[mmillner81]

I was diagnosed as a type 2. I'm 27 and I weigh 144. At the time of diagnosis, my sugar level was 300. I was put on Januvia and glyburide. My AIC count was 9.5
I've been eating pretty good and exercising a lot. I've been eating slow digesting carbs, little fat, high protein. I have cheat days now and then, but I'm working on getting better at it.
I saw my endocrinologist yesterday. I told her my morning levels were 180-200. She still wants to keep me on Januvia and glyburide with and extra does of glyburide in the morning.
I've been reading a lot on type 1.5. I was told my another doctor that I should consider going on insulin.
I'd rather be on insulin. I'm sick of having high numbers. I know insulin can control my diabetes and make me feel a whole lot better
My doctor doesn't want to put me on it and is convinced that I am a type 2. My family has lots of reasons why I shouldn't go on insulin. One of them being that the cost of my insurance will go up if I'm on it
I think it's time for a new endocrinologist who will listen to me.

[BrianSCohen]

MMillner,

I sympathize with your concern. I am struggling with whether I might be 1.5 as well. You don't provide any information on how long you have been diagnosed or exactly what you have been doing to get your diet and exercise in order. Yes, you could go on insulin to get your numbers down in the short term, but in the long term you will be skipping over the two most important primary treatments that are going to make a difference in the long term.

Let me ask you a few questions first.

How many grams of carbs are you eating at day and at eat meal (try tracking with fitday.com)?

What is your exercise regime?

For fairness, here are my answers. You can see my statis in my sig.

I eat 50-100g of carbs a day. With 40-50g at breakfast (oatmeal, prefer steel cut) and the remainder in 10-20 g for the other 4-5 meals.

I exercise with weight training 3 days a week for 1-1.5 hours each, with 2-3 days of cardio for a total of about 3 hours/week.

I still struggle with my morning fasting numbers which can hover above 120 mg/dl despite my best efforts.

You may very well be 1.5. If you end up actually being a type 1.5, your insulin production will be affected. It is certainly appropriate to ask your endo to consider testing for declining insulin production (c-peptite) as well as the tests for antibodies indicative of 1.5. In either case, you basically treat diabetes fundamentally the same. You may very well be entirely right to consider insulin, but you really have to ask yourself some hard questions about this. Insulin will eventually be a treatment for many type 2s a certainly for type 1.5s, but please don't look on it as the first treatment. Your long term health and happiness are best served by utilizing diet and exercise as your primary therapies.

[ShottleBop]

180-200 sounds way too high--from what I've read, any sustained BG of more than 140 increases greatly your chances of developing neuropathy and other complications. If it takes insulin to get to safe levels, that's what it takes.

I have found Gretchen Becker's book, The First Year: Type 2 Diabetes: An Essential Guide for the Newly Diagnosed, to be very helpful.

Another possibility is that you don't do well with a high-carb diet. Do you test much after eating? You may find that even slow-acting carbs raise your blood sugar unacceptably high. (I am pre-diabetic, not on medication--my doctor prescribed a glucometer and told me to watch what I eat. I have found that too much of almost any carb will spike my BG above 140 in the first hour, and have adopted a very low carb diet.)

[mortis505]

Tell your endo that you want additional testing to be done. If you only weigh 144, It sounds more like you are a T1.5/LADA. Request a C-peptide and a GAD-antibody test be done. If she tries to convince you that its not necessary, request a second opinion or find a new doctor. At the very least remind her that its your health and not hers.

[DCaplinger]

What neither of you are saying, is the most important part. Have you had an anti-body test? If you aren't sure, ask! The only way to know if you are a Type 2 or a Type 1.5 is to have an anti-body test done. If you have no anti-bodies, you are a type 2, if you do have anti-bodies, you are a Type 1.5.

Either way, don't ask to be put on insulin... demand it. Tell them it's your care, not theirs. You want to be put on insulin to get your numbers under control. Later, if it's not needed, you can come off of it, but you need to get those numbers down now.

Regards,

[mmillner81]

I mentioned the GAD antibody test to her and she questioned why I would want it. I told her, and her response was that it was very expensive and she wasn't sure if my insurance would cover it.

[Janlaton]

So call your insurnce AND ask if they will cover it. If Yes go ahead and insist on the test. It is your body not the doctors. Like above, be sure you are tracking your carbs and getting enough exercise, you may be on the best med for you and need to take more control for yourself of food and how active you are. I know that is a hard statement, it was for me but sometimes the truth is necessary to hear.

[BrianSCohen]

MMilner,

I was diagnosed 7/05, and finally got real testing in 1/06 with an HbA1c of 8%. At that time, I still had fasting levels that averaged 140 mg/dL and varied between 120-160. By 5/06, my next HbA1c came in at 5.7%, but I had made ZERO progress on the morning fasting levels. It took me until 10/06 before I could get the whole diet thing figured out enough to get my morning fasting levels down to an average of 120.

You may just be hard on yourself. How long have you been diagnosed? Your first post here was only a month ago. A month is a short amount of time. Did you get another HbA1c from your endo? Was it greatly improved? How are your other numbers throughout the day? Are they ok? If your other numbers during the day, particular before meal and after meal are < 120 and < 140 respectively, then you are fine.

If you want to take immediate action on your own, you can just start on what I would term the easy "zero carb" diet. For the next couple days, here is what you eat. For breakfast, eggs and meat. For lunch Tuna and Salad. For dinner, steak and green veggies. If you want a snack, you can eat nuts. This should have an effect within a day on your overall levels. The second thing you do, is get a bottle of "medicinal" dry red wine. Before bed, you have two 5 oz glasses, this will knock down your morning levels.

You can follow up with your endo as soon as possible. It may very well be that you are actually doing great, and that you have made outstanding progress getting your blood sugar under control. I just can't tell. You have to give this time. It may be that a short course of insulin will help. It may be that you are type 2, there is just not enough info.

[DCaplinger]

Originally Posted by mmillner81

I mentioned the GAD antibody test to her and she questioned why I would want it. I told her, and her response was that it was very expensive and she wasn't sure if my insurance would cover it.

IF you are Type 1.5, this is the only way to confirm it. Tell the doc the same thing I tell my pharmacist... I didn't ask what the insurance company said... I asked for the test. If I have to pay for it, I'll do so, and I'll deal with the insurance company later.

The test is a STANDARD, not an exception. Any Endo that would not run a GAD test on any new patient should be questioned. It is a test needed to make a proper diagnosis.

Get the test done, even if you end up having to pay for it. If you are misdiagnosed, the test will confirm it, and you can turn it right back to the insurance company if you are Type 1.5. My own Endo agreed with my PCP with her diagnosis of Type 2, however he agreed the GAD test was necessary, so he ordered it. It proved I was not a Type 2, and I'm now on the correct treatment path. You should insist the doc have a GAD run. Also, I don't ask my doctor what tests he will order... I tell him waht I want, and he orders it in addition to the tests he wants. You need to learn your rights in your state. Insurance companies may or may not have the power to deny tests that are required for proper diagnosis of diabetes in your state.

Regards,

[UpNorth]

You really need to insist on having those tests done! If your endo refuses, find another one who will test you! Your bodyweight talks against T2... And so does the results with your current medication by the sound of it...
But by now, i sure hope your endo has started to work with you, not against you!

[grace girl]

As you can see from my siggie, I was initially dx'ed as type 2 as well. It took three doctors before one of them just looked at me and my numbers and did the tests...type 1.
You won't really know unless you have the tests. Insist, or if you have to, find another doctor.
It's too important not to know, and it seems to me that there are a lot of wrong dx's floating around out there.

[Real4]

Originally Posted by BrianSCohen

If your other numbers during the day, particular before meal and after meal are < 120 and < 140 respectively, then you are fine.

Personally, I'd be very disappointed with myself if I were to have those numbers. When I began to approach those numbers, I went (at my, not the doctor's suggestion) onto insulin. My worse A1c since then has been 5.7.

Everyone has to make their own decisions, and those numbers are far better than the average, non-caring diabetic, but you certainly can do better.

[jillrapp]

First, if your doctor won't listen to your wishes, and take time to explain to your satisfaction why something should not be done to YOUR body that you believe would be best, then get a new Doctor. Second, Insulin is not just for type 1's or 1.5's. Most of the time the only good reason insulin is not given to type 2's is because oral medication is deemed 'easier'. Glyp and Januvia did me NO good and I could not get control of my morning fasting and after breakfast numbers until going on NHP twice a day. Now I feel terrific and with only 2 shots a day. My doctor asked me, since I'm doing so well with the Insulin, if I wanted to control my diabetes with short acting and intermediate insulin only and not Metformin. For now, all is good so I'll wait and see, but I'm no longer afraid of Insulin either. By the way, I eat approximately 120-140 grams of carbohydrates a day, watch my diet otherwise, and excercise 4-5 times a week for an hour each time.

Good Luck and follow what your gut tells you - your doctor should be working "with" you!

[jerryn]

Watch out for the Januvia. It messed my thyroid up and put me Hypo! It took 1 year for the thyroid to completely bounce back. I take metformin + bayetta. When I was originally diagnosed my numbers were like yours. My glucose was at 314
Now most of the time I'm at 120 except for when I wake up.

[iameaton]

demand those tests.

I was diagnosed as a type 2 and put on the metformin in May 2008. July 2008 I went to a ob/gyn specializing in diabetes (I am also trying to get pregnant) and she said she doubts I am and I am in the process of getting those tests done. I've gotten the c peptide results which show lower than normal. gad is in my future.

In the mean time I'm on insulin and am feeling so much better!

So long story short, I'm in the same boat you are in am loving insulin!