How do they tell?

[lizabetic]

Well I was never rushed to hospital - pressume I had no ketones..
Yet still I was put straight on insulin and classed as type 1, probably due to my age 16 and weight, however they still question between type 1 and type 2. At least my endo - if thats what he is - does.

and thanks for the reply about the c-pepide, yup I believe mine is somewhat dead then :O

 

[lucy123]

I am a bit confused now because I thought type 1 were automatically put on insulin on diagnosis as they don't produce any. If someone was incorrectly diagnosed as type 1 and started on insulin when they don't need it, isn't that dangerous? Sorry if I am completely wrong.

 

[Robster65]

Possibly down to whether your GP has a special interest in the subject. Or whether the surgery are proactive enough to have regular refresher courses for staff.

Just for the record, I was walking round relatively normally,albeit drinking lots and had lost weight. But it was picked up before I needed to be rushed anywhere. Symptom presentation or age/weight don't seem to be as reliable for diagnosis as many would imagine.

Rob

 

[Mark T]

Ah, I found one of the documents I was looking for!

It's on the http://www.diabetes.nhs.uk website.

Factsheet 32: Getting it Right: Improving the Classification, Diagnosis and Coding of Diabetes

 

[lizabetic]

Lucy, I suppose it would be dangerous!! I was hypoing on 5 units at the time, I suppose you could argue fortunately that I was eating to accomate for the insulin (rather than the other way round!). My GP I believe was a specialist.

Also Mark can I ask what yyour local hospital is? I'm essex too 🙂

 

[Mark T]

Lucy, I suppose it would be dangerous!! I was hypoing on 5 units at the time, I suppose you could argue fortunately that I was eating to accomate for the insulin (rather than the other way round!). My GP I believe was a specialist.

Also Mark can I ask what yyour local hospital is? I'm essex too 🙂

I'm Mid-Essex PCT, my Diabetes centre is at Broomfield Hospital.

 

[HelenM]

The document that Mark linked to seems to be reinforcing the idea of classification by treatment and age. Many people with LADA would be classified as T2 according to that very simplistic algorithm.They would be classified as T2 if older than 35 and not put onto insulin at diagnosis or if younger than that, if they had not gone onto insulin in the first 6-12 months.
The official document from the World Health organisation shows classifying diabetes ins't easy and it will inevitably change as they learn more.

Type 1 includes those cases attributable to an autoimmune process, as well as those with beta-cell destruction and who are prone to ketoacidosis for which neither an aetiology nor a pathogenesis is known (idiopathic).

LADA is mentioned as being a form of T1

The slowly progressive form generally occurs in adults and is sometimes referred to as latent autoimmune diabetes in adults (LADA). Some patients, particularly children and adolescents, may present with ketoacidosis as the first manifestation of the disease (26). Others have modest fasting hyperglycaemia that can rapidly change to severe hyperglycaemia and/or ketoacidosis in the presence of infection or other stress. Still others, particularly adults, may retain residual beta-cell function, sufficient to prevent ketoacidosis, for many years (27). Individuals with this form of Type 1 diabetes often become dependent on insulin for survival eventually and are at risk for ketoacidosis (28). At this stage of the disease, there is little or no insulin secretion as manifested by low or undetectable levels of plasma C-peptide (29).

Type 1b is the catchall category for those who seem to have T1 but they haven't the foggiest notion why.(10-15% don't test positive for autoimmune antibodies)It is possible that they have unknown antibodies, a new one, ZnT8 was found in only the last couple of years

There are some forms of Type 1 diabetes which have no known aetiology. Some of these patients have permanent insulinopenia and are prone to ketoacidosis, but have no evidence of autoimmunity (33). This form of diabetes is more common among individuals of African and Asian origin. In another form found in Africans an absolute requirement for insulin replacement therapy in affected patients may come and go, and patients periodically develop ketoacidosis

.

 

[everydayupsanddowns]

Great post Helen, thanks!
M

 

[SusieGriff]

Basically if you are rushed into hospital you are Type 1, esp. if in DKA.
If you are still walking round functiuoning almost normally then you are Type 2.

Have you been tested for GAD antibodies ? And do you have any Type 1 grandchildren ?

I don't know if i've been tested, no-one has mentioned it. I'm seeing the consultant next week, I'll ask him then.
also no-one that I know of in my blood line family have T1. an aunt has T2, that's all I know. there may have been family years ago that we didn't know about that had it.

 

[mcdonagh47]

I've been reading the thread 'how were you diagnosed' and wonder how they determine whether you're type 1 or type 2? I seemed to have the same symptoms as a lot of t2's, i.e.lethargy, thirst, peeing a lot, blurred vision, my BG was 'hi' and I keytones i my urine when I went to the dr. and was taken immediately into hospital, put on an insulin drip for 3 days and declared Type 1. why was it different to Type 2?

The diagnostic criteria for dxing Type 1 in England and Wales are in the NICE guidelines. Adult section starts on page 34...
you need all the usual symptoms
plus ketonuria
and/or marked weight loss
and/or NO features of the Metabolic syndrome ( dyslipidemia, hypertension, obesity etc)

And they don't want Docs to routinely test for GAD antibodies and C-peptide ( too expensive? or unecessary if you have raging bgs and ketones ?)

NICE Guidelines for Type 1 Diabetes ( April 2010) are in link below...any chance of a sticky or is it one already ?
http://www.nice.org.uk/nicemedia/live/10944/29390/29390.pdf

 

[Mark T]

...And they don't want Docs to routinely test for GAD antibodies and C-peptide ( too expensive? or unecessary if you have raging bgs and ketones ?)

I would not think too expensive, according to the Exeter Diabetes genes web page a test for GAD is ?20 and Urine C-Peptide is ?10.20.

 

[Nicky1970]

The effects of high blood sugars tend to produce the same symptoms, although in a Type 2 person there is less likelihood of high ketones I think, or at least less likelihood of diabetic ketoacidosis (DKA). Initially, they are likely to consider your age and perhaps if you are overweight, as if you are over 40 and overweight then statistically your blood sugar levels are likely to be high because of insulin resistance, rather than a total lack of insulin, which is what Type 1s have.

Some people get diagnosed incorrectly if their symtoms are not severe, as Type 1 symptoms at diagnosis tend to be more acute and come on more quickly.

DKA doesn't usually present in Type 2 because Type is characterised by both high blood sugar levels and large amounts of insulin (which is either of poor quality or the cells can't recognise), and the body only begins to metabolise fats uncontrollably in the (near) absence of insulin.
However Type 2 diabetics are at risk of Non-ketonic hyperglycemic coma.

As Northerner wrote, symptoms in Type 2 are more subtle and the disease takes longer to progress. Sometimes there are no apparent symptoms. It isn't unusual for Type 2's to be diagnosed through routine blood tests, sometimes after they have presented with a complication of diabetes.

 

[Mark T]

I managed to re-find some of the links that I had seem a while back.

The first is http://www.athenadiagnostics.com/content/diagnostic-ed/endocrinology/mody

This is a diagnostics lab not the NHS or similar, but figure 1 presents an approach to diagnosing MODY.

 

[AlisonM]

When I was initally diagnosed they said Type 2 because of my weight and age. However, after finding this place and doing a fair bit of research I started challenging that diagnosis and eventually got them to do the necessary tests which proved I'm actually LADA/1.5. I have a few immune deficiency conditions (adrenal insufficiency, pernicious anaemia and Rheumatoid Arthritis) which apparently make Type 2 less likely. Other than that my general symptoms were much the same as everyone else, except for the peeing part, I didn't get that till after Dx.

 

[Blythespirit]

Thank you all for all your imput on this thread! I'm currently putting together a list of questions to ask whoever I'm seeing at the hospital on Monday. I've often wondered how they decide which type a person has on diagnosis. I got my diagnosis over the phone one Friday aternoon and was just told I was T2 and put straight on Metformin. I wasn't told how they come to that conclusion and just supposed it was part of the blood test I'd had done and that 'something' must have shown up to prove that.

I developed D very quickly. Fine in the June and off the scale by November. I felt very unwell but only lost about 4lb in weight. So no slow creeping up there. Also, after really good BG's most of the time, my recent progression has happened very quickly too. And nothing is working to bring it down. Starting to think there's more going on here. I feel even worse than I did when I was diagnosed, plus I have terrible upset tummies most morning coupled with severe heart burn, headaches and nausea. Not to menntion night sweats.

I'm learning so much on here. It's like a veil being lifted and I can see D for what it really is for the first time. I'm in awe of you all and the way you deal with even the most difficult of circumstances yet are still here to support each other. Sending hugs to you all. XXXXX

 

[Northerner]

Hope you get some answers on Monday Blythespirit, and that they can work out an appropriate treatment regime so you can get your levels under control 🙂 Glad to hear you are finding the forum so helpful 🙂