Hi - I just discovered tudiabetes, as I have been trying to figure some things out.
Basically, my question is: do I have this straight?
I am either a Type 2 or a Type 1 (LADA).
If I’m Type 2, then I have insulin resistance and the oral meds (Janumet/sulfonyurea) should be helping lower my numbers by helping glucose get into my cells (they’re not).
If I’m Type 1 (LADA), then the same oral meds are blasting my pancreas trying to produce insulin that it is increasingly unable to do, and I would be WAY better off on insulin, especially while I still have some beta cells as backup.
My dr (GP) is unaware of LADA and has referred me to an endo, but I can’t get in until March. I want to ask my GP to do a c-peptide test and then perhaps put me on insulin – OR, if my c-peptides are higher, then I’ll go back on the oral meds to some extent. I am wanting to lower my numbers with low-carb dieting and exercise and keep other meds to a minimum.
Surely my doctor knows what c-peptides are, right? Do they do those tests on Type 1s to find out how much insulin they are producing?
When I was diagnosed diabetic 11 years ago I dont think my doctor even heard of late onset type 1 diabetes. You were put on metformin and they wished you good luck. I found the metformin was not really working so I went on a diet and lost weight down to my high school best and at my most athletic at 18 years old.
I did 1 hour of heavy exercise per day. Unfortunately did not do low carbs because it was not politically correct at that time but ate an extremely deprived calorie diet which is also somewhat good.
What ever I did I was not evr able to get BG below 110. which is much better than 200 but not a good sign. You wonder if i would have been allowed a small amount of insulin if my pancreas would have been saved.
Drugs like Avandia and metformin reduce insulin resistance.
Sulphonylureas force your own pancreas to make more insulin. Some people say this burns it out, who knows for sure. I really detested this medication because you have no control compared to insulin. It forces your own insulin production even when you dont need it and not enough when you need it. Fast acting insulin is much better.
Januvet I have never taken.
You wonder if there is such a thing as a pure 100% type 1 or type 2 diabetic. There certainly is insulin resistance and cetainly there is loss of pancreatic capacity. But I think it is rare to have no pancreatic function and no insulin resistance and only insulin resistance and over producing pancreas. Most people end up with a bit of both problems.
I think c-peptides are related to insulin production but maybe checking autoimmune anti-bodies is also required to be sure, cause some so called type 1 still have insulin production. Conversely it is possible to have the worst of all worlds and have little insulin production and insulin resistance. These people need prodigious amounts of insulin.
If you are a very mild diabetic you may cope with diet: low carbs and low calories and exercise. Mild meaning pancreas working and not too much insulin resistance. Metformin a good drug for those on whom it works. With very mild diabetes sulphonyl ureas may help. Otherwise insulin therapy, low carbs, exercise. High carbs and insulin may lead to massive weight gain.
Sorry for rambling on, other readers feel free to correct or to add, no problems.
Hi Rebecca! Sounds like you have a good grasp on things!!
Your doctor should know what c-peptide test is. Another way test that might help is GAD antibody test. Most (but not all) type 1/LADA test positive for GAD antibodies. This will tell you if you have an autoimmune reaction that is causing your diabetes.
It’s good to be proactive about this because many people with LADA are misdiagnosed as type 2’s (even by endos).
Also, you are still producing some insulin… so even if your c-peptide is high now, but you should have it tested later too… to make sure that it is not decreasing!
Are you testing your blood sugar at home? What are your fasting numbers like?
The C-peptide test will give you a very rough idea of whether you are producing insulin. The other tests which are usually done for LADA are islet antibodies or GAD antibodies.
I would never assume anything about what a GP knows. They have a limited amount of time to update their knowledge and if their interest is not diabetes, they may have received no new education about it since they were in med school. If that was 20 years ago, forget it
If you are not responding to Janumet or a sulfonylurea it is very likely you have LADA, especially if you are normal or near normal weight and have any family history of other autoimmune disease.
Eating low carb will work as a stop gap, but if you see your blood sugars getting worse over the next couple weeks despite the diet, you must insist on getting a prescription for insulin. Your doctor would be likely to give you Lantus. Start out with a VERY low dose. My doctor was not aware of the Type 1.5 forms of diabetes either. He wanted to start me out on 10 units which is a very low dose for an overweight Type 2. I started off at 5 out of caution which turned out to be enough to get me hypoing. You’d want to start off at 2 and work it up every few days.
I am testing at home pretty frequently. Fasting BG has always been high. I have done low-carb with and without drugs, regular diet with drugs, and my numbers don’t change too much. Right now I am not taking my drugs (but eating LC) and my BG throughout the day is 180ish before meals (or LONG after meals), and up to about 260+ even two hours after a meal (low-carb).
I have not noticed a “response” to Metformin (and I’m on the Januvia/Metformin combo drug). It doesn’t seem helpful at all and never has … nothing noticeable anyway.
When I went on the sulfonylurea last fall it was .5mg/day and my sugars started going down … and then they KEPT going down until I had some lows that really knocked me for a loop. I think the lowest I measured was 59, but those are hard to come back from! Anyway, I just stopped taking that. Obviously I am producing some insulin or the sulf wouldn’t be able to do that, but I felt like the drug had side effects too and if I really just need to supplement my pancreas with insulin shots, then hey, let’s do that.
As my numbers went up, my doctor said “I don’t know what to do with a skinny diabetic” (which is overstating the case somewhat, but was nice to hear). But in other words, weight loss of about 35 pounds (I’m 5’2") had no impact on my numbers … in fact they continue to go up. I was able to keep them low with low-carb/ex in the beginning (2.5 yrs ago), but now it doesn’t seem like enough.
I think my doctor will cooperate, she is a really good doctor, just as you say, a little uneducated!
In my opinion (thought I am NOT a doctor), you should start on insulin as soon as possible!!! Or perhaps try some different type of medication.
These are way too high for fasting numbers.
Is there anyway that you can get into the endo before March??? Is it due to the endo’s schedule or insurance issues?
If it is because the endo is too booked, I think that you should call and express an urgency. Tell them that your fasting numbers are above 200. You need to change your treatment soon. I don’t mean to alarm you, but I know that it doesn’t feel good to have numbers that high and it is not good for your body either. I hope that you are able to see an endo as soon as possible!!!
You sound like a LADA. It took me 10 (from age 42 to 52) years to graduate from diet and exercise, to orals, to orals plus Lantus, to Lantus plus Humalog, to finally a pump. I’ve never had better control Get a referral for an Endo and go see them. They’ll diagnose you correctly and get you the treatment that works best for your situation. My regular doctor was amazed how i progressed over the years and had never heard of LADA or type 1.5. See an expert!
Even the experts may not see LADA. My Endo still says insulin resistance based on my tummy grease only when weight loss did not do the job completely,and Avandia and Metformin did not work at all. Some insulin resistance for sure but insufficient insulin is the much greater problem.
Stay on a low carb diet with the insulin. This is a make fat drug so use as little as possible to keep your BG in the normal range. This sounds like a shoe that is big on the inside and small on the outside. Kind of contradictory. If weight gain if a problem for you latter on the low carb is a must. Also you can use exercise too.
