In October 2013 I went for a routine physical and the glucose came back at 100. This raised a concern, because one year prior, my glucose was 71 and 79 by lab work (measured twice). I'm 5'1" and in October, I weighed 120 lbs. I've always had a healthy diet, but I lowered my carb intake significantly and what carbs I do have, minimal, are complex, such as quinoa and brown rice. I run regularly, 20-40 miles a week depending on upcoming races, but I also added strength training twice per week. I've since lost 7 pounds, now at 113 and 4% body fat. In January I had an A1C done and it was 5.8, my insulin levels (fasting) <1.5, not sure exactly how low, and the c-peptide was at 1.4 (normal range is 1.1-4.4). The fructosamine level also rose from 170 to 234 in one year. The endo said she thought the insulin levels were low and had I been heading towards type 2, she would have expected higher insulin levels. My cholesterol, HDL and LDL levels are all great, I'm definitely not overweight, and I am very active. My fasting numbers have been slowly creeping up from the 90-105 range in October 2013 to the 105-116 range now. The endo tested for antibodies in January, but they did not show. Is it possible for them to show up later? Did I just happen to catch this early? Both the endo and my regular physician have no other advice for me to lower my numbers. I'm due for another A1C in April from my regular physician. What does this look like? I have no risk factors, no cardiovascular disease, no gestational diabetes, and I'm within normal weight and I'm not on any medication.
Hi Jenny: I actually responded to you over on the DD site. Sadly, on DD, I see the same people always promoting the "you can be young and thin and have Type 2" instead of helping the person/OP with getting a correct diagnosis and treatment. It is highly unlikely that a person is young, thin, and athletic and has Type 2; what is likely is that the person has been misdiagnosed and has Type 1/LADA. Many, many people have come here on TuD with a very similar story to yours. Most are LADA. No amount of exercise and low carb eating will stop the immune-mediated destruction of the beta cells if in fact you have LADA.
I have written several blogs that may be helpful to you. The first is on medical misdiagnosis of insulin-deficient diabetes. The second is my top ten tips for the newly-diagnosed person with adult-onset Type 1 diabetes. I hope they are helpful to you. Best of luck to you!
Thank you Melitta. With not being insulin resistant and not having ongoing high blood sugar issues, I’m more inclined to think LADA. I’ve read your blogs now, thank you for the support. I especially connected with the allowing myself time to adjust and grieve, especially since I felt I was doing everything possible to keep myself healthy.
Getting Diabetes, be it Type 1 or 2, is never your fault, just be sure to keep that in mind!
Good luck :)
Hi Jenny: Glad you found them useful. If you are in fact pre-Type 1, you are certainly in an excellent place to be able to take really good care of yourself. And you are being very proactive and not in denial, which is good. Remember that you need to be your own best advocate within the medical system.
Jenny, be sure to get the full antibody panel, when you get your A1C drawn next month. Show the link to your doc so they know what to order. If you only get the GADA, YOU may be missed many are GADA negative but other autoantibody positive. I was GADA negative but ICA positive.
http://labtestsonline.org/understanding/analytes/diabetes-auto/
Since you are being proactive, I would increase my testing to see just what is going on. It will be useful to have a record of fasting and post meal numbers, if you need to start advocating for yourself at some future date.
Here's a video about endurance athletics and low carbing. While not about diabetes it might help you continue your running and still keep your carbs down.
Thank you.
It sounds like you're kicking some ■■■! If you keep doing that as well as testing your BG regularly and your A1C as frequently as you are, if anything develops, it seems like you're very likely to be on top of it. The upward trends are ominous but, if you don't get diabetes, it's still good to be kicking ■■■. If diabetes turns up, being on top of it is totally the way to go. Keep up the excellent work!!
Although part of me wonders if you were able to get ahold of some under-the-counter meds, it might stave it off but the medical industry is not equipped to process that sort of thing. Brian (BSC) has some great posts about his experience going out of pocket and getting his own insulin in the face of doctors going "you're fine..."
It really does sound more like LADA than anything else. One note of caution, however: not all Type 2s are insulin resistant. I'm not, for example. I am very sensitive to insulin; I just can't make my own.
But based on everything I've read here, LADA has to be the betting favorite.
Isn't insulin resistance the hallmark of type 2, david? I'm sorry if you've mentioned this previously, but have you tested for antibodies and c-peptide? Not making yoru own insulin and being sensitive to insulin are hallmarks of type 1!
LOL - It's the most common pattern, Zoe, but not the only pattern.
See this post.
There are several reasons why long-term T2s often suffer progressive loss of beta cell function. For one thing, many of the commonly prescribed oral hypoglycemic agents facilitate beta cell destruction by increasing levels of a toxic substance called amyloid. Some recent research also indicates that even T2s experience some degree of immune attack on their beta cells. (Bernstein discusses both of these factors as well as others.)
Bottom line: as with nearly all aspects of diabetes, nothing is ever as simple as it seems.
Yes, I'm aware that long term T2's suffer progressive loss of beta cell function. I've never heard of type 2 without insulin resistance, but what do I know..lol. Bottom line is we each determine what is true for ourselves and what works to maintain blood sugar stability...and one can hope also peace of mind! Or is that asking too much of a fickle universe?
I’ve heard of type 2 having low insulin levels after being type 2 for a long time, but I had not heard of it being low in the beginning as well. I learn something new all the time. I’m so grateful for all the help and support.
I don't really know what my insulin production was in the beginning, I never had a c-pep test until many years in. One possibility is that I had some significant IR in the beginning that has since declined, since I am much healthier now in several respects. Without any old test results to compare to, there's no way to know for sure.
I'm also confused when people talk about testing their "insulin levels". Is there some specific test that actually looks at insulin production? I thought the only way to estimate that is to look at c-peptide, a byproduct of insulin production. Maybe that's what people mean when they say "insulin levels"?
I had both fasting insulin levels checked, my value was <1.5 and my c-peptide level was 1.4, range of 1.1-4.4.
Oh, I see, I was thinking this is primarily a test used on Type 2's which would make sense if it is only applicable for people not on exogenous insulin.
If your antibody tests come back negative, then in view of your weight, exercise level, and age, you could ask your doctor about MODY. This is a basket of a number of inherited problems with glucose - insulin regulation. It needs an expensive genetic test for a definitive diagnosis unfortunately.
Unfortunately, diabetes is really a spectrum of conditions, representing a variety of causes and a variety of ways that diabetes can present itself. Most of us are familiar with the defects of insulin deficiency and insulin resistance, but the respected researcher Ralph Defronzo suggests that there may be at least eight defects involved in diabetes. The trouble is that for the most part we can't even test for these defects. In fact, we can't really tell whether insulin deficiency (as measured by insulin and c-peptide) is really beta cell loss or a defect in signalling.
What this means is that unless you test positive in an area that suggests a specific diagnosis, you will be given a diagnosis of T2. Being T2 simply means that you "diabetes of some kind." In the end, what kind of diabetes that you have matters very little, only that you properly manage it.
ps. Are you really 4% bodyfat? Essential bodyfat for women is considered to be 10-13%, lacking essential bodyfat can mess your body up big time. 4-6% is considered to absolute minimum possible for males (such as preparing for a bodybuilding contest).
pps. MODY is a genetic form of diabetes, present since birth, and is unlikely to suddenly appear although it may progress some through the years and decades.