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Eyad

am I 1.5 Type?

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Eyad

I'm 31 years old and I was diagnosed with type 2 .. 14 years a go and passed through several type of medications .. reaching the current combination formula since 18 months:

Diamicron 60mg 2 tablets

Diabex *XR (metaforman) 1000 mg 2 tablets

BYETTA (exenatide) injection 10 mcg twice daily

 

I've found the result pretty reasonable but not perfect .. now my GP think it's the time to start insulin era for two reason:

- not happy with taking the max dosage of my tow type tablets.

- result of my last C-peptide test

Serum C-Peptide 0.8 nmol/L

Serum insulin 8 mIU/L

 

Please do not hesitate to advise me.

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mom24grlz

so you were diagnosed with type 2 at the age of 17?? Did they originally run tests to rule out type 1 or automatically tell you, you had type 2? I just haven't heard of many 17 year olds being diagnosed with type 2. Most I've heard has been type 1.

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aggie168

Hello, welcome to DF,

 

1) A true T1 or T1.5 will have the hallmark of anti-body within their system. There are various type of test for that. GAD-65 is usually the first test.

 

2) Someone switching over to insulin at various stage of T2 is just an "Insulin Dependent T2". So do not confuse the issue as the two type are not the same.

 

3) C-Peptide results usually comes with a "reference range" statement behind the value. That has to do with each lab's equipment. That is the only way you can qualify the results. Example, mine from many years ago, was 0.7 with a reference range of 1.1 to 4.4. In other words, I produce a little bit of insulin on my own but quite a bit below their lower limit. Therefore, if I disconnect myself from the pump for say 12 to 24 hours, even without eating, my # will climb up and up. On the other hand, my number will not sky rocket to a dangerous level as quickly as a true T1. That is the mix blessing.

 

====

 

A) Yes, when you switch to insulin, definitely, you are ditching the Diamicron. You may be dumping Metformin and Byetta as well. Work with your medical team.

 

B) Your mindset will be totally different, Your current oral and injection does the following: Diamicron to push your poor pancreas to produce more insulin and then Metformin to suppress your liver to slow down glucose dump and then Byetta to again work your pancreas. In other words, you are doing everything in your power with chemical/medication to push your body to conform to the situation

 

C) When you switch over to insulin, you are replacing what your body is missing as naturally as possible. Granted the insulin you are injection is also created by a phamacitical company in a factory. The mindset is very different. It is shameful the medical community only push insulin as the last resort. Perhaps they figure people are in general more use to pill popping than injection. In your situation, have you start insulin much sooner, you "may" have save some more of your pancreas function as reserve.

 

D) One last piece of advice, when you switch over to insulin and when your body gets everything settle to it, you body may require less glucose intake as fuel. i.e. Your body is using it more efficiently. As such, you very well may need to reduce your food intake to match it. What I am trying to say is the most common complain when people switch over to insulin is they gain weight. In various instance, it is the net results of overeating even though you are eating the same amount of food as before. As your body converts your meal as fuel more efficiently, you need to eat less to match it. Otherwise, the excess will get store as fat. Most people overlook that simple fact.

 

Hope the above helps and not too confusing. :)

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jwags

The only way to know if you are type 1.5 is to have GAD antibody tests done. Also you don't mention what your diet is like. For many of us eating carbs equals bg spikes. Also the sulfonyurea drug you are on may have also worn out your beta cells.

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Hooterville

If the OP is truly T2 insulin resistant, there is no reason to stop or lower Metformin. Staying on Metformin will allow an insulin resistant T2 who is insulin dependent to require less insulin. A T2 going on insulin is no reason to "dump" Metformin.

 

Just responding to another post above, not the OP.

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NoraWI

When there are no beta cells left, the antibody attack subsides. A GAD65 antibody test may no longer give a positive result after 14 years of pressing the pancreas with sulfs. The OP may be a LADA who has now lost enough beta cell function to require insulin. That is why it is important to begin insulin early in order to preserve pancreatic function. He should still ask for a GAD65 test as there may be residual beta cell function.

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aggie168
If the OP is truly T2 insulin resistant, there is no reason to stop or lower Metformin. Staying on Metformin will allow an insulin resistant T2 who is insulin dependent to require less insulin. A T2 going on insulin is no reason to "dump" Metformin. Just responding to another post above, not the OP.

 

You are absolutely correct. That is why my response to the OP "You may be dumping Metformin and Byetta as well. Work with your medical team." :)

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Hooterville

If a T2s medical team suggests a T2 go off Metformin because the T2 is going on insulin, the T2 should question that advice vigorously.

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Eyad

First of all, I'm amazed by the size of the interaction here, I want to thank you all, and I had to be here years ago.

I may have misled you a bit by choosing the wrong title, where what really concerns me as priority is:

Do I really .. need to start insulin NOW? What determines this clearly?. Some contributions has touched on this, but I would be happy if anyone explain it in detail. I attached my c-peptide result to show the range.

C_peptide.png

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ant hill

Welcome Eyad :D,

Just a few things to look at? Have you been thirsty and eating a lot and visiting the toilet often? Loosing weight? Lack of energy, Lethargic? :confused:

A GAD65 test will have a more correct diagnosis.

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Eyad
so you were diagnosed with type 2 at the age of 17?? Did they originally run tests to rule out type 1 or automatically tell you, you had type 2? I just haven't heard of many 17 year olds being diagnosed with type 2. Most I've heard has been type 1.

 

 

Honestly at that age, I did not discuss much ..I was told that I'm type 2 and I lived with this fact. In recent years, I'm re-thinking in some hypotheses.

However, I may saw more than ten Doctors did not question the fact of being type 2 .. except diabetes educator I've met recently. I recon this issue will be the subject of discussion with my endocrinologist next week. Thank you

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Eyad
Hello, welcome to DF,

 

1) A true T1 or T1.5 will have the hallmark of anti-body within their system. There are various type of test for that. GAD-65 is usually the first test.

This test will be on my agenda soon

 

2) Someone switching over to insulin at various stage of T2 is just an "Insulin Dependent T2". So do not confuse the issue as the two type are not the same. difference

difference is clear, I just put two overlapping questions, I apologise.

 

3) C-Peptide results usually comes with a "reference range" statement behind the value. That has to do with each lab's equipment. That is the only way you can qualify the results. Example, mine from many years ago, was 0.7 with a reference range of 1.1 to 4.4. In other words, I produce a little bit of insulin on my own but quite a bit below their lower limit. Therefore, if I disconnect myself from the pump for say 12 to 24 hours, even without eating, my # will climb up and up. On the other hand, my number will not sky rocket to a dangerous level as quickly as a true T1. That is the mix blessing.

 

I have attached my result in an earlier Post ..I will be happy if you took a look

====

 

A) Yes, when you switch to insulin, definitely, you are ditching the Diamicron. You may be dumping Metformin and Byetta as well. Work with your medical team.

 

B) Your mindset will be totally different, Your current oral and injection does the following: Diamicron to push your poor pancreas to produce more insulin and then Metformin to suppress your liver to slow down glucose dump and then Byetta to again work your pancreas. In other words, you are doing everything in your power with chemical/medication to push your body to conform to the situation

 

C) When you switch over to insulin, you are replacing what your body is missing as naturally as possible. Granted the insulin you are injection is also created by a phamacitical company in a factory. The mindset is very different. It is shameful the medical community only push insulin as the last resort. Perhaps they figure people are in general more use to pill popping than injection. In your situation, have you start insulin much sooner, you "may" have save some more of your pancreas function as reserve.

I can say I've asked this question [the medical community only push insulin as the last resort.] to all endocrinologist I've met and almost I did not find two similar cables answers, patients' fear of needles is the only reason that convinces me to postpone insulin as an option.

 

D) One last piece of advice, when you switch over to insulin and when your body gets everything settle to it, you body may require less glucose intake as fuel. i.e. Your body is using it more efficiently. As such, you very well may need to reduce your food intake to match it. What I am trying to say is the most common complain when people switch over to insulin is they gain weight. In various instance, it is the net results of overeating even though you are eating the same amount of food as before. As your body converts your meal as fuel more efficiently, you need to eat less to match it. Otherwise, the excess will get store as fat. Most people overlook that simple fact.

 

This note is very valuable, and will be taken into consideration certainly.

 

Hope the above helps and not too confusing. :)

 

 

I really appreciate your effort, and sharing your knowledge.

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StringCheese

Type 1.5 doesn't always mean LADA it can also mean MODY, I have had a fasting blood sugar in the diabetic range for the last 7 yrs but my A1c was normal so my Dr never bothered to tell me anything but loose weight and didn't tell me my fasting was abnormal, though as of Aug my A1c was 10.2 so they then told me I was diabetic. But after I was diagnosed so was my brother we are both GAD negative and our dad was diagnosed as type 1 when he was about 28 yrs old (I'm 30 my brother 29). My sister on the other hand was diagnosed as type 2 when she was 19ish. I'm betting that if my brother or I had gone to the Dr she did when we were 19 or so, she would have told us we were type 2 as well since we are all overweight. But my Dr now thinks I'm likely a MODY patient given my family history, "medical mystery" was her first choice of words.

 

My brother and I are on insulin now (we were diagnosed this past yr) and it's made a world of difference A1c from 10.2 to 5.5 with it. MODY is almost always misdiagnosed as type 1 or 2 and because the testing is so expensive and most insurance companies wont cover it a definitive diagnosis is usually not given unless you have extra money to spare for the testing yourself. It really doesn't matter which type you are as long as you have your blood sugar in check. As for insulin, it's been great for me and my brother and has definitely been worth it. Even if you are type 2, your pancreas isn't producing a normal amount of insulin, I would think going on insulin could only help you.

 

I hope you find what treatment works best for you!

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aggie168

Hello Eyad, the image of your c-peptide results is hard to read. So what is the reference range? :)

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Eyad
Hello Eyad, the image of your c-peptide results is hard to read. So what is the reference range? :)

 

reference range (0.3 - 2.3) and mine is 0.8.

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Eyad
The only way to know if you are type 1.5 is to have GAD antibody tests done. Also you don't mention what your diet is like. For many of us eating carbs equals bg spikes. Also the sulfonyurea drug you are on may have also worn out your beta cells.

 

What concerns me most jwags is that I am on the maximum dose of metformin ..It is upsetting the stomach and disturbing the whole life, so I'm trying to find a balance.

Thanks

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mom24grlz
reference range (0.3 - 2.3) and mine is 0.8.

 

Ok from what i understand High levels of c-peptide and high levels of blood glucose indicate type 2. Your c-peptide is not high.

Low levels of c-peptide and high glucose indicate type 1.

People with Type 1.5 diabetes typically have low, although sometimes moderate, levels of C-peptide as the disease progresses.

 

So looks like your levels are showing type 1.5, though i don't know how low you have to be on the scale to be qualified as type 1. But in reality type 1.5 is just slow onset of type 1 :)

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aggie168
reference range (0.3 - 2.3) and mine is 0.8.

 

1) That implies you are on the low end of insulin production but is still within the accepted limit of normal insulin production.

 

2) It also indicate you are not over producing insulin, which is a classic sign of a T2 with sensitivity issue.

 

3) You really need GAD-65 or other anti-body test to see if you are a T1.5 or T1...

 

What concerns me most jwags is that I am on the maximum dose of metformin ..It is upsetting the stomach and disturbing the whole life, so I'm trying to find a balance.

 

1) You can consider trying different brand of Metformin, generic or even XR (Extended Release). They all act differently.

 

2) I am one of those that Metformin can update my stomach randomly. As such, when I switch over to insulin, I dropped Metformin like a rock. Note, you will find someone will argue that it is good for you if you have T2 insulin sensitivity issue. Metformin will lower your insulin needs. That is very true. However, I am of the believe that it is better to take what you must to live (yes, a little bit more) than taking something else that upset your body. No more Metformin moments. Life is good. :)

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mom24grlz
Have been Diabetic for 18 yrs and have never heard of Type 1.5. Totally confused....

 

it's also referred to as LADA (Latent Autoimmune Diabetes in Adults) which is a slow onset of type 1. Instead of needing insulin right away those with LADA or type 1.5 can take years before they need insulin.

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Eyad

Today I saw my endocrinologist, and she still not in a hurry to initiate insulin, she thinks if I began - compared to my age - I will have to take two types of insulin together and a total of four to five injections per day, and I'll probably gain some weight as well.

So endocrinologist asked me to switch from Byetta to Victoza, and she is betting that the nausea will be much lower, - and this is what I've read in many patients reviews who have switched-. As expected she asked for GAD antibody tests to bring it with me next appointment in two months.

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jwags

Many type 2's after 10 or so years of diabetes will lose most of their beta cells. So they progress to insulin just like a type 1.5 or a type 1. It is vety common to take 2 types of insulin. You take a long acting basal or background insulin like Lantus or Levermir and then you take a fast acting at meals. The number of shots you take should not deter you from proper treatment. After many years of diabetes you can be both insulin resistant and insulin insufficient.

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dancinglotus

Hey Eyad!

 

Welcome to DF. I am also type 1.5, LADA, dx'd 2 years ago at age 42. At first, they assumed I was type 2, but I couldn't tolerate any of the oral meds, so they started me on Lantus. About 6 months after 1st dx, they finally did an anti-body test when my diabetes educator recommended it. Then they put me on Humalog with meals in addition to the Lantus.

 

Now, I've always had weight issues, but I was down to a size 12 for over 2 years when they put me on the insulin. I started gaining weight right away, and I wasn't overeating, but I was still eating carbs. My diabetes educators told me to cover for the carbs, but that some carbs were fine. Well, I gained 20-25 lbs. within a short period of time on just the Lantus, and then my weight skyrocketed from there when they added the Humalog. My weight gain after that was partly to my giving up and eating what I wanted since I couldn't stop gaining weight anyway and was going through a difficult time. I had injured myself on the job and had to have back surgery, so I wasn't exercising either.

 

Insulin is a miracle drug, but especially if you are prone to gaining weight, you really need to watch your carb intake with the insulin. I've learned a lot from the people here, and by watching my carb intake, I can take less insulin, and hopefully, I will be able to lose weight soon. I haven't gained any more weight for a few months now, but it is still a struggle to lose it.

 

Good luck to you & hope to see you around! :)

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aggie168
Then they put me on Humalog with meals in addition to the Lantus..... I started gaining weight right away, and I wasn't overeating, but I was still eating carbs..... My diabetes educators told me to cover for the carbs, but that some carbs were fine. Well, I gained 20-25 lbs. within a short period of time on just the Lantus, and then my weight skyrocketed from there when they added the Humalog.....

 

Insulin is a miracle drug, but especially if you are prone to gaining weight, you really need to watch your carb intake with the insulin. I've learned a lot from the people here, and by watching my carb intake, I can take less insulin, and hopefully, I will be able to lose weight soon. I haven't gained any more weight for a few months now, but it is still a struggle to lose it.

 

Hello,

 

Consider the following, before insulin, your body are not processing the blood glucose efficiently. The indirectly way to look at it is you have to over eat to get a percentage of it into your body as fuel. Once you have the proper balance (i.e. taking the correct amount of insulin) and your body is processing the glucose properly, you need to back down on what you normally eat. Otherwise, guess what, your body have excess energy and it is store as fat. (i.e. I heard people said, "I did not change what I eat for the last so many years. I eat similar meal each day.... etc. But I am keep on gaining weight....")

 

Also, many that goes on insulin also retain water. Talk to your doctor, consider adding a water-pill if necessary.

 

Hope the above will start a "light bulb" and promote further investigation. :)

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goslow12

**** why is diabetes so confusing?!

 

I've never heard of Type 1.5 before and have been T1 for 10 years now!

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