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Originally Posted by mfuller  I was initially diagnosed a little over a year ago as being type 2. I was put on 1000mg of metformin to be taken once in the evening with dinner.
As of a couple of weeks ago I relocated and met with a new endocrinologist. He retested me and my GAD was 6.6 and my C-Peptide was 1.1. As a result of those tests he immediately diagnosed me as being type 1 and took me off the Metformin and put me on insulin.
I have only been taking the insulin for a couple of days, but my blood sugar readings have been unusually high for me...in the 220-230 range 2 hours after meals the last couple of days.
Prior to coming off the Metformin I had lowered my A1C from over 9 to 6.0 over the past year.
Do you guys/gals think my current diagnosis of being type 1 is accurate due to the fore mentioned GAD and C peptide scores?
Thanks for your time reading this and any info any of you may offer. |
I think it sounds pretty clear you are type 1/ 1.5 but that's just a casual observation, if you really had doubt you should seek a second medical opinion.
Now that is separate to what you are talking about with the insulin. The thing about insulin is that if you are not taking the right types and the right amount, you won't have good BG levels. It's a lot more precise than other "meds". While you can pop a pill or two of many meds, you need to find the right dosage and strategy for insulin to work. To do that there are three "rules":
You can have too high a dose (getting hypos)
You can have too low a dose (staying high)
You can have about the right dose. (finding your BG stability)
So, it's never a case of insulin "not working" in that overall sense that it's ineffective full stop. It's a case of not finding adequate dose yet. Insulin dosage is a fine balance in getting good results. Here's an example.
I take approximately 52 units of basal insulin in my pump (effectively the same as long acting). It does a reasonable job in the scheme of things. (This is in conjunction with bolusing for meals). Out of interest, my doc was not prepared to go there because I seem to need a lot of basal insulin (am a resistant type 1), so I had to break with med. advice and push up to find the right amount.
If I was to take 48 units, I would likely be high all day.
If I was to take 55 units, there's a chance I would be having hypos during the day.
So, that's a practical example that if your insulin dosages are not really in the ballpark, in my case approximately 5% of ideal dose, you'll be having general systemic problems.
You need to work with your tester and your doctor to find correct doses. Some doctors approach this as something in their court - you should try a dose for weeks/ months, come back, they will adjust. Others will let you get involved with adjusting and this to me is the only way to go, to be able to be involved in the process and make adjustments yourself (or with a quick call to the doc, etc).
Now, from what I can gather you are just on basal insulin? I guess it might get a little blury in half/half situations where your pancreas is still contributing quite a bit like yours, but it's possible you need rapid acting to go with it, to take with food. If you want the best chance at acceptable control. Without rapid not only will food spike you, but your basal is very unlikely to do its job correctly.
Why did you doctor not prescribe and suggest bolus insulin? I have no idea. Maybe you should ask him. If he says "because I don't think you need it for control", then if you want to play along, I would test that proposition very thoroughly for a few weeks and if you keep spiking up after meals and having difficulty coming down, I would insist on a bolus insulin as well.
Good luck. Not an easy time, once you get a handle on how insulin works and if you keep seeking the best approach, it will get a lot better.
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