Type 1.5 question

I’m going to try to keep this supremely simple.

I had the c-pep test and antibody tests done last month. My c-pep came back at .4 (normal range: 1.1 - 5.8) and my GADA came back within the normal range. My islet cell titer came back negative, but my insulin autoantibodies were double the highest number in the normal range indicated by the lab. The test was done after a sixteen hour fast.

Does that sound consistent with a LADA diagnosis? Will a non-fasting c-pep value increase? Could the insulin autoantibodies be caused by the basal insulin I’m injecting?

My next endo appt. is 7 August. I’m sure she’ll cover all this with me, but these are the questions I have, and I’d like to have some input from you guys.

eta: I was diagnosed with diabetes more than ten years ago, and started on insulin over six years ago.



Sure – you do not have to have GAD antibodies … but do have insulin antibodies.

Were you diagnosed as type 2? Yes only 4 yrs without any insulin, you are 1.5.

Yes, it certainly sounds like you are Type 1.5 to me. Four years before you needed insulin is a good stretch but not beyond the range. The GAD “within normal range” indicates Type 1.5 (or Type 1). Type 2’s do not have antibodies at all. I’m assuming you were looking to do a differential diagnosis between Type 2 and 1.5? Your c-peptide is quite low indicating you are not making much insulin. This tends to indicate Type 1.5 as well, but ten years past diagnosis is less clear as Type 2’s do have decreased insulin production.

Well, you could still have some resistance and need an oral med too. Despite it being so early in the game for me, I do suspect I have a bit of both. I would like to stay on metformin, only a lower dose, because I do think it has helped my appetite (or maybe it was just losing the spikes by low-carbing … ?).

But yes, I too really want the whole story of what happened!

Connie, I’m curious because you say “If I even look at a piece of bread, I need short-acting” and that your glucose is not managed. The standard of care is a basal/bolus regimen and while some people manage for awhile on just basal, it sounds like you are ready for the MDI. Don’t look upon short acting (bolus) as a failure to eat correctly but as the normal treatment for someone with little insulin production of their own. With a c-peptide of .4 this is what you need imho. Also that is a high basal rate so I think Linda is right that you have insulin resistence as well as insulin deficiency. Do you have weight to lose? It would probably help that resistance and lower your basal rate if you did this.

Hang in there, Connie. Your story is painful, both in terms of having docs (and your own mom!) tell you that this is all your fault and you’re not trying hard enough! I know Linda will have a few choice comments on that subject! Also, you are right, the moving around has interfered with your continuity of care, but that is nobody’s fault either. I have a close friend who works for the VA as well as a Type II friend who gets his care there. I haven’t been all that impressed with how up to date their info is. Do get yourself a book like Using Insulin or Think Like a Pancreas and learn to do Insulin Carb ratios because your doc might give you just a set dose or at best a sliding scale. Good luck and give yourself a break please!

Connie, <<>>

What a long and rocky story … and sounds oh, so familiar! I think you, like I have got “elements of both.” The main thing now is to focus on treating both. There are tons of oral meds for insulin resistance and the right one would help you get your insulin dosage down. I hope you are settled in one place for a while, and can get an Endo who will work with you and find the right one.

Do you keep your own medical records? Having them would help you and the Endo find a protocol that will work.