Insulin by Type and Question about Resistance

[zoelula]

Hi all:

I had my first visit with an endo yesterday and thought I would have some clarity, but I am more confused. I'm still trying to sort out if I'm Type 2 or 1.5 (she had me re-do my c-peptide of .38 because she didn't trust the lab and the antibody tests are not available in Guatemala). But my new endo said a couple things that make me wonder if she knows what she is talking about. Here are the things I need clarification on:

Am I correct in thinking that Type 2's generally need more insulin than type 1's or 1.5's because although they produce less (or none) themselves they don't have any resistance? (She said the opposite)
I'm trying to decide if I can trust this person at all! Thanks.
Zoe

[Subby]

Hey Zoe. My opinion from just observation (so hardly expert) - just too much variation. With type 1 we are talking very low needs "just because", to very high needs "just because" and through added insulin resistance. With type 2 you run the gamut from obviously no insulin at all, to a small amount, to a large amount, to a huge amount. Variation between people, not only natural progression.

I just don't think a generalisation works either way in any useful way without clarification. Why was this raised, was it to support a hypothesis or argument?

[zoelula]

Yes, it was raised because she was telling why she thought I was not 1.5. Initially she thought I was because my c-peptides are so low (.38). Then after we talked she said that she didn't think so. I asked why and she said because I benefit from such a low dose of insulin (and go low very easily). When I said isn't this indication that I AM Type 1.5 that's when she said no, Type 1's need much more insulin (because they produce little or none). It also came back around when I mentioned resistance and she asked why I thought I had no resistance and I said because I needed only a small amount of insulin, and too much knocks me hypo.

[Subby]

Don't you love fencing with a doctor when the ground becomes treacherous with silly assumptions?

it doesn't sound like she understands or admits the existence of type 1.5 at all. Or even a substantial honeymoon, given those assumptions of instant extremely high insulin requirements. That's just ignorant, and is a major bummer.

As for the point you made about just a little insulin causing you hypo, I honestly don't know if your suspicion is reasonable that it indicates a lack of resistance. I mean, it sounds fair to me to cause suspicion, but I just don't know enough about if this can reasonably occur for a type 2 or not, or how to find out. That "just because" factor I mentioned in my first post, (basically, variation between body factors, bits of resistance, etc) means that what is 1 unit for one person may act like 5 units for another, even between type 1s. Resistance likewise has extreme variation. It's all so variable...

She's still taking another cpeptide? Perhaps that is something to wait and see if it convinces her to look more carefully and closely at this, rather than forming premature conclusions. Sorry it didn't go better. It may still be a step up the ladder to clearing it up.

[zoelula]

She did acknowledge that my c-peptides seemed to indicate Type 1 (she obviously was not well acquainted with 1.5) but said she didn't trust the lab where they were done. I did it again at her lab and should hear soon.

[zoelula]

Thanks, Subby. She did seem reasonably open on 1.5 (or too polite to say if not). I understand some docs admit the concept just don't give it a name. She did seem cautious about increasing doses so maybe she will treat me safely whatever she thinks. Lack of knowledge about 1.5 is to be expected in a Third World Country but if she doesn't understand basic facts of diabetes then I won't feel all that safe. I'm trying not to get too frustrated but will just wait and see what the new results bring.

Meanwhile I'm gathering consensus on the whole Type 1 and Type 2 insulin dose thing (though I do hear your point that it might not be so black and white).

[Subby]

No problem. The reason I might come across a little harsher than seems reasonable, is that honeymooning is an initial phase of type 1 that is extremely common. Basically, it is a time when BG may have gone haywire enough to prompt a diagnosis of type 1 (or other symptoms have led to diagnosis), but insulin use may be minor or even negligible from what will become the "full dose" later on when production pretty much ceases. A honeymoon can last up to a year or even longer.

My main problem with her insistence that type 1 is proved by high insulin requirements, is not the vs type 2 argument, and not so much the lack of consideration for 1.5, but more ignoring or not mentioning the very common honeymoon period (she must be aware of it... surely). Just a bit of a concern both for honeymooners and for the quality of the decision making. Keep an eye on what she says ;)

[Ategeler]

I agree with Subby. It is a shame that they do not offer the GAD antibody test b/c that would settle it once and for all. Is there some other way you could get the test done?

[xMenace]

Don't be too quick to judge doctors. They generally do not freely give out their knowledge, rather they try to brush us off with curt answers. If you dig deeper, you'll probably find you are actually on the same page.

New type 2's often start on small doses of insulin because they still make some of their own. Similarly with type 1.5's. Type 1's usually plunge right into high insulin requirements.

Many type 1's have high insulin needs. Insulin resistance is not monopolized by type 2's. IMO insulin dependance can and does easily lead to metabolic syndrome.

[zoelula]

The only way I can get the antibody tests is to go to the U.S. I'll probably be doing that in September. Thanks, xmenace, I think I've been confused about that. Her comment then would make sense if she is considering whether I'm Type 1, but she obviously doesn't know about 1.5. I'm waiting for her to e-mail me my results and her recommendations and go from there.

[BlueSky]

With such a low c-peptide, T2 seems very unlikely to me. But as long as you are being treated with insulin, it really doesn't matter what type you are. It is just a case of using as much insulin as it takes to maintain satisfactory blood glucose control.