So what is the practical difference between a Type 1 and an insulin-dependant Type 2?

I finally got a solid diagnosis right before Christmas, after first being diagnosed as “some kind of diabetic” right before Thanksgiving. I’m a Type 2, but because my insulin production is at the very lowest side of normal according to a c-peptide, doc has informed me that my pancreas is going downhill and I will probably be totally insulin dependent within a couple years. I asked if that meant that I’d be Type 1 at that point, and he said “no, you’ll be an insulin-dependent Type 2.”

OK, great! But what does that mean? I’m lucky in that I don’t have the struggles with weight and exercise that a lot of Type 2s have - I’m not overweight, I’ve exercised regularly for many years, and going lower-carb hasn’t been too difficult as I’ve always tried to eat whole-grain unprocessed food. I almost wish I had a few pounds to drop because I’d love to have some hope that I could control this without insulin, but endo pretty much said it’s not gonna happen, at least not to the level it needs to be (even eating next-to-no carbs in a day and 2000 mg metformin, I rarely see <200 blood glucose, I’m taking Lantus now once a day and hopefully will get better control soon!)

Sooo… not too many lifestyle changes I can make, and I am making the ones I need to (that is, I’m resisting the Christmas cookies, and eating fewer carbs in general). What else do I need to concentrate on as a Type 2? Or should I just assume that despite the name, the advice given to Type 1s apply more to me, or at least will when my pancreas totally goes kaput?

As far as I know, Type 2 means that you are insulin resistant. This means that your body doesn’t use insulin properly, resulting in high blood sugars. Having high blood sugars for extended periods of time damages your ability to produce insulin. This usually takes time to occur.

Type 1’s are insulin deficient, meaning they don’t produce enough insulin. They usually aren’t insulin resistant, but can become insulin resistant.

Because you are insulin resistant, you will probably have to take higher doses of insulin than a Type 1.

Welcome Barbra. Type 1 diabetes is an autoimmune disease where one’s own body fights against the beta cells in the pancreas that produce insulin and kill them. That person must then inject insulin. Type 2 diabetes is a package deal usually (but not always) including insulin resistance, central obesity, hypertension, (high blood pressure), high cholesterol. Many of these people can make lifestyle changes, and/or take oral medications and eventually insulin to control diabetes. The insulin does not make them type 1 because that is an autoimmune disease. Type 1.5 or Latent Autoimmune Diabetes in Adults (LADA) is a type of type 1 diabetes that come on slower in adults but requires insulin within a couple years.
Practically, if you need to take insulin you may pretty much do things the way someone with type 1 diabetes needs to do them. I don’t know what your age is but you mentioned being active, not being overweight and the metformin doesn’t seem to be working. You may want to ask your doctor to check for antibodies, especially since he has already determined that you don’t have much beta cell function. Hope this helps.

I am not LADA/Type 1.5. I discussed that with my doc, which led to a visit to the endocrinologist, where we discussed LADA in more detail and did a c-peptide. Because the c-peptide is still in the “normal” range (barely), his official diagnosis is Type 2, not LADA. He was certain enough of this that he did not feel it necessary to run an antibody test.

I asked the endo if he had many patients like me - that is, no family history, not overweight, etc. and his answer was he has patients who run the range of massively obese Type 1s to thin & active Type 2s. He said he cannot predict what type of diabetes a person has by looking at them, and although many Type 2s have weight/exercise/eating issues, it’s by no means universal.

And that’s what leads to my question. So much information for Type 2s involve diet and exercise, and though it’s good information, I pretty much have resigned myself to not being able to control my levels that way. So I’m just wondering if I should pay more attention to the advise given to the Type 1s or if there’s some major difference between Type 2s w/Insulin that I have to keep in mind.

When people have very little insulin production of their own, then they must provide all of the needs (both basal and bolus) with insulin injections…usually Lantus (basal) insulin and a fast acting insulin like Novolog, Humalog, or Apidra to correct high blood glucose levels and carbohydrates in meal. This involves having a target BG range, a sensitivity factor (how many mg/dl one unit of insulin will lower BG) and an insulin to carbohydrate ratio (how much insulin is needed for the amount of carbohydrates eaten). Which is exactly what people with type 1 diabetes must do.

Hi Barbara,

Yep, count those carbs & keep exercising. Exercise really helps to keep BG down & increases insulin sensitivity for most people regardless of the type of diabetes. Type 1’s tend to see a BG increase & then a drop from strenuous workouts, so we test frequently during exercise.

Seems somewhat short-sighted that your doctor didn’t do an antibody test. Mine didn’t either until I insisted.

Hope the Lantus gets you where you need to be. If the Lantus doesn’t help your fasting morning numbers, talk to your endo about taking two doses–one in the morning & another right before bed. No matter what they tell you, Lantus doesn’t last in most people as long as they say.

Dear Barbraw.

You would be the fly in the ointment for one my Doctors who said it’s all your fault just loose weight it will be fine. You could look up Diabetes self there was a blog that said 10% of type 2 have autoimmune disease like type I. You should never never have BG near 200. In addition to the Lantus you need fast acting insulin right now to inject before you eat. The amount will be a function of the grams of carbs you eat. You will have to find out yourself how much for each type meal. Also the fast acting insulin is good for fine tuning the BG if it does not go down to something reasonable like 140 (the perfectionist say less and when you are experienced you can try for lower), 2 hours after the meal. The metformin if your body can stand it is ok with insulin. May make the control easier.

As with all diabetics exercise the more the better is good. Type 2, if you really are, the BG will not drop to dangerous levels during exercise as it can in type I as long as you dont have any fast acting insulin action pending. A good book is :" Using Insulin". A nice long read.

Heh, yeah, exercise. The crazy thing is - this past summer, I was incredibly active. Bought a new mountain bike, was out on it 3-4 times a week for a minimum of 75 minutes each time. And this wasn’t just riding easy on a nice flat sidewalk - I was on dirt, sugar sand, rocks, hills, etc, and came back home a muddy, sweaty mess. Before I went to the doc for a routine physical in November, I’d have said I was the healthiest I’ve been in my adult life. So much for exercise!

That said, I’m certainly not going to give it up. The snow prevents me from biking like that, but we have snowshoes and skis and, when all else fails, a spin bike in the basement. I exercise every day for minimum 30 minutes, and usually longer.

Interesting about the rise then drop in BG from strenuous workouts. I haven’t tested in the middle of a workout, but I’ve tested right after, and it’s always low. How long does the up then down typically take?

As far as antibodies - yeah, I’m sure I could force it. And I might, eventually. For now, I like & trust my endo and my normal doc (an internist) and am happy to follow their advice until/unless I find reason to doubt them.

For the record, he gave me a choice of Byetta or Lantus. After hearing the pros and cons and asking him what he’d do if he were in my situation (answer: Lantus) I went with that.

As far as high BC and fast-acting insulin, I’ve been on Lantus for a grand total of two days. I’m gonna wait and see if it works before I freak out and insist on something else :slight_smile:


What you’re describing sounds suspiciously the same as what I had dealt with. I was diagnosed with Type 2 back in January of '04. I had recently been sick (about 3-4 months prior to the diagnosis) and had lost a bunch of weight without doing much to lose it. I was by no means overwieght prior to the diagnosis. When I was being taught how to use my meter, my first BG test was “HI”. At first I thought my meter was simply greeting me, but unfortunately it meant that it only reads up to 600 and anything else was, well, “HI”.

What followed was prescriptions of pills…metformin, actos and glipizide, followed by a few “Honeymoon Periods” where everything is great until all of the sudden, for no good reason, your BG’s go into the crapper. I moved to Lantus and pills. Then eventually dumped the pills and moved to Lantus and Humalog. And now finally, to where I am with a pump. All of this took about 4 years.

I can sympathize with your wanting to know exactly how to treat yourself. Your doctor says Type 2, but everything points to Type 1 or 1.5. All you really want to know is what exactly it is that you have. My gut says you are 1.5 and that in the next few years your pancreas will eventually shut down completely. Sorry. My suspicion is that with your first diagnosis if your pancreas is making ANY insulin at all, they will most often diagnose you as Type 2.

If you don’t mind, let me ask you…Were you sick anytime within a year or so of your diagnosis…and I’m talking sick, like “Geez I’ve never been THIS sick” kinda sick? I’ve read that being that ill is sometimes what causes the autoimmune event…your body attacking the beta cells in your pancreas which eventually causes its shutdown.

>>My suspicion is that with your first diagnosis if your pancreas is making ANY insulin at all, they will most often diagnose you as Type 2.

Well, that’s pretty much what it means, isn’t it? The way my Endo explained LADA and everything I’ve read about it says that it’s characterized by low c-peptides. I don’t have low c-peptides, I have normal c-peptides. It’s just at the low side of normal.

And, maybe people will yell at me for this… but does the exact diagnosis really matter? Would my treatment really be all that different if I was LADA versus a Type 2 with somewhat low insulin production? My Endo seems very knowledgeable about diabetes, and if he’s got enough info that he thinks he can treat me, I’m willing to give him a chance.

He’s told me that I’ll be completely insulin dependent within a few years. That would have scared the heck out of me a month ago, but I’ve read enough about it now that I’m OK with it. Heck, given the amount of trouble people seem to have with keeping their BG in check with orals and diet/exercise, I almost prefer it!

>>Your doctor says Type 2, but everything points to Type 1 or 1.5.

I consider my doctor’s diagnosis as a pretty big “point”!

>>Were you sick anytime within a year or so of your diagnosis

I was pretty sick around mid-september, a very bad cold. You know how miserable those can be. But I’ve had pneumonia before, it was nothing like that. But I’ve also read that being ill can cause an autoimmune event. However, I don’t think the timing is right for that… I was already losing some weight, and my A1Cs indicate high glucose for a while before September so… who knows?

Anyway, thanks for the answer! More info is always good!

Question - Type 1.5’s out there – were you all very sick within a few months of your diagnosis? Just wondering. People on tudiabetes told me I’m 1.5/LADA probably, but I haven’t even gotten a cold within the last 3 years.

I don’t know how this works for Type 2’s, but for many Type 1’s exercise can cause a liver dump of glucose. Some Type 1’s go real low during exercise, followed by a high. Other’s go high, followed by a low. Fun, huh? So, we test. Some have to stop mid-way to eat to prevent hypos. A real work-out makes me go high. Regular exercise lowers my BG. The up/down (or down/up) usually takes place over several hours.

I’d have gone with Lantus also. Heard of too many side-effects with Byetta.

Glad you’re not upset at the possibility of being insulin dependent. In some ways, I think Type 2’s have a harder time with all those meds.

If I were you, I’d consider a second opinion. Maybe not right away, but sometime within the next few months or year.

From purely a treatment standpoint, T1 and insulin-dependent T2 aren’t significantly different. The main difference is that you wouldn’t have an auto-immune disorder if it were T2. I don’t know enough about T2, but I find it hard to believe that a T2 wouldn’t have any insulin production at all. Obviously, many have very low insulin production, low enough that they require insulin like a T1, but to have all their beta cells completely close shop just sounds implausible to me.

I don’t know how old you are, but it also sounds odd that a T2’s insulin production would cease within only a couple of years, even more odd if you’re relatively young.

There are plenty of people who don’t get sick. There’s been theories about some association between a virus or sickness preceding onset, but that’s just not the case for everyone.

I was not sick that I recall before my diagnoses as T 1.5…just like you, I had not even had a cold for years.

Dear Barbraw.

Read you description of your mountain biking, excellent, super, fantastic keep that up cause the only down side with insulin is weight gain. You cannot run your body on Lantus alone. You cannot take a big enough dose of Lantus to cover the very damaging highs that you get after meals without subsequently going low a night which is not a pleasant experience as you will discover in due time. You can operate with fast acting insulin only but you have to inject it often. This is what a pump does.

Dear Barbraw.

The only practical difference is on the plus side (I suppose I am a type II , tests were never done) I can do any reasonable amount ( 2000 calories or less) of exercise without any worries about a low as long as I do not inject an appreciable amount of fast acting insulin. On the minus side maybe the type I has less propensity to gain weight because of less insulin resistance.

I’m 38.

The doc didn’t say that I’d stop all insulin production, he just said there was a very good chance it would go low enough that I’d eventually be insulin dependent.

More specifics: the c-peptide I had done was actually 3 readings. The first was a fasting reading. Then I was injected with some form of glucose, and a reading was taken at the 5 and 10 minute mark after that.

My fasting reading was 1.0, where the normal range is .9 - 7.5.

My 5 minute reading was 1.7, where the normal range was something like 1.5 - ?? (I can’t recall, but it was 7 or 10 or something like that)

My 10 minute reading was 1.5, I don’t recall the normal range, but once again I was on the low side.

As far as a second opinion… if I’m unhappy with my treatment after a few months/years, I’ll get one. But it’ll involve a fair bit of travel. My Endo is the only endo within a few hundred miles - I live in a very rural area, luckily my town is the health care hub for a huge region and we do have a pretty big hospital and plenty of doctors. Just not so much on the Endo side. My regular doc is new to me (in fact, that’s why I went in for a physical - I’d been wanting to get into this guy for a couple years, but he’s very much in demand. I happened to meet someone who works for him, and she was able to get me in) but comes highly recommended. We’re pretty sure he saved my niece’s life a few years ago when she had toxic shock because he came up with a very unusual and unique idea at a critical time, and that’s not the only great story we’ve heard about him. So we’re happy with him.

But as always… if the treatment doesn’t work, we’ll keep looking!

To me, I guess what it comes down to is this…You will know in time. We could probably sit here for days discussing the possibilities but the truth will reveal itself eventually. I personally wouldn’t concern myself too much with figuring out which Type you are in order to figure out how to manage this. Use the management regimen that works for you. All our bodies are different and we all will have different ways of treating ourselves. Find the one that works for you. Just be ready to roll with the changes.