You have mentioned testing your blood glucose and I am guessing it is blood on a strip method? If this is what you have been doing, you might want to try one of the Continuous Glucose Monitors. My husband insisted that I get one 2 years ago when my GP put me on long acted insulin for my Type 2 which likely saved my life because the numbers from it made no sense for a T2 that and I was losing weight w/o trying to. Started doing tests including C-peptide that was around .3 so not Type 2 after all instead LADA. Might give you a better idea of what is going on. Also not all T1 or LADAs will test positive for anti-bodies.
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Just think and be open about doing some counseling as well.
I think the OP is being very measured and looking for insights from us grizzled veterans. I could give horror stories as to how grizzled I am and how his numbers look so puny compared to the fluctuations I see every 10 minutes but there’s no purpose.
You know why?
There have been several other likely-T1’s here who only through extreme exercise and extreme low-carb have been able to keep their bg’s in check for years to the point where they haven’t gotten any official diagnosis or treatment. Because their numbers didn’t quite go past the grey zone and into “prediabetes” they weren’t getting the attention or tests they deserve from the health care system. And the prediabetes attention is usually T2-track, which doesn’t necessarily help in the case of very onset of LADA for example (telling a guy who is eating zero carbs for two years and exercising via 10 miles of running every day and is 6 foot and who only weighs 125 lbs to “eat more healthy and get more exercise” for example.)
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come on, 2 blood tests, his FBG is 88, normal range fasting insulin, A1c is 5.5%. Wouldn’t listen to his doctor and now has an appointment with an endo. I think the grizzly old veterans shouldn’t feed the fears of a vulnerable person.
@jack16
I’m thinking that you don’t get the misdiagnosing problems we can face.
I do. I was overweight, not obese but I was swimming 75 laps 5 days a week and eating a very healthy vegan diet. I had an uncle that was type 1 and I repeatedly asked my GP and my endo if I could be a type 1 and was repeatedly told no and never tested. Luckily medications made me sick and I refused to take them so I was at least put on a long acting insulin after a few years.
My story is not uncommon, one listen to one request that if I could be a type 1 and test me would have gotten me the proper care earlier. I was misdiagnosed for over 8 years, I know of people that have been misdiagnosed for over 12 years. I did not have the proper care for those 8 years. 40% of type 1’s are misdiagnosed as a type 2 at first.
My thinking is while the numbers are not far off normal, he has noticed a change. My numbers weren’t far off either when I first sought the doctor out. How nice it would have been to know at the very early onset. Simple tests would answer the issue. We are not feeding an idea that is impossible, we are saying a simple test will help solve the issue.
In my book it is better to check and find out than to suppress a possibility that might exist. If he were to listen to you and not get tested and it turns out he is LADA how would you feel about that? A simple test is not a farfetched idea.
C-Peptide is not usually evaluated by itself. It is usually evaluated by a concurrent fasting blood glucose. Medicare requires a low fasting c-peptide with a concurrent high fasting blood glucose to be considered type 1 diabetic.
What was your concurrent fasting glucose?
John
2 blood tests 5 weeks apart. A 10hr FBG 88 c-pep 0.79, fasting insulin 4.4 (2 to 20 mIU/mL), A1c 5.5%
also “I want my thyroid checked. The past two winters my hands and feet have been freezing and I’ve been diagnosed with primary Raynaud’s in my feet (not classic but all other vascular issues ruled out). Wondering if thyroid is playing a role in my blood sugar control in addition to effects from my statin”
I most certainly do get that 10% of T2 are misdiagnosed and are LADA/T1, I wasn’t aware that the stat works out to 40% of T1. Without blood tests, we still don’t know you are LADA, but could be T2 who progressed to insulin. If you take a large amount on insulin and are overweight, I would think T2.
His doctors assurances with normal blood tests wasn’t enough. OP is seeing an endo soon.
Feeding his, what seems unfounded fears in the meantime, is doing him a disservice.
If you were classic type 1, your fasting c-peptide would be low and fasting glucose would be high. In your case everything is low. Maybe thyroid has something to do with it or maybe pituitary problems. You need a really good endocrinologist. Make sure they run a Free T3 test.
John
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So that is my other primary concern. I know diagnosing thyroid issues can be complex but I am suspicious that maybe possibly I have some type of under active or slightly over active issue. My hands and feet in particularly have been ice cold over the past 2 years with symptoms of Raynaud’s developing in my feet.
Endo ran some thyroid tests in the blood work ordered but I’m not sure how to interpret. I’d love some feedback on anything I should bring up based on the following:
Cortisol (a.m.): 13.4mg (normal 4-22)
T4 total: 6.9mcg/dL (normal 4.9-10.5)
T4 free calculated: 2.3 (normal 1.4-3.8)
T3 uptake ratio: 34% (normal 22-35%)
TSH: 1.66mlU/L (normal 0.4-4.50)
At first glance all seem normal to me but again I know things can be very complex when interpreting results in the content of the clinical settings and symptomology and history present. My cold intolerance has been quite substantial the past 2 years (but I also
Lost over 50lbs during this span) and I do get occasional light headedness but I am assume that may be from my very tight neck and shoulder muscles. Would love some feedback because I know thyroid plays a huge role in metabolism and possibly may be contributing to my blood sugar
There is likely something else going on with you. Maybe some cardiovascular problems? Consider seeing a cardiologist for evaluation.
John
Why do you say that?
I am currently under the care of a cardiologist for preventative reasons due to family history of heart disease. I am currently on a statin (Livalo, previously was on generic Lipitor and my cardiologist switched me to Livalo thinking the Lipitor was raising my blood sugar). All ekg’s and echo’s are normal and I also had a coronary heart scan last year that showed zero build up.
I’m on the statin because prior to the statin my cholesterol and LDL were both high with low HDL. Based on my dad and his side of the family (all have high cholesterol and some have stents already placed including my dad) and my numbers I’ve been on the statin for the past few years. My numbers have been excellent while on the statin. I will be honest and say that most of my issues/symptoms started around the time of going on the statin.
I go every 6 months for a checkup with the cardiologist and routine bloodwork to keep track on things and that’s why I’m all over the blood glucose numbers and changes. Otherwise I’d have no clue
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Discuss it with your doctor first and consider a trial period without the statins.
John
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Hi. 
I was diagnosed with LADA last summer at age 47. My a1C was quite a bit higher than yours (6.8, I believe), but my fasting BGs were occasionally under 100. My c-peptide was either 0.78 or 0.79, I can’t remember which. But juuuuuuuuust below “normal.” I was quite thin (6’1", 150 pounds). I asked my doctor to test for antibodies, and they came back positive for GAD.
While I was waiting for the antibodies test to come back, I did a bunch of research to try to figure out if I was likely to have T1 or T2. I came across a couple of articles that made me realize that I am basically the poster child for LADA. Those articles stated that there are basically 5 “markers” of a person with elevated BG that makes them more likely to have T1 than T2. 1. Normal to low-normal weight; 2. Under age 50; 3. A family history of auto-immune diseases; 4. A personal history of other auto-immune diseases; and 5. Symptoms. If you have two of those markers, odds are good you’re LADA as opposed to T2.
I have 4 of those markers. Under 50, thin, son with T1, and I have another autoimmune disease. I didn’t have any symptoms, but we caught it pretty early.
I think if you have any family history of autoimmune disease you should ask for the antibody testing. My doctor told me that insurance sometimes won’t pay unless c-peptide is low, but you’ve already jumped that hurdle.
Best of luck to you!
Edit: Here’s the article https://care.diabetesjournals.org/content/29/5/970
History:
The ancients defined diabetes as having polyuria, which always causes polydipsia. They found there were two kinds: mellitus, where the urine has sugar, and insipidus, where it does not. US medical schools no longer teach insipidus to primary care physicians, so the New York Times had a story of a woman who suffered from insidious all her life, and went from physician to physician seeking a cure. Every physician checked her blood sugar, said she was not diabetic, she just had a psychological problem of drinking too much water that caused her polyuria, so she should stop drinking so much water (but she was too thirsty to stop). Finally, after many years, she found a tertiary specialist who knew about insipidus, gave her vasopressin, and that cured her polyuria and polydipsia. Letters to the editor complaining that a physician who had never heard of insipidus was incompetent caused the New York Times to change the format of the column to prevent any such letters in response to future columns: primary care US physicians are not expected to know anything about insipidus.
Today, US primary care physicians know about 2 types of diabetes (both mellitus): Type 1 (juvenile) and Type 2 (adult).
In the old days, when a patient came in for a physical, every competent physician would test for sugar, maybe random blood sugar or sugar in the urine (or both). If there was any sugar in the urine, or the random blood sugar was elevated, the competent physician might order a glucose tolerance test: the patient must come in fasting, and the blood was tested for glucose and insulin. Then glucose was administered, and the blood re-tested for glucose and insulin after one and two hours. Type 1 diabetics had no insulin, elevated blood glucose fasting that rose much higher after the glucose. Type 2 diabetics had insulin (fasting blood glucose might be normal or elevated). After the glucose, both insulin and blood glucose rose rapidly to above normal levels.
My endocrinologist informs me that the old glucose tolerance test is now considered obsolete by the most up-to-date physicians: the modern test for Type 1 is antibodies. This is a much better test, because it is more expensive than the glucose tolerance test, and can detect Type 1 that requires treatment even when the patient has normal blood sugar and insulin levels.
In my home town, we had one physician who had far more patients than any other physician. He always tested for blood glucose. If blood glucose was more than 100 mg/dl or 5.5 mol/L, he diagnosed diabetes; if blood glucose was less than that, he diagnosed hypoglycaemia. In either case, the patient had to go on a strict and somewhat complicated diet, maybe take some medications, and come in for a check-up every two weeks, so he earned far more money than any of the other physicians in my home town. While his patient outcomes were not as good as those of the other physicians, by the modern standard he was, by far, the best physician in my home town!
All of your levels look great. Keep in mind, if you are eating low carb, you are requiring relatively little insulin from your body, compared to most people who eat higher carb. So being barely under the reference range (which is prob not based on people doing keto) makes sense and might not be pathological whatsoever, especially when paired with a glucose level indicating the level of insulin production is entirely adequate, so there’s no need to be producing any more (which is what would raise your c-peptide). It’s only concerning if c-peptide is low and glucose is high, because that means your body needs more insulin, but is for some reason unable to produce it. If your body is meeting its needs, the system is functioning.
Given that your current blood glucose control is based on a very tight diet, and your family history of T2 and weight loss with the diet, it seems entirely possible you do have some form of prediabetes or early T2 that would be evident if you went back to eating higher carb, but is currently diet controlled. Given that you’re essentially already treating diabetes on the lifestyle front, I don’t think it’s possible to know exactly whether you’d meet criteria, unless you want to do a glucose tolerance test or go on a carb binge for a few days while monitoring the results. While a non-diabetic should have some flux in response to carbs, they should be able to tolerate that and return to baseline levels pretty quickly, whereas if you have some impairment, you won’t. The good news is that whatever is going on, your current lifestyle is managing it very well, so doesn’t seem to be anything else you need to do on that front for the time being if you plan to stick with your current diet, except probably repeat those labs at whatever interval you and your dr decide on to keep tabs on things.
Raynaud’s can be its own thing. It can also be a symptom of many different autoimmune disorders, chronic Lyme disease (which a positive Lyme titer indicates but a negative Lyme titer doesn’t typically rule out, since most Lyme tests aren’t comprehensive), and lots of other stuff. So hard to interpret that part of things, but would not assume it’s an indicator of endocrine problems.
Ok Dre:
I need to add my 2 cents, my history, and my thoughts. In 2014 I started having high blood pressure and had fasting glucose in prediabetic range. A1c was 6.4. Unfortunately, my doctor gave me blood pressure meds and just shrugged at my glucose. “People can stay in the prediabetic range for a decade or more” she said. Fast forward 2 years at a point when I was under extreme stress and had a physical. Fasting glucose was 290 and A1c was 9.2 - yikes! I researched and went on a keto diet. Fasting glucose went down to normal and A1c down to 5.4 (without metformin or any other drugs). In retrospect it is pretty amazing how keto kept my glucose in check. Of course at 60 years old, I had been diagnosed as type 2. I thought I had “reversed it”, but over the next 3 years my fasting blood sugar and A1c gradually increased to prediabetic ranges (often over 110 and 6.1). I got a lot of my information from the Diet Doctor website- highly recommend for technical medical information (including cholesterol and statins). It was from there that I got the idea to have my doctor check for LADA. It was frustrating that I was maintaining a strict diet and exercise, but my glucose control was slipping. Lab results indicated that GAD antibodies were very highly positive (off the chart at >250) insulin was about 5, and c-peptide was 0.8. Clearly a case of LADA. Started seeing an endocrinologist who said I should just stay the course with diet and exercise with glucose in the prediabetic range. I suggested insulin, but he didn’t think it necessary and it could give me hypoglycemia. In retrospect, I wish I had been more insistent. A little over a year later, my fasting glucose was sometimes over 170, A1c 6.2. He still thought that was good control, but this time I insisted on insulin and started on a long acting insulin (Levemir). So for the last 3 weeks I have titrated up the a dosage which is making me satisfied with my glucose control. Average glucose of 100 over the past week - this would be a A1c of 5.1, and not a single incidence of hypoglycemia.
Long story short - I had similar numbers as you after my initial diabetes diagnosis when I was on a keto diet, but I was clearly diabetic when I was on the standard American diet. I did some tests to see if I was really diabetic after “reversing” it with a keto diet. I ate a small bowl of steel cut oatmeal and had my glucose shoot up to 200.
My thoughts: get tested for LADA. Do a little testing yourself by eating carbs to see what happens to your glucose. Get insistent with your doctor, as low carb eating can hide diabetes. I wish I had pushed for insulin a year earlier because the sooner you start insulin, the more you can maintain some beta cell function for a longer time. I fear my betas are almost all gone now. The standard of care for diabetes in the US is quite lax. As long as A 1 c is less than 7 they are happy. Personally, I think that is too high and inviting complications, particularly if there is a readily available way to get better control. Of course, as the years pass, I may have more difficulty keeping this control depending on the trajectory of my diabetes. Good luck. You are starting out well taking charge of your health!
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Thanks so much for the many responses and pieces of advise I’ve received. My consultation with the endo is scheduled tomorrow and I will certainly bring up LADA.
I do take solace in the fact however that my A1c and fasting blood glucose have been in the normal range (and sometimes just crossing the prediabetic threshold) in the presence of this lower c peptide. That generally gives me a positive feeling towards my situation. If my A1c was running higher I’d be much more scared/concerned. But as some of you mentioned my diet could be masking things and that’s where the gray area for me comes into play. The whole idea is to maintain control of your health while you still can and while it’s still predictable and I thank a lot of you for recognizing my efforts in doing this. Hopefully tomorrow’s consult is informative and substantive. I’ll update everyone on what transpired
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