That’s a big dose of insulin per day
How many carbs are you eaing?
Has your doctor suggested combining Metformin wih insulin?
Hana brings up an interesting point, about doctors getting sued for misdiagnosing someone as having Type 2 diabetes when they actually have Type 1. I am continuously amazed at the sheer number of us who acquire Type 1 diabetes as adults but are misdiagnosed as having Type 2, simply because of our age not etiology. And it is misdiagnosis and malpractice, because Type 1 and Type 2 are entirely different diseases (just unfortunate that they have the same name). The tests exist to distinguish between Type 1 and Type 2, so why do the misdiagnoses continue? Also, I have never heard of anyone in the U.S. suing a doctor for malpractice for making the misdiagnosis–has anyone ever heard of a case?
From what I understand from a couple of doctors with whom I had this conversation, the c-peptide and GADA levels will read the same for a T1.5 in honeymoon as for a T2. High serum insulin levels (above normal for non-diabetic people) are not even an indicator, as the death of beta cells in T2 would cause those to drop below non-diabetic normal, and – depending on the degree of T2 progression – as low as T1.
This analysis makes it sound like the correct differential diagnosis for honeymoon-phase T1 would require genetic testing – which is expensive and not commonly available. Failing that, one needs to monitor and see how the patient responds to standard treatment regimens, and only if/when the patient is nonresponsive to oral medications should GADA levels be checked to confirm T1/LADA.
I think that’s right. The definitive way to distinguish between T1 varieties and T2 would take time and depend on response to oral medication such as sulphonylureas. Metformin could help T1 in honeymoon possibly, as it acts on sensitivity. Thus doctors should never take a risk and firmly diagnose T2 if there is even a hint it might be a T1 type. I would think that looking at the BGs and ketones at presentation should be a clue for close monitoring. BG in a new T1 type can be very high ( above 20 or 360 depending on your units) T2 is likely to be lower, in addition, ketones are often present in T1, but more rarely in T2.
Age isn’t any use as a guide. The oldest new T1 I’ve heard of was about 90 at diagnosis. and there are plenty in their 20s, 30s and 40s. I remember reading somewhere that the rate of diagnoses of T1 is increasing faster than T2
‘I would think that looking at the BGs and ketones at presentation should be a clue for close monitoring’
I suppose It does depend on the stage at which the person first goes to the doctor. It must be much more difficult in the early stages but like Hana I am amazed to read the number of people with dangerously high BG levels who are diagnosed as type 2, given a prescription and told to come back in a couple of months.
I probably left it later than most ( I’d ‘known’ that I probably had diabetes for a long time) but the GP, who I’d never seen before, didn’t waste time. I had a fasting glucose of 380, and by then was very thin. He sent me straight to hospital. I actually didn’t quite understand at the time and thought it must be an outpatients clinic and was a bit shell shocked, when within the hour, I was in a hospital bed on continuous insulin. However, by bringing down my BS in hospital, they were able to monitor my response to insulin,( with controlled carb meals), monitor ketones etc. The docs diagnosed LADA before the results of tests. In retrospect, I assume this was because of my response to insulin ie I didn’t need very large amounts.
The health care system here is sometimes a bit OTT but its bolt and braces approach was for me certainly better than what seems to be the UK approach…
Yea Marie, we do have some horror stories. My own doctor turned green when I told him of one of the people who had written in to Diabetes.co.uk. The diabetes nurse just said “It wouldn’t happen here” and she’s right. Diabetes is a big issue in Britain at the moment. there’s a lot of worry about how much it is costing the NHS and a lot of “Blaming”. It’s inevitable that Healthcare professionals vary in their intelligence and may get caught up in the prevailing wind… I’m certain it can happen anywhere.
The method of funding makes a lot of difference and the registration of all people with a family practice, with referral to specialists being by the GPs and some specialist nurses only, leaves a few cracks for people to slip through. That’s if the medics have good will. Inevitably because they are human, some are just idiots.
My labs said the range was 0.9-4.3ng.ml for the c-peptide. Not sure what that really means and I’m sure there are different ranges for different testing methods. Hope that helps
I was wondering if you show no beneficial effect with metformin at a reasonable daily dose would that not be evidence for type 1 ?
Iff s T1 has any degree of insulin resistance, which is possible, and still has some insulin production Metformin might provide some improvement. I shoul think the effects of a sulhonylurea might be more diagnostic.
Dear Hana.
Then again there are many type ones that use very little insulin showing that the pancreases are still working somewhat so they might have lower BG from the sulfonyl ureas just as a type 2 would. Why do you think a sulfonyl urea would be more diagnostic?
Using antibody testing is the definitive way to distinguish between Type 1 and Type 2. It’s easy and it’s relatively inexpensive. If a person is antibody positive, he/she has Type 1 autoimmune diabetes, according to the WHO Expert Committee. GAD seems to be the antibody most commonly seen in adult-onset Type 1.
That will pick up an autoimmune T1, but not a viral or a pancreatitis
Just that a fully developed T1 probably wouln’t be able to respond to it. I’m just guessing. I’m a retired Science teacher not an endocrinologist. Metformin doesn’t act on the pancreas
My endo keeps it simple if you are a diabetic with some tummy grease and older than 12 you are a type 2. so a science teacher may be better for diagnosing.
I am officially type 2 but metformin and avandia did nothing for the average BG nor for its standard deviation. So I wonder.
Keeping it simple, nearly killed one of the people who wrote for help to Diabetes.co.uk. She was a LADA and ended up in hospital with DKA, only hours from death. We had warned her to go to A&E if she had high sugars and felt unwell. In your case, they may have got it right by good luck.
However, if you are on insulin of any kind, your weight battle is balanced against you, especially if you are on fixed doses and end up feeding the insulin.
Incidentally, Kapusta is Cabbage and Zeli kyseli is Saurkraut. Dogs will eat boiled cabbage mixed in with meat. I couldn’t get a reply on the other thread.
Sorry for the misrepresentation of the Czech language. No sure if they did get it right in my case as the avandia and metformin did not work at all. And loosing 80 lb of body weight and exercising 2 hours per day did not bring the BG into the normal range which it should have if insulin resistance was the only problem. Thank God the avandia did not work since it has been shown to increase heart attacks significantly.
I used a fixed dose of Lantus and vary the novorapid according to needs. The more insulin you inject the hungrier you will become.
Will be switching to Levemir to see if that helps with weight.
I maybe one of those ,diagnosed at age 42 1/2 in 1983 , slim with type 2 diabetes …lost 6 pounds in 5 days ; bloodglucose according to Lab reports 300 plus .Was put on medication ( cannot recall name ) ; had to go to the Lab weekly for a bloodtest and numbers did NOT come down …did urine testing ( not successfull 
) …I asked my Doc to put me on insulin , hospitalized for 5 days …KETONES !! … went through a honeymoon stage with only 2 units of insulin daily and cycling my butt off to keep numbers low . Just my story …and a reasonably happy pumper today .I consider myself a type 1 …C-peptide test was performed prior to pumping to confirm .
tmana wrote: <<From what I understand from a couple of doctors with whom I had this conversation, the c-peptide and GADA levels will read the same for a T1.5 in honeymoon as for a T2. High serum insulin levels (above normal for non-diabetic people) are not even an indicator, as the death of beta cells in T2 would cause those to drop below non-diabetic normal, and – depending on the degree of T2 progression – as low as T1.>>
I’m not sure that’s true. I’m honeymooning in T1.5 but am also T2/insulin resistant and have been diagnosed as T2 since 1978, when in my 20s. The GAD test was only done last month. I have none of the classic T1.5 indicators (I’m about 15kg overweight now, have always had high cholesterol), but am still GAD positive. My c-peptide is now below normal but not zero. So, what those docs said isn’t necessarily true. A GAD test can still be done and be positive without all the beta cells gone. True T2s do not have a positive GAD, but can have beta-cell burnout which can account for some T2s needing insulin all the time.
And I disagree that testing should only be done if response to orals isn’t happening. That’s exactly what happened to me. I’ve been asking for the GAD test as long as I’ve known about it (several years) and both my GP and my Endo said - no way, impossible. I finally beat them down and got the test and it was positive.
There are people like me who will fall through the cracks because they have insulin resistance on top of T1.5, and doctors will make assumptions they shouldn’t be making as 100% certainties.
I’m either on the longest honeymoon on record with T1.5 or I got it years after being diagnosed with T2 (30 years ago). Despite being very young for T2 (28), which is one indicator, back then, diet did help. Really, no one knows how this has evolved for me. But in Australia, it’s the difference between getting subsidised insulin pump supplies (for T1) and not (for T2).
Bobby. Number 1. Stop thinking of it as a disease. Its not. Its just a medical condition one just has to cope up with it. I’m type 2. With my intake of insulin that was increasing with every given week.
I just discovered the easy part then. Start exercising, and learn my limits of EVERYTHING. That cut the intake down and got me back on pills.
Idfinitely agree. diabetes isn’t an illness. It’s a metabolic disorder. I am fitter now than when I was a 40 year old non-diabetic. Resting hear rate below 60