I saw my endo this morning. I was sure that my A1C would go up because of 2 encounters with steroids. It’s gone from 5.9 to 5.7! He did a happy dance with me He was impressed with my diet (~30 carbs a day), and my standard deviation (up to 27).
I just read through some of the posts on Manny’s LADA discussion. The lab I went to has ‘normal’ c-peptide levels 1.0-4.4. Mine was 1.2. The endo’s comment was that I’m an insulin deficient T2, probably LADA. When I asked the difference between insulin deficient T2 and T1/LADA, he said there really is none!?!?!? and that ‘some clerk’ had probably decided on the terminology. My next bloodwork will include GAD - my pancreas was fubar’ed by chemo and steroids. When I asked, he said it’s worth doing, I might be surprised. Happy to!
So… the conclusion is that my onset was fairly typical for T1, my tx is typical T1, I never responded to T2 meds, etc., etc. Arrrrrrgh!
Good Grief! Well, welcome to the LADA/Type1 type! What I’ve found is that soon, except for here on TuDiabetes, it’s just plain old Type 1. As usual, my best to you and the furkids.
Well, you should really be proud. A 5.7% is really quite good. I do find your endo’s comments that insulin deficient T2 and T1/LADA being the same a bit confusing. I don’t think they are the same, but who am I to question?
From the perspective that a Type 2 who has insulin deficiency probably also has insulin resistance they are not the same.
From the perspective that at this point the therapy (maybe a deficient type 2 takes some metformin or Actos too) is pretty much the same then really they are very similar. Kind of like “We got here for 2 different reasons but now what we need to do is very similar”. They both have to watch carbs (or cut them out- whatever your preference), we both have to check blood sugars often, we both have to take multiple daily injection or use a pump etc. I personally see way more similarities than differences but that is just my view of the world I guess.
Congratulations on the great A1C. It does seem that if your treatment is working, as it obviously is, type is irrelevant. Depending on your GAD test perhaps you can join Natalie in the type weird club.
MossDog, I don’t usually say this here because it’s not popular, but I think it’s more important to distinguish by tx than by dx. Yes, I know the differences, but I think most of us are a type of a Type, there is no one-size-fits-all. I sometimes get frustrated here when someone posts asking only one type or another to respond; personally I have learned from almost everyone. Part of what I love about TuD is our differences!
Part of the pervasive problem with strict typing, IMHO, is medical professionals. I found out really quickly that if I I don’t say I’m T1, I can get the wrong (if not dangerous) tx. My endo excepted of course.
I’ve borrowed Natalie’s type weird for a while LOL. Maybe we should start a group:)
Welcome to the club, my dear! Some nice, thoughtful comments up above.
I imagine that, for me, 20 years after first indications, a GAD test would be pretty meaningless, so I have decided to ignore that issue. All I know is that I have had 2 CDEs and a few fellow PWDs who are pretty knowledgeable have told me that I’m more like a Type 1 than a Type 2, and after the treatment screw-up last year, I know to tell medical folks that I’m Type 1. I absolutely don’t care what the academics say, I just care about not being killed by mis-treatment.
But yeah, I’m really Type Weird – it’s as good a title as any when I’m among friends!
Thanks Natalie. I’ve been wondering if this is a good gift for the new year
It wouldn’t matter a bit to me what I’m called except for Medicare. I still have 4 years but am really concerned already. Paying out-of-pocket for pump/dex supplies seems daunting.
Hey, I’m closer to Medicare than you are – only a year and a half away. And therefore even more terrified than you are!
Both my pump warranty and my CGM warranty run out before I go on Medicare, and I decided to switch from the Medtronic to the Ping and the Dexcom. The Ping, because it has a food library, and the Dexcom, because I’ve seen a whole lot more positive comments about its accuracy, whereas the Medtronic is OK, but not GOOD! Plus I’ve seen a lot of people comment about how long they can stretch out a sensor – if you only use 2 a month, and they cost $75 each, then that’s $150 a month – not great, but not horrible, either. If I already have the basic equipment, I might be able to manage supplies, and just use the equipment past warranty until it dies. And by then, Medicare may have changed, although it’s a toss-up whether for the better or for the worse.
There is always the chance that my current ins., which will be secondary to Medicare, might cover my stuff if Medicare doesn’t. They are covering an extremely expensive medication for a friend of mine that Medicare won’t cover, and that she will die without, so maybe there’s hope. I just can’t imagine going back to shots!!!
And I’m also thinking about ways to “game” the system – how to make sure that whatever beta cells I have left are thoroughly exhausted, and not producing any insulin when I have to take the C-peptide test. I’m certain that I won’t score high on the C-peptide, but I worry about being JUST above the cutoff for pump coverage.
Maybe I could have my psychiatrist write a letter stating that I need the pump for my mental health?
Love my Ping, but I think I’ve used the food library once. Love my dexcom too, I’ve felt naked the couple of times I’ve left it at home, a lot worse than forgetting earrings LOL
I told my endo today that he might have to coach me on lowering my c-peptide… he said to just run around 60, for an hour or so before. Hoping things will change for the better before either of us gets there!
Jrtpup, for Medicare purposes, you actually don’t have to be a Type 1. The requirement states either autoantibody positive or meets the c-peptide requirement. If you meet one of those two, then you have to meet some of the other criterion, but those are the main two. Someone that is a Type 2 insulin deficient person would qualify under the c-peptide requirement. Here is the link to the manual – I just copied the paragraph about the C-peptide or autoantibody part but you can read all of it starting on page 126.
Continuous subcutaneous insulin infusion (CSII) and related drugs/supplies are covered as medically reasonable and necessary in the home setting for the treatment of diabetic patients who: (1) either meet the updated fasting C-Peptide testing requirement, or, are beta cell autoantibody positive; and, (2) satisfy the remaining criteria for insulin pump therapy as described below. Patients must meet either Criterion A or B as follows:
Kelly, thanks a bunch for that! Don’t know why I never looked myself, it’s nice having a personal research assistant here LOL.
The A & B criteria is easy for those of us already on a pump. This is the part that interests me and the rest of us already pumping:
Updated fasting C-peptide testing requirement:
• Insulinopenia is defined as a fasting C-peptide level that is less than or equal to 110% of the lower limit of normal of the laboratory’s measurement method.
• Fasting C-peptide levels will only be considered valid with a concurrently obtained fasting glucose ≤225 mg/dL.
• Levels only need to be documented once in the medical records.
(There’s another criteria if you have renal insufficiency.) Emphasis is mine.
I’m relieved… the lower limit at my lab is 1.1 and I was 1.2. I think that’s within 110%? (Not enough coffee yet to think.) Can someone who’s awake confirm that?
Danny, if I’m already ‘documented once in the records’ I’ll do the Fudderwacken dance myself, or at least try. No, you can’t watch!!!
I was going to post it the other day when you asked about the fasting part but this didn’t really answer that question. This is kind of why I asked you “why” you were doing the c-peptide! I haven’t had enough coffee either, but if I did the math right (and at this moment, that is very questionable!), then yes, you just made it!
We have tons of personal research assistants here! Someone always has a link if you don’t know where to look!
Did you end up doing this fasting and also have the glucose to go with it? If so, you really don’t need another one when you are ready to move over to Medicare (unless they change their rules again!). Note the section that says it only needs to be documented once. For some reason, some companies are making people get them again. I did have a friend that got her first pump thru Medicare but at that time, her c-peptide was not done fasting. They changed the rules and she had to get another one done with the fasting. Some people had that and are still having to get them and they really don’t need them done again.
He was impressed with my diet (~30 carbs a day), and my standard deviation (up to 27).