You don't sound flip or smart-ass. Keep reading, keep asking good questions ;)
OH, NO apologies at all. I apologize if I came across harsh, sorry..not my intention. I guess it just gets frustrating sometimes when people perceive this as easy, like staying in an 80 - 90 range is something easy..maybe it is for some, for most of us, it's a daily challenge.
i'm sorry you had to come here to this 'site' and join this club...it is, however, manageable and this site really does provide a great deal of support and lots of info too. Dr. Bernstein, I don't know...some love him, some do not. You'll have to make that decision as you go through this. It sounds like you're doing great so far...control is the ultimate goal, no? if you can low carb and keep it under control right now, you're doing great! :)
Thanks jrtpup, I will! I just know how irritating it can be for some newbie to come in and start preaching to people who are living with reality for a long time. I won't find out until Friday for sure whether I have those antibodies, and Friday seems a long way off right now...
Taking insulin early on may preserve basal function in the long run which is what you want. A short vacation from insulin may just give you more problems down the road.
Maurie
I'm not sure why I'm bothering, Type 1, because you don't seem particularly open to hearing information that disagrees with your preconceptions, but it may be of great value to someone else who is struggling with a diagnosis. In general onset is more rapid the younger a person is, and less rapid the older. There are, of course, exceptions to this general principal. I don't believe there are many Type 1 children who are treated with oral meds (nor should they be), and there are also not a lot of pediatric endos that advocate low carb for their children patients. To quote John Walsh that most of us on here look upon as an expert: "Correct diagnosis of LADA is important because insulin treatment will be required much sooner than in Type 2 diabetes. If LADA is suspected, a GAD65 antibody test should be done." and "Adults diagnosed with diabetes at an age considered "too old"for the onset of Type 1 and who do not immediately require insulin for treatment are often told they have type 2 diabetes. For many, this is a misdiagnosis. Their diabetes is actually a slow form of Type 1 diabetes referred to as Type 1.5 or LADA. People with LADA number over 2 million people in the U.S. or double the million or so people with"(classic) Type 1 diabetes.
If it has no other purpose, the term is of critical importance for the very reason you state: giving people the understanding that people like me who are diagnosed in middle age and manage on oral meds may not be Type 2.
I started insulin 5 months after my formal diagnosis (by which time I was very symptomatic), when it became apparent that the sulfs were not going to work, and I STILL have measurable C-peptide after 18 years. I don't know if it was from going on insulin, but let me tell you it makes control easier! Even though my insulin production has definitely deteriorated over the years, and it's harder now than it used to be, nevertheless, I'm glad I came along before all those T2 drugs -- it would have been agony to have had to try them all before being allowed to go on insulin.
I was diagnosed as a T2 in 2005. I found Bernstein soon afterwards, starting on his diet in 2006. I could never attain his goals. My fasting numbers were chronically elevated, not dangerous but high enough that they clearly were not normal (120-140 mg/dl). And I couldn't eat more than 10-15g of carbs with any hope of being under 140 mg/dl at 2 hrs. My A1c was in the 6-6.5% range, all perfectly fine with most doctors, not with Bernstein.
I tried all the medications, eventually trying several triple medication regimes, none of the medications made any noticible difference. I never had much success in getting the right tests. I was granted a c-peptide, it showed I had low insulin. After years of asking, I got a GAD, it was negative. At that point, my endo at the time refused further discussion.
I made my own decision to start insulin. I started early, before I destroyed my remaining beta cell function. I'm glad I did. Today, using MDI I have good control. All that really matters is that you get appropriate treatment. I could go through life wondering why am I this way? Why did it happen? But at some point it really doesn't matter.
Today, even on insulin, I still eat very low carb. But if I am 140 mg/dl 2 hrs after a meal, I consider that great. At this point, I only correct if I am over 180 mg/dl 2 hrs after my meal.
One thing you will realize reading Bernstein is that while he thinks that people with T2 have some struggles with insulin resistance and weight, he treats T1 and T2 essentially the same way. In both cases, he advocates a low carb diet. In both cases, he recommends a variety of treatments. He prescribes a number of T2 drugs for T1 patients. And he recommends early use of insulin. He actually suggests that you learn to inject insulin as soon as your are diagnosed (as a T2), just so you are prepared. And he firmly believes that tight blood sugar control can preserve your remaining beta cell function in all cases.
My personal take on Dr. B's books: they are filled with valuable tips and insights usable by all of us. And he certainly has very tight goals.
But to come away believing that my bg could never be out of the 80's or 90's... again I have to separate "goal" from "attainable". It's surprisingly easy to have the goal be unattainable and then what, is every T1 who ever has a bg above 100 a failure? I don't think so.
i don't believe this is true at all, age has nothing to do with the onset, whether it's rapid or not. I know just as many adults who have been DKA as children, or had a long honeymoon..has nothing to do with age, really. I guess you're not understanding my point, which is...why does there have to be a distinction between a child and adult getting type 1, they don't use a different Dx for a child when he/she may present 'slow onset', not DKA, long honeymoon, it's still just type 1. The LADA just puts more confusion into the mix. I'm not saying it's not true, of course it is, it is latent..but it's just type 1. there's not a latent onset termed used for a child who may present in the same way when diagnosed, they just simply say type 1. that's my point.
MANY children have the same slow progression too and have a honeymoon stage.
That term LADA is a 'new term' used to maybe describe the process but why isn't it then used for a child who presents in the same way say as YOU? Mary Tyler Moore was in her 30's, she wasn't DKA, they found it after she miscarried but she wasn't diagnosed or termed LADA, just type 1. If someone asks, I just say I have what MTM has, type 1.
The spectrum idea is interesting. While the classification of T1 as being a result of autoimmune attack on the beta cells, and T2 as obesity-related insulin resistance is convenient for researchers in studies, it does not take into account the full range of PWDs. You can get a good indication of that range when you observe the people here: there are thin, non-insulin-resistant, antibody-negative T2s, and there are obese, insulin-resistant, antibody-positive, or child-diagnosed T1s. And everything in between. It seems to me that diabetes is just not as simple as the organizations and media make it out to be, and the stereotypes are not helpful in the real world. So, while it may be important to carefully distinguish type in academic studies, it may not be so meaningful in real life. Yes, many people fall squarely into the classic boxes, but a significant number of people do not. So maybe Dr. B has a point.
The thing I like most about Bernstein is his insistence that diabetics are entitled to normal blood sugars. Being a lifelong Type 1 with no beta cells at all, he has nevertheless managed to achieve a remarkable level of health at age 76. I'm also reading about the amount of damage is done at levels even above 90 on a consistent basis. Maybe I am just unrealistic (or stubborn) but I feel that I have to find out whether his 83 number is at all attainable for me at this stage, though I know that the longer term prospects aren't so good. I am not at all attracted to the idea of toggling sugar and insulin for the sake of being able to eat a "normal" high carb (40-50%) diet. Although this ultra-low carb diet is tough, it's a lot easier now that I'm used to it, and I just discovered I can have a couple of pieces of dark chocolate without getting over 100. So today I'm feeling optimistic, and I realize that if I DON'T end up having the antibodies the chances are good that by maintaining a low carb diet I can restore some of my beta cells. That gives me some hope, too.
What I don't like about Bernstein is his insistence that diabetics are entitled to normal blood sugars. It is like saying that people with mild developmental disabilities are entitled to read and enjoy Finnegan's Wake. Harry Potter or even Hemingway might be possible but Joyce...
I wish you only good luck in trying to keep your blood sugar in a twenty point range but I wouldn't get to attached to that goal.
Maurie
I understand. At this point I'm holding on to my optimism. It seems better than the alternative.