Hello;
I went to see a new endocrinologist this week due to my A1C being 8.5 and my primary physician wanted me to take more Lantus which I said I couldn't because it is causing me to have rapid drops in my blood sugars. She says that she thinks I am going from type2 to type1 is that even possible? I have not heard this before. I have asked around and nobody else I know has either, and I come from a long line of diabetics. I also take Januvia and Metformin.
No it’s not correct to say going from type 2 to type 1… But many GPs barely know the difference. I suspect they mean becoming “insulin dependant”-- which is a term that is associated with type 1… However an insulin dependant type 2 diabetic does not “become” type 1… That’s something often misunderstood by people who aren’t informed on the topic. Hopefully new endocrinologist will help you get things sorted out.
The endo is the one who said "you are going from type 2 to type 1"? I would find a new endo.
Nobody "goes from type 2 to type 1". However many of us are Type 1's who were initially misdiagnosed as Type 2's usually due to age. There is still a misconception in the medical community (let alone in the world at large) that Type 1 happens to children and Type 2 to older people.
Are you on a fast acting insulin as well as Lantus? What are your usual blood sugars like on fasting and two hours after meals? You need to take both and to balance your doses of each according to your results. If you are in fact Type 1, you should be on a basal bolus regimen of insulin and not on Januvia and Metformin.
Did your endo suggest testing to confirm your type? You need a full suite of antibody tests as well as a c-peptide. Then you will know which type you are and correct treatment can begin.
No she did not suggest typing. She did start me on Novolog on a sliding scale and lowered my lantus from 50 to 30 units a day. She said she didn't think the Januvia was doing anything but she said keep taking for now. Her scale doesn't seem to work or I am not used to it yet because my sugars are dropping even after eating twice it went to 50 and 70, the other times though they raised 60 to eighty points 2 hours after eating. My fasting sugars are coming down though they were over 200 every morning and now are in the 130's to 150's.
Thank you for the information, it is helpful. I have a strong family history of Diabetes and still for some reason I feel like I never really knew anything.
I have been on Insulin since November last year. Started on Metformin in 2008 and then added Glucotrol and then the Januvia and then finally had to start Lantus and take away the Glucotrol. So I don't think that is what she was trying to say. Than you though.
I'm with Zoe...find a new endo...they need to give you the "full suite of antibody tests as well as a c-peptide". There's an LADA/T1 group here that has information on adult onset T1 information. With me, the oral med for T2 I was on was causing lows and highs. When it peaked in my system, insulin response was higher and lows resulted, and when it was cleared from my system, I had highs.
Sliding scales are an old outdated way of dosing; the insulin to carb ratio is the best way. You need to find out how many carbs one unit of insulin covers and than take that amount at your meals; different meals may have different I:C ratios. I recommend the book Using Insulin by John Walsh.
I would do what Zoe says; but I would also go to a new endo, if at all possible. You do not want to start out with a endo who puts you on outdated regimens and had said to you,"You went from a type 2 to a type 1". You ARE now insulin dependent, but then, many type 2's are. The treatment paradigms are different for Type 1's who tend NOT to be insulin resistant; as type 2's are, and do not require as much insulin.
Do check out the book " Using Insulin" that Zoe recommended, then check out a new endo, if you can. Inform yourself about your condition as best you can. YOur relatives may have diabetes, but it is your diabetes and your body. It is ok not to know everything. You will learn, my dear.
God bless,
Brunetta
Like everyone says there are T2s on insulin, some even on an insulin pump. If you wish to see what one looks like just visit my page. It is also possible to be a T1 that was misdiagnosed as T2.
What you need is an Endo that knows the difference. What troubles me is the statement that you are going from T2 to T1. I would be much more comfortable had she said that you have been misdiagnose as T2 and are really a T1. If you choose to stay with this endo at least ask her to do the necessary testing to determine the difference.
All this being said what we may be dealing with here is a poor choice of words by your endo, You should at least find out what she meant because T2 never changes to T1.
As others have said, you don't go from Type 2 to Type 1, but misdiagnosis is really common for people with adult-onset Type 1 diabetes, so you can be misdiagnosed with Type 2 but then the diagnosis corrected to Type 1. Here is a link to a blog that I wrote on medical misdiagnosis of insulin-deficient diabetes. I hope you find it helpful, and best of luck to you!
Definitely find a new doctor. You can't go from type 2 to type 1. Sometimes, not that often, people have characteristics of both from what I have read, and often adults who are type 1 are misdiagnosed as type 2. I was told I was 1.5 and 2, which isn't possible. My doctor was probably more knowledgeable than most but he was a lunatic when it came to not hospitalizing me- I was already in dka when I saw him. He is no longer my doc even though he did give me some good advice about treating my D and diet. He told me about Dr. Bernstein- but he really had no idea about the facts because he said that Dr. B doesn't use a basal insulin or something to that effect, that his diet allows him not to use one. I don't think he understood what a basal insulin is. I have encountered many doctors who have no clue about D, but an endo should have some clue and yours doesn't.
I'm not sure what testing you have had done but you should have c peptide & antibody testing at the least to see if you may be type 1. I have found following a lo carb diet helped me reduce my a1c to normal or near normal levels most of the time.
If you're on insulin, most of the time it is better to stop oral meds and go on a fast acting for meals as well as your basal/lantus for background insulin. This is true whether you're type 1 or type 2.
Hope this helps a bit.
Your endo might not know the difference, but the endo also might just have been trying to simplify things since you are still fairly new to diabetes and have been told for a long time you were type 2. You'll have to figure out which it is.
Really, when we become type 1, our pancreas tuckers out. For some people it happens to some people faster than others.
Educate yourself and don't trust any doctor unconditionally. I see a kidney doc, an endo, and a primary care. Each of them manages something different and they don't communicate so I have to educate myself enough to share information. All three docs have different opinions about the same symptoms I have. Frustrating.
Definitely ask for a c peptide test.
I had trouble with Lantus. I had inexplicable lows in the middle of the night and would wake up in my kitchen eating. I switched to Levemir with split doses and haven't had those crazy lows. Levemir might not be better for you, but it might.
The higher your dose of insulin, the less reliable the insulin acts. I would ask about splitting the dosages, because that might improve your control.
I was diagnosed as a "type 2" diabetic January 2010 at the age of 23 and 100 lbs. My blood sugars were pretty decent for almost a year, by 2011 I was barely eating (maybe 15 carbs a day) and exercising multiple times a day to keep my blood sugar down. I demanded insulin and a c-peptide test to see how much insulin my body was still producing. My c-peptide came back at around 3 and I demanded I go ahead and start on insulin. I was first put on basal 24 hour insulin only and then a month later mealtime insulin as well. Within 6 months my c peptide was zero meaning I did not make insulin anymore and I was rediagnosed as a "type 1".
Also I come from a long line of type 2 diabetics no type 1s. I have been on insulin for three years. Did MDI for 6 months, got on a Dexcom CGM right away and have been on an insulin pump for 2 years.
This is kind of random and I am more curious than anything, but does insulin suppress c-peptide? It seems interesting to me your insulin would go from 3 to 0 so quickly (I thought insulin helped preserve beta cells?).
Yes I believe it does to an extent but I believe my diabetes seemed to come on rather quickly when typically most LADAs can go 2-3 years or even longer without requiring insulin. I would assume everyones beta cells are destroyed at a different rate.