Newly re-DXed (kinda)

[GeishaGirl]

So, I've rediagnosed myself. My endo is hesitant to DX me as a T1 because my insulin levels are "normal" even though my GAD levels are "very high". I forgot to mention that my GP put me on Glipizide, and I was on it for the c-peptide -- which would explain a "normal" insulin result.

My risk factors for T2 were high, sure, but I was DXed at 26 -- very young, and I've since dropped 40 pounds but problems have only gotten worse.

My risk for T1? VERY BAD. My mom AND her father are both T1s, and I did some research and found out that while passing T1 on is less for mothers than fathers, the risk goes up exponentially if the mother gives birth before 25 (yep).

So I'm on shots now. I'm actually really grateful, and really happy about it. I'm thankful I spent my childhood watching my mom do this same thing (with outdated and VERY LARGE needles -- mine look invisible in comparison!) and that a liver infection 10 years ago made me lose my fear of needles by having blood drawn every week for months.

My job is VERY cool with the sudden change. I'm not embarrassed about it, so I'll just slip into a corner in the English office and have a quick injection in the tummy. If I'm wearing a dress and have to hike it up to hit the tummy, the Dept Chair said I could kick him out of his office any time for the privacy.

Sugars have been soooo much better, but that's another post entirely.

[Psycho Penguin]

So you are taking insulin while your sugars and insulin levels are normal and you're not a T1? isn't that dangerous?

[GeishaGirl]

It's what the doc gave me. The oral meds were literally doing nothing. My daily sugars were in the 400s and I saw the letters HI a few times a week, even on a low-carb diet. On insulin, I'm in near-normal ranges, with mid-200s being high.

And my point was that I think my insulin levels are "normal" because I was on Glipizide, which forces the pancreas to overproduce. I'm *probably* producing 30-50% of a normal person normally, but the Glip upped it to "normal" and that's when I was tested. I want another c-peptide soon now that I'm off Glip.

[KCP]

Hmm, i wouldnt call sugar levels of 400 or high normal, penguin.. :P
Welcome to the T1 side :)

[BlueSky]

Hmm, i wouldnt call sugar levels of 400 or high normal, penguin.. :P
Welcome to the T1 side :)
Insulin levels were in the normal range, but blood sugar was high. It sounds like the doctor was a bit clueless ... :o .

Anyway, congrats Amanda on getting it sorted. With you being GAD positive, insulin is the only way to go.

[mortis505]

If its possible, It might be time to look into a new Endo.

Glipizide is in a class of drugs called sulfonylureas. It is used to help control blood sugar levels. . It causes the pancreas to release insulin, which helps to lower blood sugar.

Now I have read that these types of drugs(sulfonylureas) will increase beta cell burnout. Which in a Honeymooning T1/1.5 will mean a shorter honeymoon.

The biggest clue IMHO should have been the presence of GAD. T2 will NOT have GAD present.

[lilituc]

Your GAD antibodies were positive and the dr still thinks you're not Type 1? I think I'd get a new doctor.

Well, actually, I guess I did.

[mortis505]

A few things you may want to show your "Doctor."

Type 1 diabetes is an autoimmune disease, so 80 to 90% of the time when Type 1 exists, the person is producing antibodies characteristic of Type 1, such as the islet cell antibodies and GAD 64 antibodies. The blood can be tested to see if any of these antibodies are present. If antibodies specific to Type 1 are detected, the person already has or is likely to develop Type 1 diabetes. These tests are currently used in the DPT-1 trial to test relatives of those with Type 1 diabetes and detect who will develop this disease.

C-peptide: If other tests fail to indicate the type of diabetes, a C-peptide test can reveal how much insulin the person is producing. C-peptide is half of the precursor molecule to insulin that is split off when insulin is produced by the body. If C-peptide is normal or high, Type 2 diabetes is likely. If the level is significantly low, Type 1 diabetes is likely. If the level is near normal but low, the results are inconclusive. This person may have early Type 1, Type 1.5, or long-term Type 2. When external insulin is controlling the blood sugar, the C-peptide may read low due to suppression of insulin production by the beta cells. This test should be done after insulin has been reduced or discontinued, and the blood sugar has risen to 200 mg/dl or over.

Type 1.5 is one of several names now applied to those who are diagnosed with diabetes as adults, but who do not immediately require insulin for treatment, are often not overweight, and have little or no resistance to insulin. When special lab tests are done, they are found to have antibodies, especially GAD65 antibodies, that attack their beta cells. This sort of diabetes is sometimes called Slow Onset Type 1 or Latent Autoimmune Diabetes in Adults or LADA.

About 15% to 20% of people diagnosed as "Type 2" actually have this type. They are often diagnosed as Type 2 because they are older and will initially respond to diabetes medications because they have adequate insulin production. The treatment the person is first put on may be diet, exercise, and standard Type 2 medications.

A misdiagnosis is easy to make when the person is older and responds well at first to treatment with oral medications. If someone does not clearly fit the model for Type 1, they may be mistakenly placed on oral agents even though limited capacity for insulin production remains. The immune system's slower and more selective attack on the beta cells allows these cells to function to a high degree for a few years. On average, insulin is required in half of those with Type 1.5 diabetes within four years of diagnosis, compared to over ten years in those with true Type 2 (Endocrine Practice, v7 n5, Sept/Oct 2001, pgs 339-345).

As insulin production falls, insulin becomes necessary to maintain control. One clue that people have Type 1.5 rather than Type 2 is their appearance, which is more likely though not always slender and physically fit. They often do not have other signs of Type 2 diabetes, such as the Syndrome X cluster of high TGs, low HDL or high blood pressure. Luckily, in these early stages, diabetes treatment is not significantly different for slow-onset Type 1s compared to truly insulin-resistant Type 2s. The only exception is that drugs designed to increase insulin sensitivity like the glitazones do not work because insulin sensitivity is normal.