New Diagnosis?

Type 1 and LADA
1

OK. Here goes…

I’m confused, and a bit shocked, but it seems that my endo reclassified me as Type 1 this morning. I say “seems” because the conversation was a bit odd, but he started the conversation with “Congratulations! You’re now a Type 1 diabetic.” Then he said "I’m joking, but … " and went on to describe the lab results that prompted the conversation - making several references like “that is expected with Type 1 Diabetes.” I am assuming the “joking” was about the “Congratulations!” part, therefore.

The change was due to a new fasting C-Peptide test that came back at 0.2. C-Peptide has been tested for me several times with it coming back lower each time. It has never been tested when my BG was high. I was initially tested for GAD-65 AB antibodies, and, when that test returned “negative,” my initial Type 2 Diabetes diagnosis was confirmed.

Note, this changes nothing for me. I am currently taking insulin via pump and use a CGM, due to some hypoglycaemia unawareness. I take no medications, oral or otherwise, for diabetes or any other condition. I’m aware that these things vary greatly between people, but my total daily dose has been recently reduced to an average of 46U/day, due to an improved, low-carb eating approach I’ve adopted. I have no comorbidities, typically associated with Type 2 - or anything else, for that matter.

I’m left feeling uncertain how to think about this. While a diagnosis of Type 1 might improve my relationship with my insurance company, the change in Dx has sent my mind reeling. Is this a response to the relief of getting some kind of confirmation of what I have been saying all along, that my case is NOT typical of Type 2 diabetes? I’m not typical of Type 1, either, really: I never have seen a high over 340, which I suppose is consisted with the fact that my pancreas is making some insulin, if not very much. I have noticed that the spikes I do get have recently become faster, as have the drops, but I am unsure whether or not that is just caused by the my change in diet or physiological changes – or some sort of extended LADA-type honeymoon.

As I said, my head is reeling. Nothing that I have been doing is changing, but I have all kind of mixed emotions and other thoughts. I need a support group.

… good thing TuDiabetes is here!

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Well, in my uneducated nonprofessional opinion, this just sounds like the later stages of T2. It’s not uncommon for T2s to lose beta cell function gradually over time. I certainly have: my last c-pep came in at 0.1. If you’re nontypical, I’m still inclined to the belief that you are a nontypical T2. There are more of us than people (and even doctors) sometimes believe. $0.02

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Nothing has changed… Except maybe a diagnostic code in a chart somewhere. Some docs will do that for the sole purpose of forcing insurance to cover certain therapies. You’re still the same person. You still have the same disease. I wouldn’t read too much into it.

I’ve been told by an endo (not my own) that the only reason to check c-peptide after an initial diagnosis is to appease insurers…

I personally think the type 1 vs type 2 model is ridiculously oversimplified. Diabetes is a spectrum with clear clusters that fit into these little boxes only at either extreme end. People like you, myself, David, and many if not most other people lie somewhere in between.

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And just to pile on one more straw . . .

As I’ve written numerous times, fundamentally I don’t care whether I am Type 1, Type 2, or Type 96. It doesn’t change what I have to do to stay healthy. Kind of like worrying about whether I wear a red shirt or a blue one. At the end of the day I still have to manage my condition to the best of my ability, regardless of what label someone, somewhere feels comfortable with. That is a constant, and the one that actually matters.

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My $0.02
@David_dns
There are SOME places you might worry if you had a red shirt on

Such as if you were part of a Star Trek away team investigating an unknown planet

(My homage to the 50th anniversary of TOS)

But I agree with all three of you fellows.
What matters is the day by day maintenance we all must do, to stay on track with what the D throws at us.

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A very weird remark to say: “that’s great!”

Now of course I would never wish any kind of diabetes on my worst enemy, You are right in indicating that it does make things easier with your insurance company.

Your changed diagnosis does give me problems however. I always justify your great Clarity tracings with the fact that of course it is easy for you. You’re a Type 2. If you become a T1, I am definitely going to have to up my game,

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I think congratulations is an oblique recognition that many blame Type 2s for developing it, which is ridiculous. Type 2 is very complex and there is a lot the medical establishment DOESN’T know about why people develop it.

Once you’re diagnosed with any Type, the real question is, what do I do about it and how will my doctor/HMO give me tools to live and thrive?

Once you’ve got 1 or 2, you now have to eat a healthy diet, exercise & sometimes take medication(s). We have a lot more in common than we are different. Except for David_dns–he’s just weird :wink:

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I choose to interpret “weird” as a compliment. If it isn’t—don’t tell me. :sunglasses:

But seriously . . .

And that is true in no small part because Type 2 isn’t a true diagnosis but a catch-all, a diagnosis by exclusion that includes a number of different profiles. Some T2s are insulin resistant, some aren’t. Some are obese, some aren’t. Some are misdiagnosed as T2 when they are really T1 or LADA, and many of those cases take a surprisingly long time to get straightened out. And even some things that the establishment thought were pretty well settled (e.g., obesity is the cause and diabetes is the effect) are coming under increased scrutiny as well.

So yeah.

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When I was diagnosed I couldn’t even get the Doc to say what type it was. Metformin was prescribed and I started attending class twice a month.

I do have a number of relatives that had type one.

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Thas, sorry that your c peptide is lower… it is good to have the change in your diagnosis whether you are type 1, atypical type 2 or whatever because you will probably have an easier time getting coverage for whatever you need. Most people find it harder to manage things with almost no natural basal insulin.

I don’t think you need highs over 340 to be type 1. There are people who are type 1 usually those who still have more beta cell function when they’re diagnosed earlier who don’t go so high. I was in dka at 279 and 400 is the highest I’ve been. There are tons of people with type 2 who have very high bg also. I met someone who was diagnosed in the 600 range I think- he went into coma at diagnosis.

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It’s not the least bit unusual for a T2 to be sky-high at dx. Many—perhaps most—T2s don’t put 2 and 2 together regarding their symptoms until something reasonably dramatic gets their attention. BG can keep climbing for weeks or months until something gives. By the time I noticed a symptom severe enough to send me to a doctor, my A1c was way up in the teens, so that had been going on for some time.

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I know an acquaintance who was diagnosed with type II diabetes and treated with multiple daily injections. This went on for many years. She ate a low-carb diet and did well with glucose control. Then she moved to a new town and doctor. She had been wanting to try an insulin pump for awhile. Her doctor told her that she’s really a type I diabetic and she soon had an insulin pump.

I had several thoughts about this. I wondered if her doctor was being kind and simply changed the diagnosis so that her insurance covered the pump and the ongoing supplies. I decided to avoid talking about the diagnosis change since I knew it contained hidden landmines. I congratulated her on her new treatment tool and we talked a lot about low carb eating.

Later I thought it was great that her doctor helped her gain access to a tool she needed. I see nothing wrong with that. And who am I to second-guess? Maybe she really is a T1D.

In the end, the label doesn’t matter. What matters is that each of us gets the customized treatment we need to thrive. The label could come into play in an emergency situation but from stories I read here, medical people are often confused about the whole T1/T2 thing anyway.

I agree with Laddie, however. Your BG traces are amazing, something I could only approach with my best day, but stringing a series of best days in a row is not very likely. I’m hoping the artificial pancreas will help me with that. We each need to play the hand we’re dealt. You’re doing a great job with your diabetes, @Thas.

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Thanks for the encouragement, and comments. As I said, I don’t know if this is a definitive test or diagnosis, like a c-peptide of 0.0, or positive antibodies test might me, but it still threw me into a loop mentally – similar to when I was first diagnosed four years ago.

Yes @David_dns, my BG was high at diagnosis, but not sky-high. HbA1c was 11.8 with a fasting BG of 292 – not crazy ER-high, but certainly not borderline. I suppose the difference in the two diagnoses for me is - was my initial Dx late in the game for Type 2, or was it fairly early Type 1 (or LADA) Dx? In some ways, my “ride” so far has been good – I already HAVE all the tools needed at this point to manage my BG, even for Type 1, rather than going the other way (getting diagnosed, and then trying to figure everything out). My reaction is emotional, not rational.

Don’t worry @Laddie, even with a Type 1 diagnosis, you can hang onto the “extended honeymoon” explanation for my good results, if you’d like. I’m not planning on doing that, though – my intention is to do everything I can to keep myself on those good patterns!