type 1 or type 2?

[tony_acunar]

I was recently diagnosed with diabetes, its been quite confusing because i was put on insulin and i kept going too low with 1 unit of lispro per meal... and 4 lantus at night. so, now im off the shots and just taking pills, i know what you are thinking... "hes in the honeymoon period" but... i did a glucose tolerance test and my pancreas is still producing insulin, 60% less than what is should, but im still producing it.. so i did a special test called the anti-gad test to check for the anti bodies that attack my pancreas and it came up negative. Is it at all possible that at one time, my immune system was attacking my pancreas and now it just stopped attacking it and it willjust stay at this 40% capacity? and i might just stay on the pills? regenerate? i dont know, and i am confused, aswell as the doctors.
-thanks
tony

[dbc]

If you don't show antibodies, then you're not T1 - at least that's my understanding.... So that means you "have" to be T2, I guess. Maybe you should tell us more about yourself - age, are you overweight, how much do you exercise?

I was misdiagnosed as t2 a year ago, and found it very confusing because I wasn't overweight, and had a frustrating time trying to manage bs levels on diet and exercise, nothing I did had a significant effect on bs levels. I've since been diagnosed t1 from the antibody test, but am not on insulin yet because the disease in in the early stages & I'm still producing some insulin. Apparently late onset t1 (I'm 53) progresses much slower than juvenile onset t1. I'm on Metformin at the moment - the Dr is not quite sure how to treat me, and when exactly to start on insulin.

So you're not the only one confused by this disease! The more you read this forum you'll find that almost everyone has a different experience of this disease, and has to work out for themselves how to manage it as best we can.

goodluck
Dave

[DeusXM]

You're T2. As for why your pancreas is producing less insulin, it's not an immune reaction because otherwise you'd have lost the whole lot. For one reason or another your islet cells have simply stopped working (proabably genetics and/or lifestyle), and since you're still producing insulin, you'll probably just need to go onto tablets and modify your diet.

[Funnygrl]

I beg to differ. I think your a type 1.

I just read an article on this on the wonderful childrenwithdiabetes.com site. It basically said that antibodies are only correct 60-80% of the time, so it's definately possible that you are type 1. I would imagine you are with the insulin decrease. With type 2 you would be making more insulin than normal, because of the insulin resistance. Since you still have some function left I would imagine you are in the early stages and you can expect it to decrease more and have higher insulin requirements.

Fore now, taking small aounts of insulin may actually increase the amount of time your pancreas continues to make insulin.

[ksa01]

I am a type 1 diabetic--all the tests confirm this, but I still produce some insulin 4 years after being diagnosed. According to my endo, there are some people like myself where most of the insulin producing cells in my pancreas have been attacked and therefore no longer produce insulin, but some cells are somehow immune to the attack and continue to produce insulin.

He says there is no explanation for why this occurs, at least none that doctors can identify. From what he knows, he thinks it is very likely that I will always have these insulin producing cells, but they will not multiply or rengenerate and therefore never be capable of producing enough insulin so that I no longer have to take insulin on my own.

If this is the case for you, as you say you are producing insulin just less than you should be producing, you need to take insulin on your own to regulate you bs. Pills don't produce the insulin you require, they just enable you body to effectively use the insulin produced by your pancreas. My doctor also said that agressively managing diabetes with insulin can prolong the "life" of the cells that are still producing insulin.

Ultimately, you and your doctor need to figure out what the best form of treatment will be for you. This should be based on you daily bs readings as well as results from A1c tests.

[tony_acunar]

I am 19 years old, I am at my perfect weight, I am also relatively active(go to college, and work at the stock room in target).. so i definately do not fit the profile for a type 2, i know, but what if i had the auto immune desiease and then one day, it just stopped? i dont know, ahh!!!!

thanks againnn
-tony

[middnite03]

i
ya know thats the second post today that you insulted someone around here like that, the other being that someone should die to do the human race a favor??? people here are asking for help and talking about treatments and idea, must you be like this???

[lgvincent]

Mr. Sugar's post needs to be removed.

[Harold]

Mr. Sugar's post needs to be removed. They have been and he has been banned. Thanks everyone for the notices.

tony_acunar From what I have read Type 1 has been classified as an auto-immune desease, hence the anti-bodies, and Type 2 as not producing enough insulin. The type2 classification covers both resistance and/or not producing enough insulin. For various reasons, not all understood, beta cells do wear out prematurely. Normal to see beta cells to wear out in the very old not in the young. Is it possible for the immune system to crank out an anti-body and then reduce that output to undetectable levels, sure. So will you be on pills forever, maybe but our bodies get use to chemicals and stop responding to them. For now all you can do is take care of yourself and you will be able to live a long and healthy life. Ignoring this condition makes life miserable.

[Funnygrl]

From childrenwithdiabetes.com:

"Type 1 Diabetes Mellitus
Type 1 diabetes has been subdivided into:

* Immune-mediated diabetes (Type 1A). This form of diabetes results from a cellular-mediated autoimmune destruction of the beta cells of the pancreas. Markers of the immune destruction of the beta cell include islet cell autoantibodies and other antibodies. One and usually more of these autoantibodies are present in 85 - 90% of individuals when fasting hyperglycemia is initially detected. Also, the disease has strong HLA associations.

* Idiopathic diabetes (Type 1B). Some forms of Type 1 diabetes have no known etiologies. Some of these patients have permanent insulin deficiency and are prone to ketoacidosis but have no evidence of autoimmunity. Although only a minority of patients with Type 1 diabetes fall into this category, of those who do, most are of African, Hispanic, or Asian origin. Individuals with this form of diabetes suffer from episodic ketoacidosis and exhibit varying degrees of insulin deficiency between episodes. This form of diabetes is strongly inherited, lacks immunological evidence for beta cell autoimmunity, and is not HLA associated. An absolute requirement for insulin replacement therapy in affected patients may come and go.

Type 1 diabetes used to be known as insulin-dependent diabetes mellitus, juvenile diabetes, juvenile-onset diabetes, and ketosis-prone diabetes. "


"Type 2 Diabetes Mellitus
The most common form of diabetes mellitus; over 90 percent of people who have diabetes have Type 2 diabetes. The onset is usually in middle age and in most cases is thought to be due to some form of insensitivity to the action of insulin rather than to insulin deficiency. Many of the people who have this type of diabetes are overweight. Initial treatment is by weight reduction and excercise with the later addition of an increasing range of blood glucose lowering drugs. Ultimately it may be neccessary to give insulin. Increasingly, geneticists are defining specific subgroups such as Maturity Onset Diabetes in the Young; but to date, this has not led to any change in treatment plans.

Type 2 diabetes used to be called noninsulin-dependent diabetes mellitus, adult-onset diabetes, maturity-onset diabetes, ketosis-resistant diabetes, and stable diabetes. "



So my understanding was that if there is not enough insulin, it's type 1. It doesn't have to be no insulin at all.

[jeggeman31]

I am a type 1 diabetic--all the tests confirm this, but I still produce some insulin 4 years after being diagnosed.

I am in the same boat Karen is. I think Karen hit it on the head 100%

[tony_acunar]

I am measuring my glucose 2 hours after i eat, and it is usually at 150, +- a few units, do you guys think thats a decent number to be at?

[kimbo]

Hi
I am not 100% sure what type i am at the moment.Today i asked about the antibody test but was told they tend not to do them here in the uk as they are expensive.So as i understand i am sitting on the fence to see what the tablets do and i assume for how long and testing for ketones daily.
I was told it is possible i have slow onset t1 as i lost a lot of weight and found diabetes with 26(475) so we will just have to wait and see.
My concern is if i am t1 but am treated as t2 can this have a bad effect on my long term health ??

kim

[liz32]

Just a little note: not all t2's are overweight and inactive: a good many are skinny as a rail..you shouldn't generalize. Thanks

[HeatherP]

Tony, 150 is a good number, especially for some one who's just starting out. The best would be if you could fine-tune it down to under 120 but that's not possible for everyone.

Kim, high blood sugar levels damage your body. That's why we try so hard for tight control. If allowed to go on indefinitely high b/s will cause complications. If you feel your doctor is not agressive enough then it's your right to seek another opinion and/or change doctors.

I would also suggest that if you haven't already you should both meet with a Certified Diabetes Educator (CDE)/Dietician.

Welcome to both of you,
HeatherP

[tony_acunar]

very goood, i just took my glucose levels after dinner, and it was 112 exelent(2 hours after dinner) now..imagine i start exercising ohh my numbers iwll be great,
-tony

[Harold]

From childrenwithdiabetes.com:

So my understanding was that if there is not enough insulin, it's type 1. It doesn't have to be no insulin at all.
Funnygrl, Found it interesesting that childrenwithdiabetes.com defined the types that much. Your post made me go out to several places and none of them went that far and usually gave simpler explanations. The one simple explanation of types I found, which basiclly concurs with your understanding and which I liked was at endocrineweb (http://www.endocrineweb.com/diabetes/).Diabetes is correctly divided into two major subgroups: Type 1 diabetes and Type 2 diabetes. This division is based upon whether the blood sugar problem is caused by insulin deficiency (Type 1) or insulin resistance (Type 2). Insulin deficiency means there is not enough insulin being made by the pancreas due to a malfunction of their insulin producing cells. Insulin resistance occurs when there is plenty of insulin made by the pancreas (it is functioning normally and making plenty of insulin) but the cells of the body are resistant to it's action which results in the blood sugar being too high. However not everyone is happy with the simple definition. As an example; Some would argue that since some morbidly obese people, who produce as much as 8 times what the defined normal levels of insulin, and do not have diabetes. That people with diabetes that only produce 4-6 times have insulin deficiency. While defining problems go a long way in solving them over defining can and does inhibit solving them. So the professionals in control reconize their lack of understanding and are being cautious for good reason even if confuses all of us to no end.

Something I was not aware of and had not heard of before were antibodies present in type 2. From Causes of Type 2 Diabetes (http://www.endocrineweb.com/diabetes/2diabetes.html) Development of Type 2 diabetes seems to be multi-factorial...that is, there are a number of issues to blame. Genetic predisposition seems to be the strongest factor. Obesity and high caloric intake seem to be another. Twenty percent of people with this Type 2 Diabetes have antibodies to their islet cells which are detectable in their blood resulting in the expected low levels of insulin, suggesting the possibility of incomplete islet cell destruction (see discussion about autoimmune diabetes in the Type 1 diabetes section). These patients often tend to respond early to oral drugs to lower blood sugar but may need insulin at some point.

[Funnygrl]

I have never heard of antibodies being present in type 2 either. That's interesting. I really think there are many more types of diabetes than 1, 2, MODY, and LADA. Seems liek more and more are being found with more and more people not being your garden variety.

With the obese people who produce much more insulin, they are on the path to type 2, since there is some obvious insulin resistance going on there.

Yes Harold, I love the childrenwithdiabetes site. It's very informative.

[Nexus]

I was recently diagnosed with diabetes, its been quite confusing because i was put on insulin and i kept going too low with 1 unit of lispro per meal... and 4 lantus at night. so, now im off the shots and just taking pills, i know what you are thinking... "hes in the honeymoon period" but... i did a glucose tolerance test and my pancreas is still producing insulin, 60% less than what is should, but im still producing it.. so i did a special test called the anti-gad test to check for the anti bodies that attack my pancreas and it came up negative. Is it at all possible that at one time, my immune system was attacking my pancreas and now it just stopped attacking it and it willjust stay at this 40% capacity? and i might just stay on the pills? regenerate? i dont know, and i am confused, aswell as the doctors.
-thanks
tony

Hi Tony.

I'm new here but new to DM. I was misdiagnosed myself as a T2 when I had my onset and ended up in DKA. There's a few ways to tell what actual type you are. These are self tests pretty much. It's true, testing GAD sometimes isn't accurate. I'd also ask for a C-Peptide test, that will show how much insulin your actually still making. It's not in percents either.

Thing to think about is this...

How were you diagnosed?
Within the month prior to diagnosis did you rapidly lose weight?
Did you feel like you were starving and ate like a pig and still lost weight?
Did you have vision changes?
Did you take long naps after meals?
Were you nausous and wanting to throw up or did throw up?
Did you go to the ER? Did they take a pH test with the glucose reading?
What's been your highest without insulin and after meals?
How many carbs are you eating per meal?

Once you answer those, then I can help you a bit more if you're interested.

Nexus..

[tony_acunar]

I was diagnosed, because i was rEALLy thirsty too thirsty, so i got my grandfathers one touch ultra and tested my blood sugar.. it said i had 500 so i went to the hospital. at the hospital, i did the test with their machine and i had 360. so thats the highest.
I did not really loose weight, i have always been a skinny guy. I had no vision changes, i always took a nap after lunch, its been my custom all my life. I was never nausous, they did not give me a pH test, i dont think... i am not taking insulin right now, and my numbers are like 112 after eating(im taking pills, avandia and this thing that makes muscles absorb glucose and that slows down the livers glucose production) ... i eat like 5 servings of carbs per meal, and 2 carbs for snacks. I did do a peptide C test and it was 4.1 aafter 2 hours or something. meaning i had an insulin ddeficiency. the thing is , i dont think im not in the ohneymoon peeriod thanks
-tony