The "what type am I conversation?"

I know in the past we have discussed the fact that what type one falls into is far less important than lifestyle, management and activity. I agree that it is, however after reading a lot of information I've grown curious as to what exactly my future, more permanent method of management will be; ie wearing a pump forever, taking oral medication or taking slow reaction insulin. I know that many variances of Diabetes exist, with many variances within those variances, I also know that I was found to be positive for antibodies or having antibody markers, from my understanding this means my body's cells are self destructing or will eventually fully self destruct until I know longer secrete any insulin on my own, or Type I.

My treating facility has lightly and CAREFULLY suggested Ketosis-Prone type 2, even though I still show markings of Antibodies, I told them how could that possible if I have the markers, they said it has happened in the past, B cells(?i think) start working at normal rates indefinitely and we cannot explain why, all we know is that some people's reaction to insulin therapy is overwhelming to the point that they must be taken off it as they can normally maintain sugar levels for months or years.
I regularly join in on chats and when I exchange A1C results with the others they are in shock that I could maintain such lows numbers with such little management.

Also, I left my last pens of Lantus at my old job, so I went about 5-7 days with no insulin at all(keep in mind I only take 10 units a night), consumed carbs, sugar and never broke 160 2 hours after meals and rapidly went back down to between 80-120. While I know the honeymoon phase can last 6 months to a year I'm at my 7th month and my most recent result was 4.90.

I want to be very clear, I am past the phase of preferring any type of Diabetes, my only focus is management, this is strcitly out of curiosity and the sake of discussion. I know very little about Diabetes considering how complex this disease is. My only intention is to hear opinions, learn more from your reactions, and perhaps verify some information I've found on my own.

Thank you all

Whatever type you have needs to be managed. You will learn what works and does not, and it is best to concentrate on your own results. I don't know what information you are trying to verify, but if it is from the internet and the DOC take it with a grain of salt. I have read some inane and even dangerous suggestions from time to time.

The title of your post will cause some be prepared. For my own type of diabetes, I would need to go back to my old job and get that Lantus pdq. If your goal is to verify your type, you will need to find a doctor who knows a thing or two.

I was diagnosed with Type 1 at age 9, had a very rapid onset (only a few weeks of symptoms) and had a honeymoon that lasted about three months (I was never able to stop insulin, but control was much easier with a much smaller insulin dose). I have read that for kids diagnosed, the honeymoon tends to last for a few months up to one year. For adults, I've read that it can last for literally years. So you could very well still have adult-onset Type 1 with such good numbers and A1c seven months in.

The honeymoon stage is different for adults (and individuals). My guess is that because the immune system of children is in overdrive, their T1 diabetes comes on much faster and is probably more complete. I was diagnosed at age 41, it was at least 4 years from the time I had significant symptoms to the point at which my body's insulin production became minimal. I tested positive for the 5-6 antibody type tests I was given and am now completely insulin dependent, so my T1 is pretty clearcut.

I feel that with good medical care I probably would have been diagnosed as diabetic 5-10 years earlier than I was. For years, I had chronic athletes foot, dandruff issues, some infection type stuff that was very slow to heal (my old PCP should have made the connection). I had all these chronic health issues that went away when my BG was managed. Okay, so I got my misdiagnosis of T2 via an emergency room trip on Jan 1, 2010, and it was still 2 solid years before I absolutely needed to be on insulin, and then my honeymoon stage really wasn't entirely over until about the 3 year mark (after diagnosis).

Also, with late onset T1, some of the beta cell production loss is probably the result of burnout, so by getting on insulin therapy early and doing a good job of managing your BG, you might be able to extend out your honeymoon even further.

Personally, I'd probably try to stick with the T1 diagnosis, continue insulin treatment, and see what happens a few years down the road. A T2 misdiagnosis can stink.

I agree with you that labels of different types aren’t important… Lots of others on this forum passionately disagree. I would caution you though to not become complacent during the honeymoon period. My results were exactly like yours… But the trend has slowly become more and more insulin (after 2 years). That’s not the worst thing in he world though. I still have quite a bit of beta cell function left, after having been diagnosed 2 years ago with a1c over 11. I believe tight control helped allow some form of “recovery,” as it sounds like it has for you too. I often wonder too about what will the future hold with this, but reality is just that there’s no way to know, so just manage, maintain tight control, and enjoy life to the fullest

Actually, knowing what 'type' one is is important for insurance reasons, if nothing else. What antibodies did you test positive for? What was your fasting cpeptide? Do you have a family history of type 2, do you have any of the standard metabolic issues which are factors for type 2, i.e., overweight, high blood pressure, high cholesterol, family history, etc...? Have you seen an Endocrinologist? Why are you taking insulin if they think you're a type 2 and apparently, don't need it? Have you tried orals? What were your numbers when diagnosed and symptoms, if any? Did you have ketones when diagnosed, what level?

Yeah, the insurance thing is big. The T1 diagnosis immediately opened the door to getting a CGM, pump, and the number of test strips I actually needed. I'm not a fan of the T2 meds. Metformin gave me stomach issues and depleted my B12 vitamin levels which was likely giving me headaches when I was taking it.

Hi Chuck: Actually, your "what type am I" conversation is quite simple. If a person is diagnosed with diabetes and is autoantibody positive, as you are, the person (you!) has Type 1 autoimmune diabetes. That is by definition of the Expert Committee on Diagnosis and Classification of Diabetes Mellitus. I just wrote a blog about slowly progressive Type 1 diabetes, and my top ten tips for the newly diagnosed person with adult-onset Type 1 diabetes may also be useful. Best of luck to you! As others have said, I would also encourage you to practice tight control via exogenous insulin--the longer you can maintain whatever remnant beta cell function you have, the better your health outcomes.

I was diagnosed at 34, weighed 130lbs 6’ tall, placed on pills to start with but after a week became to ill to function or walk and was placed on insulin. I was antibody positive 10 years later, but now 27 years later my new tests say that I’m antibody negative and my c-pep is undetectable with normal lab testing…what kind of diabetic am I…???

A few antibody tests are not always going to be the acid test for a T1 verses a T2 diagnoses.

Hi John: Well, your tests are still completely conclusive! If, after years of Type 1, you have no measurable c-peptide, then it would be downright strange if you still had autoantibodies. The autoantibodies indicate that an autoimmune attack is occurring. If there are no beta cells, no c-peptide, there is no autoimmune attack and no autoantibodies. That's why it's good to do the autoantibody tests for diagnosis, when there is question or uncertainty, but after many years there's not really a point. Autoantibody testing may not be perfect, but it is close, and for people who are misdiagnosed, the testing can literally be the difference between life and death.

I was diagnosed type 2 and type 1.5. I had no family history of any diabetes and no signs of type 2 such as metabolic syndrome. I was already obviously in dka and in an emergency situation at the time of diagnosis and I nearly died due to the misdiagnosis and the wrong treatment. There is every reason to want to know what type you are so that you can receive the best possible treatments for you. I'm not really sure why anyone has a problem with this. No one would say we don't care what type of cancer you have and neither should you, lets just treat it according to X. It is very rare for type 2 to go into dka at diagnosis and honeymoon's can last a long time in many people, children and adults, so since you had all the antibodies, you went rapidly to dka, and you I guess have a low c peptide, I'm guessing you're type 1, but I could be wrong of course. I hope you get this figured out and have the treatment you need. I would treat by keeping your bg as close to normal ranges as possible for as much of the time as possible and try to extend whatever remaining beta cell function you have, which seems to be a lot at this point. Good luck :)

Unfortunately, diabetes testing for autoimmune T1 is not always conclusive. Only 85-90% of T1 patients are antibody positive and significant numbers of patients with T2 and non-diabetic are antibody positive. We can argue that the T2 patients are really T1, but there are many non-diabetics that are antibody positive and never go on to get diabetes. And this confounding goes both ways, if you are antibody positive, unless you progress to sustained insulin deficiency, you can't conclude T1. If you actually return to normal pancreatic function, it may well be entirely appropriate to not just assume T1 and undertake what might be inappropriate insulin treatment. Diabetes is complex, we are all individuals and it can just be very hard to navigate getting appropriate diagnosis and treatment.


very true, i tested positive for both antibodies when diagnosed. last time we checked last year i had no cpeptide left and no antibodies; endo told me the same thing, no more beta cells left to attack.

Great answers from everyone, and great information! I'll update with my status as it changes, for right now any amount of insulin I take is overwhelming, i'll keep healthy and go from there. Thanks again

It gets into a gray area and I'm not sure there are many doctors around who would make the correct diagnosis. The typical doctor probably isn't calling anyone with an A1C below say 6.0 a diabetic. Seems to me that some of the slow onset T1s whose damage is partial will be able to temporarily go off insulin once their remaining beta cells have rested for a while. This is especially true if they have cut way back on sugar intake. The problem is that the underlying damage and disease will still be there.

Then if they go completely off of insulin, they could have a serious event down the road. Yeah, oral meds (metformin) might help for a while, but many have pretty serious side effects, and would not actually address the underlying condition. So IMHO, for practical reasons if someone passes the antibody tests, I'd still want them to have the T1 designation, and if meds are needed, I'd go with insulin first and then maybe add oral meds only if they had a lot of insulin resistance.

I would think knowing what type is important for treatment and OP im glad youre trying to figure out whats going on with you!

I was T1 from 1984-2009, when we moved. Somehow one of the clinics changed me to T2 (not the endo though, perhaps my utilization of immediate care or something...) so then the LocalHealthNetwork has had me as T2 since then. I guess it didn't affect the endo stuff (pump parts, TEST STRIPS!!) but it sort of made me wonder. I finally noticed it when they upgraded their "My Chart" thing and sent them a note and got something about "send a request to your doctor through blah blah blahcakes" and blew that off because well, there are more interesting things on the internet than MyChart.

I had my yearly physical yesterday and the doc, who I like a lot, really fantastic health care provider, said "hey, this says T2, I'll fix that" which I was also pleased with. So I'm back to T1! Of course, perhaps he should have seen it before but I sort of blew him off last year as I had the two bizarro health things and was just fried on going to the doctor after June.

Also, the extended 'honeymoons' aren't very fun and often involve a bit of damage to our bodies. When I got my T1 diagnosis through testing, the doctors quit pushing T2 meds on me while talking about getting me off insulin.

Here's my epiphany on this...

Doctors have a strong bias towards a T2 diagnosis because it is easier to make. Additionally, the treatment of T2s is pretty bad, both from a medical and personal standpoint. Doctors assume that T2s aren't taking care of their bodies (eating and exercise), so a T2 having high BG numbers is normal to them. I was not able to control my BG with Dr Bernstein type dieting, exercise, and metformin, and when I went to a GP and told him my problem, he said 'your A1C is 6.4, you are doing insulin for you.' Because I was new to the area and had to do the new patient waits, it was at least 6 months before I was able to get an endocrinologist to prescribe me insulin. Then it was another year before I got a T1 diagnosis (I had to switch endos and demand the blood tests).

Doctors see insulin as a last resort for T2s, so they want to go through a combination of 3-4 meds (some pills include 2 meds) before starting insulin. So the T2 misdiagnosis they see as acceptable is pretty dangerous.

Finally, I don't see much danger is treating the borderline diabetics as if they were LADA T1s. We're talking 1-2 Lantus/Levemir shots a day. Arguably going on insulin therapy is good for T2s, and if insulin resistance is seen, then add metformin.

Gotta add...

A T2 misdiagnosis is life threatening, and involves both a lot of suffering for the T1 LADA patient as well as a lot of damage to their bodies. A T1 misdiagnosis is an inconvenience, and might even result in better care for the patient.