Replies to This Discussion

Permalink Reply by Zoe on July 25, 2011 at 7:57am

Sorry to say this, but the PA is an idiot. You don't become T1 because you take insulin; many type 2's are on insulin, although often it is after many years. Type 1's are not born this way, but get diagnosed at various stages of their lives from early childhood to middle age. Some people can get misdiagnosed as Type 2, however, when they are really Type 1. (I did) You do have some external indicators of possible Type 1 or LADA which is a slower onset of Type 1. The fact that you needed insulin in a short period of time, and the fact that you have another autoimmune condition in your thyroid illness. Type 1's on the other hand are usually not overweight. You don't mention how much insulin you use to see if you have insulin resistance which is more characteristic of type 2. What I would suggest is that you get antibody and c-peptide testing to clarify your type. Meanwhile the good news is that you are insulin and you brought your A1C down from 12 to 6.5. Congratulations!

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Permalink Reply by Megzway on July 25, 2011 at 8:12am

I take 50 unites of Novalin NPH at bedtime & I'm on a sliding scale for meals 3 times a day. I usually take anywhere from 7-10 units of Novalog for meals. My morning BS has been a bit high for my liking. 115 to 130 so I really need to get in gear & loose weight.

I was going to start the pump but lost my insurance & got scared I wouldn't be able to afford the supplies so I just stuck with the scale for now. I could go on the pump since I'm able to get my insulin for free through Lilly but I need an endo to get me started & I can't afford that. So I will wait for new health insurance. We are hoping by November to get it through my husbands job.

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Permalink Reply by Zoe on July 25, 2011 at 9:56am

I don't know much about NPH, but your doses do sound like you have Insulin Resistance (characteristic of Type 2). You might want to get on a more current insulin regimen of basal (Levemir or Lantus) and bolusing for your meals by an Insulin to Carb ratio. Sliding scale is an outdated way of dosing. You should learn things like dosing and carb counting before you get a pump. I know you have limited medical care at the time, but highly recommend the book Using Insulin by John Walsh to get yourself up to speed. You don't technically need an endo to get a pump; I only use a PCP. But yes, it would make sense to wait for the insurance to cover supplies.

I agree with the others that it might be beneficial to be thought of as type 1 for insurance purposes if you want a pump, but if they do antibody testing and c-peptide it might show you to be type 2 anyway.

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Permalink Reply by Tim on July 25, 2011 at 8:04am

You are correct that insulin dependent does not automatically imply Type 1.

If you think that you'll get better care or better supplies by being classified as T1 throughout the health care organization, you might want to push whatever organizations that help you to make T1 "official" through an antibody test.

If it helps you feel any better... I was diagnosed as "juvenile diabetes" (this was before T1 was the in vogue term) without any blood test. Just peeing in the cup and having the test strip turn jet black was good enough 30+ years ago :-). Others will insist on an antibody test but I won't!

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Permalink Reply by Trisha01 on July 25, 2011 at 5:35pm

Yup, peeing in the cup and the strip turning black, is all it took, at what 27 or 28 years ago. I agree with the antibody tests. It is my understanding, that those tests are designed for NEWLY diagnosed folks.

Trisha

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Permalink Reply by Lila on July 25, 2011 at 9:04am

Being dependent on insulin does not make you a Type 1.

Type 1 diabetes is caused by an autoimmune attack on the pancreas. People with Type 1 test positive for antibodies. Type 1 is insulin-deficient diabetes; Type 1s do not make enough insulin of their own.

If you are not sure what type you are, you can get an antibody test and a C-peptide test. The former will show if you had an autoimmune attack and the latter will show how much insulin you're making. Generally, T1s test positive for antibodies and have low C-peptide counts. Whereas T2s generally test negative for antibodies, and T2s often still make insulin of their own, but the amount is insufficient due to insulin resistance. Hence the need to inject.

I agree with Zoe that the PA is an idiot. However if you are thinking of getting a pump, it might be worth capitalizing on someone being an idiot. Insurance companies are usually more open to giving pumps to T1s; if the diagnosis is T2 (regardless of whether it is medically correct or not), the patient might find it hard or almost impossible to get a pump.

I should also add that there are doctors who will automatically throw a patient out of the T1 club, even if medically they are T1 as shown by antibody and C-peptide, simply because they are fat or look fat without actually being clinically overweight, or if they have any signs of belly fat, insulin resistance, or metabolic syndrome.

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Permalink Reply by Tim on July 25, 2011 at 1:57pm

About your last point: the DCCT run during the 80's and 90's recognized weight gain on the intensive insulin therapy available at the time: Weight Gain Associated With Intensive Therapy in the Diabetes Contr... and certainly in the past couple decades most of the decent endos I've had in the past 30 years knew about this too.

There is a supposition that more modern intensive insulin therapy has less or even no risk of weight gain but I do not honestly know of any broad studies that prove this. Most of the analog insulin makers have some (not so deep or broad as DCCT) studies that show less weight gain using their products than for traditional Regular and NPH (which was DCCT) but there's still some. And I am by my nature more critical of drug-manufacturer-sponsored research.

But yes, like you I've encountered docs who weren't so good and had that attitude.

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Permalink Reply by Melitta on July 25, 2011 at 1:47pm

Hi Megzway: Several things make you "look" like Type 1. Needing insulin at week 6 in pregnancy (requiring insulin at less than 25 weeks gestation is suspect), thyroid, needing insulin so soon. Certainly there are other women here on TuD who had autoimmune gestational diabetes, were not at "fighting weight," and progressed to Type 1 diabetes. Antibody testing (GAD, ICA, IA-2) and c-peptide should clarify if you care to. The crucial thing is that you are on insulin and seem to be getting good care (okay, except for dumb comments by the PA). Check out my blog on autoimmune gestational diabetes.

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Permalink Reply by Super_sally on July 28, 2011 at 10:24pm

Hi Megzway,

I would say that the weight may well be independent in your case. You are also hypothyroid, which makes weight management harder.

You may do better with counting carbs and bolusing accordingly rather than sliding scale. Plenty of info around here if you're interested.

In my pregnancy I was on insulin by 12 weeks. And after the birth it took less than 2 years to need insulin again. I tested c-peptide about a year back, it was very low normal. Tested Anti-GAD it was negative. Don't know where this leaves me. No one has said to me either that I am type 1 or type 2, they just say diabetes. I have no insurance so it hasn't become an issue for now.

Melitta, I'll check out your blog!

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Permalink Reply by Rye on July 25, 2011 at 2:27pm

Yeah I would not listen to that PA....I would ask your regualar doctor which type you actually have. It makes me angry that people in the medical field often give out these crazy diagnoses based on the most inadequate information.

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Permalink Reply by Megzway on July 25, 2011 at 2:45pm

Thanks everyone. I actually have the pump. In my closet still in the box. I was able to get it before my insurance ended just never started it because I'm scared to w/out having an endo to help me with using it if need be. I'm finding that a lot of Internists and PC doctors aren't really up to date on diabetes the way an endo is. So far the 2 endo's I saw really knew their stuff where as the general docs just don't know much.

I do know how to do the carb counting with insulin. Again just something I have brought into my regime. I'm also on Humolog vs Lantis because my husband & I would like to get pregnant again in the near future. The endo said she preferred Humolog in pregnancy to other insulins.

Melitta I believe they put me on insulin so soon in pregnancy to get my sugars in control. My fasting was 156 & they didn't want to take the chance of harming the fetus while working on getting my number down with diet & exercise. They tested me early on because I had been pre-diabetic before getting pregnant & they wanted to take special care that the baby wasn't harmed. Happy to report she is perfectly healthy 3 yr old. :) I was actually a model patient that the doctors modeled their other patients on when they met weekly to review casses.

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Permalink Reply by Megzway on July 25, 2011 at 2:50pm

oh I am also on 1000 mg of Metformin twice a day to help with the resistance.

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