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Rose17

Prevention of insulin-dependency?

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Rose17

Hi all,

 

I was diagnosed as a Type II diabetic almost a year ago, when I was 21. I was doubting this diagnosis because I was 21 years old and barely even 120 lbs, definitely not overweight. So I saw another endocrinologist recently, who told me I'm more likely to be Type I, specifically juvenile diabetic, but I don't yet need insulin. He said that I tested positive for GAD antibodies (I think the number was 8.9), but since my A1c had went down from 6.7 to 6.4 with oral medication and diet, I didn't need insulin yet. I am posting here because I'm wondering if I'm more of a Type 1.5. It's so frustrating that no doctor has suggested anything but Type II or that I am going to inevitably be insulin dependent.

 

Is there anything I can do to prevent being dependent on insulin a little longer? Or any advice on what I should be asking my doctor? I know you are not doctors, but I was hoping to get some info from people who have experience dealing with this, especially since I'm newly diagnosed. Sorry if this has been discussed already!

 

Thanks!

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Subby

There are theories that reducing the strain on your pancreas to produce insulin, will slow down the dying off of beta cells. Three elements of that could be reducing weight, eating less carbs, and in a slightly ironic twist, taking insulin.

 

As I said, theories - you'll need to look into them and weigh for yourself if the data is there or not. This is obviously a church of hope for some people, and other people can take advantage of that with promises. There could be a fundamental difference between you and T2s on diet, which is a potential point of confusion here. If you have an antibody attack, it suggests a certain rate of beta cell loss might just be inevitable whatever you do.

 

You mention T2 meds: if you are taking a sulfonylurea, that may accelerate the process of overburdening your pancreas. I am not sure, if your issue is primarily insulin deficiency (lack of insulin, normal needs) versus insulin resistance (high needs, high insulin).

 

It could be very useful to get a c-peptide to determine what your pancreas is currently up to. It will help with a diagnosis (or knowledge of likely insulin needs), too.

 

And by the way, nobody wants to take insulin, but in the end if you do need it, the act of injecting is seriously not that bad. I have always found shaving more of a hassle.

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Subby

It may not go into preventing/delaying insulin dependency, but this is a good read about Type 1.5 and types in general, from a reputable source. What type? More articles at the top.

 

It also mentions at the bottom a fine but useful distinction. Insulin dependency is a term for when you have a clear and present need for insulin or will be in a lot of trouble in a couple of days. Many T2s and T1.5s, may use insulin but are not actually dependent that way. Why is that useful? Well, it might take the sting out of the idea of insulin a little: it's definitely not all or nothing. You could be in a position to get some support from say a basal shot a day, or some added insulin at certain meals, to help your body along, rather than the situation of needing to replace all insulin manually.

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Rose17

Thanks for the replies. I'm pretty sure my c-peptide was normal on my last test. Thanks for the clarification about dependency.

 

It's not so much that I'm afraid of insulin shots (my dad is type I, both of my grandmothers as well), but more that I'm worried that I'm not getting proper treatment and this is going to hurt me in the long run. After meals it's not uncommon that my blood sugar is in the 200s (and on more than a few occasions it was about 350), usually fasting it's anywhere from 110-130s, though recently while sick it was in the 140-160 range. Right now I'm on a pill that's a mixture of Actoplus and Metformin twice a day. I'm not sure really whether I'm insulin resistant or deficient, although it was mentioned that I had low insulin levels at one point. It's confusing because for a long time my PCOS was causing insulin resistance, especially when I was in my young teen years.

 

Thanks for the info :)

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Subby

I think you are right to be wanting to find some better answers. To me those numbers indicate the meds are not providing firm control for you. Have you been getting HbA1cs as well?

 

What is your attitude to carbs? It is these which primarily impact BGs at meals. You may find that reducing them goes a long way to reducing those spikes. That can be a hard barrier to broach with medical professionals following typical high carb guidelines. But I don't think you need to be a militant low carber to see that if carbs are a major cause of hyperglycemia, they should be on the table as something to be handling with care.

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Rose17

Well my first A1c when I was diagnosed was 7.1, then it was 6.7 in October, then this past December it was 6.4, so it is going down, though I'm not sure how as it is high most of the times I test my blood sugar. That said, I've only recently been testing positive for GAD65 antibodies.

 

I have really bad digestive problems, so carbs used to be my go-to food because they are the gentlest on my stomach. For example, I can barely digest lettuce and most vegetables properly. Meats are usually okay, but being away at law school makes it pretty difficult for me to have time to cook, which is a terrible excuse. So my attitude to carbs is that I LOVE them, but I am pretty decent at controlling them. For breakfast I try not to have more than 15g of carbs, lunch usually even less (I have really low-carb bread, I usually eat a turkey sandwich), I think dinner is my biggest issue. I think it's because my carb intake rises a lot at dinner, and I'm always insatiably hungry so I tend to overeat. But again, my weight is fine, and it even usually decreases while I'm at school to about 115-117 lbs.

 

Do you find that smaller, more frequent meals work better? I'm usually in class all day and most professors don't allow eating, so I find that to be a little difficult.

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Subby

You are certainly keyed into what you are eating, that is great. Some diabetics do come to the boards eating 80+ grams of carbs a meal and wondering why they are getting higher blood sugars. Being aware puts you in a strong position to change it up if you suspect there are issues there or want to see if another way is better.

 

I get very hungry at night too, and this is the worst time for me to eat carbs (I spike terribly and insulin does not work well for me at that time). This is mostly linked with how much I eat during the day. If I don't eat enough or skip meals, I will have extreme hunger later on, enough to stop me sleeping.

 

Making sure I eat enough through the day (this might include some more moderate quality carbs too: I don't personally think reducing carbs as much as possible is the only way to eat healthily) is one thing I need to do. The other is simply give myself great dinner options and later on, have great low carb snack options. Both take some setting up since I don't usually stock a lot of food or always cook a lot, but it is worth it for me.

 

As for meals, 3 meal/x snacks never worked for me. Some time ago I decided to try 4 slightly smaller meals through the day. This works a great deal better for me. Not only for my digestion, but I also don't have this feeling of a real empty stomach I used to get, especially up towards dinner. Makes it easier to match insulin, and no change in weight that I found. Sure, these kind of things are not always conducive to living life, that's for sure.

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TommyC1
And by the way, nobody wants to take insulin, but in the end if you do need it, the act of injecting is seriously not that bad. I have always found shaving more of a hassle.

 

Amen to that.

Shaving is a much greater hassle than using insulin.

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jwags

Since you have positive GAD antibodies, it indicates that the antibodies will probably do damage to your pancreas to the point you can't produce enough of your own insulin. Type 1.5 is really LADA or slow onset type 1. No one knows how long your honeymoon period will last. I think by choosing carbs wisely you may be able to extend it a little. Type 2's also burn out their pancreases by over producing insulin. I probably have about 50% of pancreatic capacity, now. I choose to use low carb foods, about 15-20 per meal, max so I don't need a lot of my own insulin. Dr Bernstein in his book, DIABETES SOLUTIONS gives you a good framework for a diet for Type 1's and 2's to minimise insulin. You could look at it and see if you could adapt it to some of your dietary restrictions. I find breads like Sprouted Grain breads are kinder on my bgs.

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