Negative Antibodies

Hi, self-tested antibodies in 2020, January, IAA, IA-2, ICA, GAD. All results were in normal range according to doctor’s assessment.

I had a diagnostic OGTT 2 years ago where my BG was 14.2 mmol/l at 2 hours. It came down on its own eventually.

I am trying to add more carbs to my diet but am seeing numbers like 10, 11 mmol/l at the peak with just 40-50g of carbs. It also takes 3-4 hours to come down below 6 mmol/l. My fasting is around 5.2-5.5 mmol/l

Last A1c was 5%. Before the carbs adventure, now it might be higher, need to call Dr. to do it again. I will see an endo in May but am looking for additional guidance. I am able to order tests on my own, I am thinking Znt8, but wonder how useful it might be.

Was the initial OGTT because you were pregnant? (Yes, this question makes no sense for half the population :-0 ).

If the OGTT was the standard 70g carb load and you were at 14.2 mmol/l at 2 hours, and today you are seeing 10 mmol/l with 50g carb load, I’m not sure I could claim that things were getting any worse.

With an A1C of 5% and no antibodies I’m not sure a doc would think there is a problem to be solved. Most docs probably wouldn’t even prescribe metformin at that point. Metformin would help deal with the post-meal spikes.

The SHAPE of the curve is actually the thing that might trigger a docs attention. Maybe doing your own measurements to get a curve that distinguishes one of the below would trigger an endos interest in treating you. image

Hi Tim, my shape would be like the green curve. In fact, it is more severe because the decline only starts around 1h45min-2h after meal. And it declines slowly. And yes, maybe things are not getting worse but I definitely am not normal.

I think rather than running more antibodies tests, you want to document your own bg curve and get to an endocrinologist with your graph.

Here in USA, I think OGTT’s are a little out of favor compared to a few decades ago.

From you using mmol/l numbers I know you are outside USA but not sure what hurdles you might face getting an endo appointment.

I have an appointment on May 14th. A while, but it is also not too urgent right now. Why is OGTT out of favour? From what I could research, the most sensitive marker of the problem is glucose load. Early on, fasting bg is just fine as are low carb meals. It is the carb load that shows a problem.

If you eat low carb, a1c will be low artificially. Carb loading basically brakes the dam.

From reading reports here over the years, many people who are eventually diagnosed as T2D report that their metabolic control of glucose is first lost in the post-meal state and finally the fasted glucose numbers start to rise.

While a positive result for antibodies is a definite marker of T1D, not all T1Ds test positive for antibodies. What’s your reason to suspect that you are T1D and not T2D?

In any case, are you doing anything to treat your high glucose numbers? Hyperglycemia can exact much damage over the years. If you haven’t already, I would at least consider talking to a doctor about starting Metformin.

An early warning measure can be detected if insulin is also measured during the OGTT. Unfortunately, not many doctors order that. If insulin spikes too high and overreacts to a carb load, it shows that the body has developed significant insulin resistance. I think you’re likely past the point to make good use of that information.

I am not overweight, second opinion endo said there is no way I have type 2. All I did last two years was eat low carb and it worked fine. It still works. I went to more carbs because my previous endo said I should but never had courage to do that. I have it now but not happy with results.

Yes, I think my first phase response is very blunt and weak. Something is wrong and at least I have plenty of strips to test with and can see danger coming up. Two years in, nothing happened yet but you never know.

While many T2Ds are overweight, it is not, however, a universal profile. Type 2 diabetes incidence has burgeoned in India. Very few of them are overweight.

Have you had any other blood test that indicates insulin resistance? There is a measure called HOMA-IR or Homeostatic Model Assessment of Insulin Resistance. Click the link for an explanation.

Sure, my last c-peptide was 1.0 (0.9-4.1) range. Note that it was on keto diet, so it could just be my normal. BG was ok.

I know almost everything you throw at me about diabetes tests. I would say that if two endos said it is type 1, and not type 2, I would not entertain possibility of being type 2. I am meeting first endo in a couple of months, to reevaluate. If I am diabetic, (which I think I am), then I need treatment to get on with my life. I am tired of this. Knowing a definite issue would give me peace of mind, even if it leads to chronic disease diagnosis.

Are you inferring that you’ve seen two doctors who gave a T2D diagnosis but you suspect T1D? That’s not an unreasonable skepticism as T1Ds are often given a T2D diagnosis often because that’s almost all of what a typical doctor sees.

A slow onset of T1D, LADA (latent autoimmune diabetes in adults) can be confused with T2D. My diabetes onset was this type.

One of our members has studied this thoroughly and reading some of her posts may help you. Do a search for posts or comments by @Melitta.

Please forgive my covering some things you already knew. It’s hard sometimes to calibrate an answer appropriately. Good luck with your quest to get a diagnosis. Your description of your symptoms suggests diabetes of some type and you are right to be concerned.

I would focus more on what treatment is best for you.

Do you do keto diet to try to control bg? Or would you prefer non-keto with insulin or type 2 meds? (Having a c-peptide test while doing “normal” diet may be more helpful.) Or is your goal to postpone any/all meds as long as possible, so you remain on keto.

As @terry suggested, you will find great documentation by @Melitta.

Here is one

1 Like

You might make sure you eat a real carb-high meal right before your appointment or blood test, so they see your instantaneous bg at 10 mmol/l or higher and decide to start treating you.

(Most endos in my neighborhood do fingerstick bg at start of appointment - but not all do.)

Pretty typical course of diabetes progression is to demand every test in the world for several years hoping for some sort of clarity or better understanding of what type of diabetes you have or a scientific grasp of what’s going on as if that will solve the problem

It remains ever elusive for many of us… that’s just the nature of the beast. We don’t all fit perfectly nicely into specific categories that can be precisely identified.

Ok, will keep it in mind.

I suggest getting a c peptide test and then repeating it over time.
If your levels are decreasing then you will know you are losing your beta cell function.
However either be fasting or carb loaded the same each test because your c peptide numbers will max out when you are loaded.