So, it’s becoming less and less clear to me what form of diabetes I have, and, while I’m going to try to see my endocrinologist ASAP to discuss this with him and ask him to rerun some tests, I figured I’d throw this out to the community here and see what you think. I’m going to lay out the evidence for T1/LADA and for T2, and if anyone can make sense of it, I’d be appreciative.
Evidence for T1/LADA
Presentation on diagnosis was with ketosis, but not DKA (had ketones in urine and on my breath, but wasn’t having any of the “really bad” stuff.
One blood test showed presence of anti-islet antibodies (80 JDF units). According to an article I saw somewhere on the web, my honeymoon should be long over by now with that load, so I think it may be an erroneous result.
Evidence for T2
- I’ve been off Humalog for over 2 months and keep having to reduce my Lantus (I take 1U if I’m going to be doing really strenuous stuff and 2U if I’m only going to be doing mildly strenuous stuff. On a recent Jewish holiday that involved a lot of dancing and about 2 drinks, I dropped down into the 60s on 2U.) 2 months ago, I was at 6U.
- As I’ve lost weight (down about 50 pounds since dx), my blood sugar control has improved markedly. With the exception of a few days when I had a small infection on my ear, my fasting sugars for the last several months have almost all been below 110, and, when I’m not fighting off this cold, have been in the 93-97 range. With the exception of one or two days, all of my 2 hour postprandials have been below 100. Exercise has also helped, but haven’t gotten as much in the last month because of the Jewish holidays.
- I’m restricting carbs, but my carb tolerance seems to be improving. Meals that would have spiked me in August have no discernable effect (my sugar may be 95 2 hours post instead of 87, which seems to be around my baseline non-morning fasting - that’s what it was at the end of Yom Kippur, which is a 25 hour fast.)
- I seem to have reactive hypoglycemia when it comes to straight sugar - just as a test, I had 8oz of soda yesterday (30 g sugar), which got me up to 137 after an hour and down to 61 after 2 hours. Starches and other carbs don’t seem to have this effect.
- My c-peptide results for a mixed-meal challenge on 9/4 indicated that I still had a very strong c-peptide response. An Israeli physician friend of the family indicated that he thought the results indicated glucose intolerance, which I understand to be associated with T2 rather than T1. The curve suggested to my mom (also an MD, as I’ve mentioned before) more of a resistance pattern than a dead pancreas pattern. Several people on this site felt that it was phase 1 release impairment, with one vote for hyperinsulinemia.
- Blood sugar at diagnosis was 539, which was a 2 hour post of a very high-carb meal. The next day, my first reading on my meter was 360, which suggests to me that there was a decent amount of insulin production. I have no recollection if this was a postprandial or not.
So, anyone, thoughts?