hope you sent him back to the clinic when he tested 400BG. With a 400 BG he must have been peeing like all get out, thirsty, and loosing weight like crazy. Dangerous levels to be sure. That low BG is curious from 7 months ago. If he was tested by his doctor on his physicals that could give more insight here too.

I hope he is seeing a Dr on this. I lean he is a 1.5 but only tests would confirm. Good Luck

#3

He could have a type of diabetes called LADA, latent autoimmune diabetes in adults, often called Type 1.5. This is a form of autoimmune diabetes that hits people over 30 and tends to work rather slowly, that is, he still has active beta cells just fewer of them and it may take time for him to lose all of his insulin production and become a true Type 1. But I agree, it does sound like he’s got symptoms pointing toward autoimmune diabetes and he really, REALLY needs to see a specialist to see if he has autoantibodies. You know what you should do? Have him use your ketone strips to check for ketones–if he’s losing weight rapidly because he’s burning fat in lieu of burning glucose (because he doesn’t have enough insulin), he will show high ketones and will be at risk of ketoacidosis, and that’s nothing to fluff off–he’ll need treatment ASAP. If he does this test and shows high ketones, don’t wait, get him to a hospital. Are you a blood relative or is this an uncle by marriage? if a blood relative, I’d say the chances that it’s LADA are fairly strong.

#4

It is certainly a possibility, have him get w/ his doc and request (ie insist on) a GAD antibody test. To many LADA patients are initially diagnosed as T2 and the antibody test will indicate what the correct diagnosis is

#5

If he were a Type 2, would ketones appear on a test at all or are ketones a Type-1 exclusive symptom?

Can you test positive on a GAD test and still be a Type 1.5? Or does GAD mean you’re automatically Type-1?

I’m going to insist on a GAD test, and actually I’m part of a stem cell study where they’ll give my relative tests for free.

#6

It is more likely that your uncle is a type 2 suffering from high levels of insulin (that can also pack on the weight). Reactive hypogycemia after a meal can drive your blood sugars down to the 50s. In order to really test for type 1, you need to have autoantibody tests to figure out whether you have an autoimmune condition. In your uncles case, it is more likely they would order an Oral Glucose Tolerance Test where they give you 75g of glucose and measure your blood sugar, insulin and c-peptide to get an idea of your response to glucose. This can give you an idea of whether you are producing insulin in response to glucose and whether you are insulin resistant.

Just because someone is active does not mean they won’t get type 2 diabetes. Just being heavy does not give your type 2 diabetes, type 2 diabetes can “make” you heavy. His loss of weight may or may not be related. In either case, any random test of a blood sugar of 400 mg/dl consititutes full blown diabetes and should be looked into immediately.

#7

Just a few things I want to clarify with you though…

You state 'Just being heavy does not give you type 2 diabetes, type 2 diabetes can “make” you heavy.

From everything I’ve read I’ve never been under the impression that Type 2 ‘makes’ you heavy. In fact, I many times read just the opposite-- That a symptom of Type 2 diabetes is actually weight loss, while an underlining cause is being overweight. I’ve just confirmed this information via several different diabetic websites just to be sure.

When you refer to Type 2’s having ‘high levels of insulin’ which packs on weight, doesn’t the high levels of insulin simply indicate insulin resistance? Body has high blood sugar, body produces insulin to compensate, insulin is resisted, body has high blood sugar, repeat previous steps.

Other information I didn’t include: he is a blood uncle. My cousin (same side as my uncle) has Type 1, I have Type 1. Our family has no history of Type 2 diabetes-- in fact, my uncles three brothers are just as heavy and more sedentary-- none of them had blood sugars higher than 95 when I tested them. Two of my uncles brothers are older and smoke.

I know that he needs to get tested and he will be, but this doesn’t feel like a Type 2 case to me at all though I could very well be proven incorrect. 1.5 seems like a very real possibility, though the GAD test will make everything official. We’ll see.

Nor did he experience ‘reactive hypoglycemia’. He hadn’t had a meal for over 12 hours.

#8

Well, the antibodies would be present in both a T1 and an 1.5. The two are very similar but the T1.5 onset tends to be slower. There is another test for C-Peptides that determines whether or not the pancreas is still producing any insulin at all

Ketones are a natural reaction to your body burning fat for fuel as opposed to carbs. T1 or T2 can spill them. Non-diabetics can as well, if they are dieting/exercising that is causing them to loose weight, but the amount they would spill would not be dangerous

#9

I see… much thanks.

#10

Weight loss is a symptom of T1, weight gain is usually a symptom of T2. A T2 that presented w/weight loss may very well be a mid-diagnosed T1.5

Recent studies (ie the Whitehall II study from the UK) indicate that the Insulin Resistance (IR) occurs before the actual onset of diabetes. The the higher blood glucose levels can add weight, the body will attempt to store as much as it can (ie in fat) before eliminating it thru urine. So while that IR cycle is going on you will gain weight because that is just how your body works. I would suggest that the underlying cause of weight gain may be T2, not vice-versa. While there is a definite correlation between obesity and T2, the jury is still some what out as to which comes first, but I believe the IR causes the weight gain

#11

There seems to be lots of confusion. Type 1a is an autoimmune condition and presents as nearly absolute insulin deficiency. Type 2 is classically insulin resistance, often with the patient having high levels of insulin to compensate (hyperinsulinimia) causing weight gain. As type 2 moves to end stage, the pancreas starts to poop out (sorry for the technical term) and insulin deficiency starts to happen. All of this is really a gross simplification, nothing is that simple. Diabetes is a spectrum disorder of insulin resistance, insulin deficiency, and a range of other problems like secretion problems. And people present with some or all of these conditions and many defy classification. In any case, your uncle having a 400 mg/dl is in what I would term “dire” condition. It really does not matter whether he is type 1, 1.5, 2 or 7. Having a blood sugar level at that level is injurious and risks DKA. He needs to get attention and in my view blood sugar at that level warrants the use of insulin under a doctors care to normalize things.

#12

Absolutely, bsc, a visit to the doc and to the ER if he starts to become nauseous and can’t keep fluids down or can’t stay “awake”

#13

Obviously he needs to get to an endocrinologist - IMMEDIATELY! Call one and tell them how high his BG was when you tested it. Leave the diagnosis to the expert!

#14

He needs to “insist” on an A1c and not fasting or random BGs to help start the diagnosis. The Hypos followed by the weight loss could very well be T1 or 1.5, but in no way can anyone determine what D he has until testing is complete and he as started on a drug or more to control the BGs. The weight gain for T2 is usually caused by poor insulin receptors and the over production of insulin to compensate. There are may cause for the receptor problems, such as extra weight, hormone issues, infections and cancer to name a few.

As many have said, the damage is happening with BGs of 400 and if the MD is not treating this symptom, that is malpractice. Get him to a competent MD or ER.

#15

IF he was truly T1 with #'s that high he’d have probably ended up in the hospital already… my guess is T2.

#16

I think the diagnosis should be made by a doctor (not his current one, who doesn’t seem to have a clue) and not by any of us.

Tell him what you suspect and ask him to have it checked out by a specialist - maybe your own doctor.

Terry

#17

Robert, I am 43, was active and with a healthy lifestyle of a triathlete. I however gave my early symptoms not too much attention and actually the week before thought my dieting and exercise were the reason my weight was dropping like never before. I had very minor blurred vision a month before and tingling in my toes off and on about a month before my “event” The “event” started 3 weeks later when lost 18 lbs over the previous week. I saw my GP doctor the Monday after, he had some simple blood work done and was on my way to the ER the same day of my GP visit where I registered a 550 BG. I was admitted to the hospital in full DKA and 1100 blood sugar and this led to a lovely 3 day ICU stay. The classic signs were there in the final two weeks before the “crash” into DKA; loss of weight, excessive thirst, urination, dehydration and progressed rapidly over 7 days. As everyone here suggests have your uncle see a doctor immediately. The ER and ICU doctors diagnosed me Type 1 with an A1C of 12% and this was confirmed by my Endo Dr and thus I am now part of this community as a LADA. Who knows whats going on here, but bottom line, go get checked, get some advice and maybe avoid this type of experience.