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MsKD

C-Peptide test and GAD65 Test results in need help interpreting them

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MsKD

O.k. everyone, I just got my test results back in my inbox. I was only able to get three done at this particular lab--C-Peptide, Serum; GAD-65 Autoantibody; Antipancreatic Islet Cells.  I'm going to need you to help me interpret them.

 

The C-Peptide Serum - Result = 9.1 (HIGH);  Range (1.1 - 4.4) --- which I would understand to mean insulin resistance

 

GAD-65 - Result = 1.5; (Range (0.0 - 1.5) --- my understanding is that patients with type 1 diabetes mellitus usually have antibody levels between 0.03 and 20 nmol/L. Can T2 also have GAD antibody levels?

 

Antipancreatic Islet Cells Result = Negative; (Range (Neg: <1:1)

 

So am I just T2 based on the C-Peptide or LADA with the GAD result thrown in?

 

Please advise. My endo is not going to be any help. I saw him the other day after my RA infusion and BG had spiked to 298 and he said that if it continued to stay there he would put me on Glyburide but only if it didn't come back down. Thankfully it came back down to 115, but it's been rollercoasting between 115 - 177. I researched Glyburide and it is contraindicative to some of the meds I already take.

 

Thanks,

 

kd

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aggie168

The simple answer is you still produce tons of insulin based off your c-peptide results. Then positive on GAD65 means your pancreas will slowly get destroy and you will loose the ability to produce insulin. Translation, you will eventually become insulin dependent for the rest of your life. Sorry for the simple answer and without sugar coating. The label of T1, T1.5 or LADA is just a label.

 

Regarding using any of those "g" labeled drug to push your pancreas, that is up to you. They are prone to burn out the pancreas faster for some people. In your case, you are not changing the inevitable... :)

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miketurco

Your bg is really high. You need another doctor. You're definitely highly insulin resistant. You'll should repeat the cpep and gad in three to six months to see where you stand.

 

I'm not a doctor, this is my personal opinion. Your diabetes is way out of control and Aggie is right on the money.

 

I don't like the "g drugs" myself.

 

No metformin?!

 

Again, you need a better doctor.

 

Do you have goals for your bg levels? If not, may I recommend 125 Max? It'll take a while, but with the help of this group and a good doctor, you can get there.

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NoraWI

Mike, MsKD is taking meds for her RA (Rheumatoid Arthritis, an autoimmune condition), probably steroids. Steroids always send BGs sky high. She has a difficult balancing act in that the meds that help her RA exacerbate her DM. The high c-peptide does indicate insulin resistance but that could be a result of the medications she takes that increase inflammation. MsKD, you have a very difficult situation there. Don't know if there has already been a discussion of insulin, but it seems to me that's what is necessary for you to keep your numbers somewhat in line.

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ant hill

 

Please advise. My endo is not going to be any help

Thanks,

 

kd

If you get these resalts and this Endo cannot help you, Well this Endo is not of much help now are they. So Fire this Endo!!! If they're an Endo at all.

 

Now Look for Another Certified Endocrinologist!!!

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MsKD

Thanks everyone for the quick responses.  I appreciate your help. My rheumy is the one that wanted me to get a second opinion just as much as I did. He said he couldn't do it since he isn't versed in that area, but he just had a gut feeling with my other autoimmune problems (Graves Disease, Allergies, Rheumatoid Arthritis) that this was another one. Also he didn't want to see me suffer through a lot of steps (various meds) if I didn't have to, but my endo doesn't agree. He's adamant that my diabetes is caused by the steroids and cannot be autoimmune. I've sent him the results but he will probably disregard them, because when I asked for these tests he said he didn't do these type of tests and they weren't necessary. At least not for me.

 

As for as metformin. I tried it and it made me extremely sick. The endo got mad at me and said that I didn't give it a chance. Then wrote me a prescription for the extended release. It also made me sick. Then he said fine. Don't take it. I couldn't. Both versions kept me in the bathroom all...day...long. It wasn't pretty. :wacko:

 

This may explain why my rheumy can't control my RA--my latest tests show my RA is way out of control--my CRP (inflammation) markers are elevated 13.7 (range = 0.0-4.9 mg/L). The rheumy did a special test (Vectra test) that showed the steroids and Remicade infusion was not working but he has bumped the steroids up again to try to overtake the RA. This will probably exhaust my poor pancreas. :(

 

I'm going to contact the endo my rheumy suggested and get an appointment.

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NoraWI

Well, your GAD65 does indicate positive for T1. That can't be a result of any steroids. But the steroids could have kicked it off or accelerated progression. The only thing to do is to take insulin. It will possibly do away with the need for any other diabetic drugs. Taking exogenous (outside) insulin may even relax your pancreas and negate their need to over-produce. Wish you the best results with the new endo! The one you have now doesn't seem to have a clue.

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MsKD

I just heard from my endo. He said "there's nothing to worry about. Nothing's changed, we can talk about it at you next appointment. " I said in June? He said "yeah, fine." He was more concerned and curious about how and where I got the test done---through direct labs via Labcorp. Because he did not and does agree that it's possible for me to be autoimmune diabetic.

 

Ain't that a trip? I'm scheduling an appointment with another endo, I just need a referral from my PCP and the secretary says the doctor will see me.

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MsKD

I just heard from my endo. He said "there's nothing to worry about. Nothing's changed, we can talk about it at you next appointment. " I said in June? He said "yeah, fine." He was more concerned and curious about how and where I got the test done---through direct labs via Labcorp. Because he did not and does agree that it's possible for me to be autoimmune diabetic.

 

Ain't that a trip? I'm scheduling an appointment with another endo, I just need a referral from my PCP and the secretary says the doctor will see me.

Because he did not and does NOT agree that it's possible for me to be an autoimmune diabetic.

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NoraWI

If you have RA, which is an autoimmune condition, it is most likely that your DM is also autoimmune, especially if you are positive for GAD65 antibodies. A positive GAD65 is definitive for Type 1. This endo is ignorant.

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aggie168

The only thing to do is to take insulin. It will possibly do away with the need for any other diabetic drugs. Taking exogenous (outside) insulin may even relax your pancreas

Like Nora suggested, you may consider starting insulin early. It is actually ten times better than any oral drug. Remember, you are injecting what you are missing and not enough verses using oral medication to force your body to conform....

 

Also, once you overcome the mental challenge that you have to use insulin for the rest of your life, the rest is easy... :)

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ant hill

Like Nora suggested, you may consider starting insulin early. It is actually ten times better than any oral drug. Remember, you are injecting what you are missing and not enough verses using oral medication to force your body to conform....

 

Also, once you overcome the mental challenge that you have to use insulin for the rest of your life, the rest is easy... :)

But you still need a Committed Endocronoligist to Diagnose you!!!!!! No Insulin till then. ;)

 

But are you Thirsty, Fatigued, Hungry all the time. Hog the WC? Weak & Tired?

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MsKD

But you still need a Committed Endocronoligist to Diagnose you!!!!!! No Insulin till then. ;)

 

But are you Thirsty, Fatigued, Hungry all the time. Hog the WC? Weak & Tired?

 

Ant -  

 

Absolutely no insulin until a complete confirmation from a reputable endo.

 

Yes to all of the above. I've always just brushed the symptoms off to maybe my thyroid medication needed changing, but my PCP said no, it was o.k. Then because of flaring with my RA--with the exception of the hunger--in a flare I never want to eat. But my Mom was like "you've become a diabetic. You need to get checked. You need to get a meter and check your BGs." My PCP ran a test and said "sorry, you are officially a diabetic."

 

But all this endo did extra was do a 24 urine test and additional A1C and leave me in limbo I guess to let my pancreas burn itself out. Every 3 months I see him he changes his mind about treatment from diet/exercise, blaming my rheumy, to pills, to insulin, but he never officially does anything other than "I'll see you again in 3 months".

 

His orders are as long as I don't go over 200 or stay over 200 and don't go back down then I'm o.k. But I've already had to get a new prescription of eyeglasses--2 prescriptions in year's time.

 

My A1C has come down from 7.1 to 6.1 but that's because of rollercoaster fluctuations rather than good control. I mostly spike after I eat which is what I try to explain to him. I even sent him a spreadsheet of my BGs before meals and 2 hours after meals and before bedtime for a baseline measurement, he glanced at it and just gave it back to me. He didn't even keep it in my file. He told me there was no need for me to check my sugars that much--2x a day was enough.

 

The doctors I am asking to see are specialists and researchers in the heart of the city and specialize in endocrine, hormone and diabetes disorders--T1, T1.5, and T2. Hopefully my PCP won't give me any grief.

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NoraWI

Why "Absolutely no insulin until a complete confirmation from a reputable endo."? Your blood glucose levels are totally out of whack. You have to continue taking steroids. What diabetic type you are is totally inconsequential at this point. Insulin is in order to get your blood glucose levels under control. The needles do NOT hurt! Take our word for it. Rethink this issue because it is your only option no matter whether you get a confirmation of type from a reputable endo or not.

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MsKD

Clarification...I mean no self medicating on my part until I get an answer from a reputable endo. I have no problem with starting insulin. My grandfather was on it and my mom does it. In fact she says I'd probably feel much better.

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jwags

My dad had an autoimmune disease that caused him to lose his sight. He was put on a daily dose of Prenisone and sure enough he developped diabetes several years later. His doctor wanted him on insulin but he refused and went on Januvia instead. His bgs were never really controlled and he developped complicstions quickly. of course they didn't advise him to cut out carbs and he wouldn't listen to my advice.

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MsKD

That's the reason if I need insulin I am open to taking it, but I need a doctor that will meet me half way and help me. As my rheumy knows I am diligent with orders but not when it comes to being left in the wind with no guidance or help.

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MsKD

My PCP came through and gave me a referral. I was able to get an appointment with the endocrinologist but not until May 26th. But that's o.k. I can be patient. My BG levels are still on a rollercoaster and are slowly creeping up and staying around 150 during the day and between the high 100s and 130s overnight. Whereas in the past they were lower.

 

Symptoms are happening regularly rather than intermittently. I am constantly in the bathroom every 30 - 45 minutes (day/night) and drinking water like crazy. Urine smells sweet. Extremely tired, mouth is dry, skin is dry and itchy, eyes blurry, and still losing weight.

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miketurco

Consider getting some keto sticks and seeing where you're at with that. How many grams of carbohydrate in your diet?

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miketurco

They're called keytone test sticks. No prescription, buy them from the pharmacist. Less than $15 for a vial of 25. They measure the level of keytones in your urine. Could explain the weight loss. If you're losing tons of weight and are in heavy ketosis, it could be a medical emergency. How much weight are you losing?

 

Best time of day to measure is either just before bed or when you wake up.

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NoraWI

Keto sticks won't tell her anything more than she knows already. She is a T1 and has Rheumatoid Arthritis that is being treated with steroids. She is drinking oodles of water and urinating a river. She is losing weight. Her body is eating itself up. She needs insulin. But I doubt she will go into DKA before her new endo appointment end of this month because her c-peptide is still within normal range. Any longer, I would worry.

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MsKD

I've eliminated all starchy foods from my diet long ago at the request of both my rheumy and cardiologist--no bread, no pasta, no rice, no potatoes. I'm on a high protein/low carb diet--with 20 - 30 grams of carbs per meal--broccoli, spinach, salads, eggs, meat, chicken. I was eating fruit at lunch, but my BGs started spiking and I stopped.

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jwags

Even 20-30 carbs per meal isn't considered low carb for some of us. I can only handle 15 carbs at some meals, sometimes less. In the morning I can only handle around 5 carbs for breakfast.

 

If your bgs are only 150 during the day and 100-130 overnight that is not high enough to produce ketones. The frequent urination could be from something else or an infection. I would go to your PCP for a urine test to rule out UTI. You could be a type 2 or a tyoe 1.. Your GAD is still fairly low. I don't think a positive GAD score always means tyoe 1. But even as a type 2 you might benefit from insulin.

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