Yes, there is a major contradiction. The whole thing is quite complicated. I believe that Irl Hirsch is actually a member of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, but Dr. Hirsch goes against the Expert Committee, which states, “Although the specific etiologies of [Type 2] diabetes are not known, autoimmune destruction of beta-cells does not occur.”
Some children with Type 1 also have insulin resistance, but Dr. Hirsch doesn’t kick THEM out of the Type 1 club. Dr. Hirsch and his brother, author James Hirsch, were both diagnosed with Type 1 as children. A lot of childhood-onset Type 1s freak out about the fact that most new-onset Type 1 is seen in adults–they want Type 1 to be a childhood disease. So I think Dr. Hirsch is caught up in this weird psychological somersault rather than evidence-based medicine.
It’s important to get the full suite of antibody tests, not just GAD65. The full suite of antibody testing (Glutamic acid decarboxylase antibodies (GADA), islet cell antibodies (ICA), and insulinoma-associated (IA-2) autoantibodies) is the gold standard, and a c-peptide test is also useful. GAD is the most common antibody seen in all people with autoimmune diabetes. If you are antibody positive, by definition you have Type 1 autoimmune diabetes. Most people with new-onset Type 1 still have some insulin production, including children.
I thought I was the only one with this story. Turns out it is way more common than anything. When I was Diagnosed I was pretty much textbook DKA (I lost twenty pounds off my already slender frame; urinating every five seconds by the gallon; and pretty much bed ridden with a mouth so dry that my tongue glued itself to the roof)with a 400+ BG level. They just discharged me two days later with Metformin and Glipzide. And because I was still making insulin I was labeled a type 2.
Well, I had to fight for an antibody test and...SURPRISE...I had GAD antibodies and my PCP still wanted to treat me like a type two because I was exercising good control. I was having good control because, for the past several months, my diet had been so restricted.
Well, as of three days ago an endo FINALLY diagnosed me LADA and put me on insulin and I feel so much better now.
The medical community should really fix itself when it comes to this. I imagine it is MORE common than type 2 because they just diagnose you type 2 on general principle.
Thankfully I found this site or else I might have wound up back in the hospital. I had to fight for insulin. My docs REFUSED to put me on it.
They basically want your pancreas to go kerplunk before they do anything.
Yeah, I totally do now (lol). I made this name when I thought my first doc knew what she was doing. For the last three days, since I've been on Lantus, my BG's have been beautiful and I'm eating more healthy. I heart insulin. :0)
Congratulations on a job well done! I was lucky. My primary diagnosed me as T2 but a wonderful nurse/CDE saw the 425 on my first finger stick, realized how out of it I was and sent me to the ER. She also told me in passing that I would not only be using Lantus but also Humalog before meals. That was over my head at the time but she clearly was making at least a tentative T1 diagnosis. Of course, nurses aren't allowed to diagnose so it took a couple more days and a second ER visit for everyone to figure it out.
Wow, that is a really interesting...and scary article, Melitta! Thank you for sharing it. I agree that I am going to have to look further out - such as Springfield. Boston is 2 hours away, and I would love to find someone a bit closer, if I can.
Thank you for the suggestion, info and support! My GP is a good doctor, but doesn't know very much about the intricacies of insulin therapy and hormone interaction (she seemed surprised that I have to take different doses of Lantus based on where I am in my menstrual cycle) so that isn't going to be an option. As you said, an endocrinologist is a must.
