A diagnosis of diabetes

[Lucyr]

It is a false assumption to think Type 1 diabetes get better treatment than type 2 diabetics. I don't know were this assumption started

It's not an assumption it's a fact, if you're a diabetic on insulin, then if classified as type 1 you have a higher eligibility for:
- T1 are eligible for education courses on insulin adjustment like DAFNE, generally T2 aren't (though anyone can do BERTIE online reading there is often said to be benefit in meeting others face to face)
- insulin pumps (subject to meeting strict requirements still as a T1, but these aren't approved for T2 except in extremely exceptional cases)
- freestyle libre sensors (majority of T1s now have these, it is now possible for some T2 on MDI to get these funded but it's subject to meeting strict requirements e.g. proving you need to test 8+ times a day and a postcode lottery)
- consultant led care: a lot more T1s receive specialist care at the hospital than T2s, majority of T2s see only the practice nurse at the GP even if on insulin

If a type 2 diabetic was falsely classified as a type 1 it would be seriously flawed to expect his diabetes to improve.

If that T2 was on insulin, and being falsely classified as T1 meant they could access something they needed for their personal variation of diabetes like a blood glucose sensor, or a hospital DSN/consultant, or education, or an insulin pump, which they couldn't access as a T2, then yes their diabetes could hugely improve

 

[rebrascora]

I am starting to wonder if @J M Hood has Type 1 and Type 2 diabetes mixed up and is thinking of them the other way around.

For clarification Type 1 is an autoimmune condition where the body's immune system decides to attack the insulin producing beta cells in the pancreas, killing them off. When this occurs in older patients the onset can be slower and may initially present like Type 2 or even respond to Type 2 medication for a while... could be months or years... but will eventually need insulin. The modern insulin regime of choice is a basal/bolus regime which allows the patient to adjust the doses and manage their own BG levels. It can also be treated with a mixed insulin like M3 but the patient would need to have a quite regimented lifestyle with regular meals of a similar carb content..
Type 1 diabetics get BG meters and test strips prescribed as a matter of course and can be eligible for Libre sensors, insulin pumps and intensive education programs to help manage their diabetes and their care will usually be overseen by a consultant.

Type 2 diabetes has a metabolic cause. It may be that the patient is carrying a lot of surplus weight (body fat) and is experiencing insulin resistance or it may be that they are not particularly overweight but have developed visceral fat around their organs and in particular their liver and pancreas which prevents those two organs from communicating effectively and balancing BG levels.... or a combination of both of those scenarios. I am sure that I have oversimplified that explanation but that seems to be the basics that are known at the moment. It can be treated by dietary changes and exercise and/or oral meds but some Type 2s will go on to need insulin. This can be a mixed insulin like M3 or a basal bolus system. Again from a flexibility of diet and lifestyle point of view, basal/bolus is often preferred but it does take more knowledge and thought than set doses of mixed insulin.
Many Type 2 diabetics have to self fund their BG meter and test strips but if they are on insulin they will get a limited number prescribed. Getting Libre sensors on prescription is almost impossible and many here on the forum self fund at a considerable personal expense.

I am not saying one type is more easy to manage than the other but I don't think there is anyone here on the forum who would dispute that Type 1s have easier access to better tech and support than Type 2s.

 

[J M Hood]

Hi and thanks for that detailed response.

What I am suggesting is that it is highly likely you were misdiagnosed in the first place in 1990. The fact that you weren't obese, relatively young at 38yrs and had classic very high BG symptoms of thirst and urinating suggest Type 1, especially as you went on to needing insulin after a short space of time managing things with diet and then oral meds. This is a route many of us who were misdiagnosed went through and is more common with people who are diagnosed with Type 1 later in life. Did it not seem odd to you that you were diagnosed Type 2 when you weren't overweight? There is no specific test which identifies you as Type 2. Diagnosis is based on clinical presentation and it sounds like you didn't present as a typical Type 2 diabetic, but perhaps your GP was under the impression (as many are) that Type 1 only exhibits in children and young adults, so assumed you were Type 2 because you were more mature. It is a common mistake that many of us experienced. I think there are probably quite a significant number of diabetics out there who are diagnosed insulin dependent Type 2 (particularly those who are not significantly overweight) who are actually Type 1 but just never got the C-peptide and GAD antibody tests, or the tests were not done under the correct procedures.

The type of insulin used to treat you is immaterial. M3 can be used to treat Type 1 or Type 2 and so can multiple daily injections (basal/bolus insulin system) although the latter is preferable for most people as it allows them more flexibility in their diet and lifestyle. It is how you use these insulins which is important and having the right support and education program to understand how they work to find the right balance for your body..... which it seems sadly didn't happen in your case, which is why you were "high risk" as you put it whilst you were using a basal bolus system... It was because the doses were not adjusted correctly for your body and your lifestyle. I wonder if you being so concerned about your diabetes classification being changed that you didn't fully embrace the new insulin regime.

Personally, from the information you have provided, I think it is likely that the consultant, was probably correcting a mistake made 25 years earlier in that you should have been originally diagnosed Type 1 in the first instance. I think it is a terrible shame that you have spent so much time and effort (and money by the sound of it) complaining about this and quite possibly getting stressed about it when it may just be a question of you not fully understanding the facts or having things explained to you well enough.

No I am certainly not an agent for Libre but it has been a game changer for me as regards my diabetes management as most other people here have also found, but it does have it reliability faults and limitations. If you are on a mixed insulin then I think you might not be eligible but as a Type 1, the new NICE guidelines suggest you should be offered it on prescription.

Thanks for reply. It is very unwise to speculate on events over 30 years ago. They have hospital records so that you don't need to speculate. Everyone makes mistakes (even Consultants). They should be on their guard and investigate the very real possibility of clerical error. This was not done in my case. If the Consultant in 2018 had asked the question; Who actually re-diagnosed me in 2015 and why ?, he would have found out about the clerical error. He and the all the Consultants over the next 4 years choose not to investigate. None were curious about why I had been reclassified. My GP's never read the Sci-diabetes report and never spotted the contradictions contained in it. My GP's and the Consultants involved were negligent and they eventually knew it. That's why they decided to cover up the error. I actually was not informed that I was a type 1 diabetic till at least 3 years after I had been misclassified. In that time period I was still being treated as a type 2 diabetic. The method of informing me about this change consisted of the Consultant saying to me (as he was going out the door) "by the way you are a type 1 diabetic". Even this is not a diagnoses, as he may have (disputable) given a opinion, but he certainly didn't give a justification. What he did was arouse my curiosity. I then went after an answer and found it in my records. The consultant couldn't give an explanation or justification as none existed. With hindsight I now realize why my GP never responded to my requests for a justification, she already knew about the mistake she just wouldn't tell me. A clerical error in 2015 plus a non-diagnoses (a lie) in 2018 resulted in my being falsely treated as a type 1 diabetic.
As discussed I went to another Hospital and showed the 2015 report to two Consultants. They agreed with me that no diagnoses took place in 2015. They organised two c-peptide test that proved I was a type 2 diabetic.
According to some it would have been better for me to remain a type 1. I may have wasted time and money (ink is no cheap matter) but a lie is a lie and I personally can't weekly accept that. If, when they eventually found out about the error, they had just told me I would have said; oh well we all make mistakes, and moved on. But they didn't because once they had lied there was no going back.
So the fact is I was diagnosed as a type 2 diabetic in 1990, was falsely classified as a type 1 in 2015 and then reinstated as a type 2 in 2021. Something is wrong. The evidence for the clerical error in 2015 is enshrined in my medical notes and is available to any medical practitioner to scrutinize. A clerical error made in 2015 is the only credible explanation for this fiasco. I will get no benefit from my pursuit of the truth as a conspiracy of lies from those in power have thwarted my attempt. The lesson is don't trust your Doctors and don;t for any reason use the Ombudsman.
For all those people that think type 1 diabetics get a better deal in the NHS you should complain to what ever

 

[J M Hood]

rebrascora Sorry cut of in mid flow. Should have ended "to what ever God you believe in". To clarify the Idea that a mistake was made originally. They could have made a mistake but the evidence suggests otherwise. Remember It was 25 years before the error took place not the six months it took for your re-diagnoses. That's the time period between reviews. In my 25 years as a type 2 I was reviewed 50 times by different Consultants. Each one of the reviews will have the potential for a re-diagnoses. It just never happened. Do you find it credible that 50 consultants over 25 years got it wrong ?
Family history: Grandmother, Father, Uncles, Aunts and sister all type 2 diabetes.
Significance of weight brought comments e;g "unusual" but not so unusual to warrant investigation.
There is no specific test for "type 2". I was reinstated as type 2 in 2021 on the bases of 2 c-peptide tests ?
Type 1 diabetics are prone to high levels of ketones. Type 2 are not. I have never in all my time as a diabetic suffered from elevated ketones. Those that think type 2 diabetics get better treatment should think on this !
With regards to the libre machine. It is accepted that this device is not suitable for all. It is not totally accurate as it does not measure blood glucose. I was infected at the puncture site. But I'm happy it works for you. I don't need a computer to do simple arithmetic and draw graphs. I have found out that simple seven day averages based on 3 months finding correlate with Hb1 results for the same time period. Found to be plus or minus 2-3 digits. Cheers

 

[Bruce Stephens]

Those that think type 2 diabetics get better treatment should think on this !

Nobody's suggested that! It's rather the opposite, but as you say, the technology more easily offered to people with T1 isn't necessarily what you'd want if you have T2. (Which is partly why it's not so readily on offer to people with T2, of course.)

I can understand why it's annoying to have this error in your medical history but I'm not sure why it matters otherwise. I'd be surprised if it caused any problems with (say) insurance since you're clearly T2 now. Similarly, there are some medications that aren't recommended for people with T1, but I'd be surprised if doctors didn't consider them for you since you are obviously T2.

I've no idea why there's so much reluctance to correct your medical history. Presumably it's the usual reluctance to admit error. That's obviously wrong, but it's still strongly embedded in health trusts afraid of being sued. (An inappropriate fear in most cases, I think, since most patients just want to know the truth and to help correct future mistakes.)

 

[Burylancs]

I don’t really understand your post or your question.

I don’t really understand your post or your question.

Insulin regime with carb counting works just as well for T2 as for T1, so long as you’ve calibrated your ratios correctly. I’m T2 and that’s exactly the system I use.

Insulin regime with carb counting works just as well for T2 as for T1, so long as you’ve calibrated your ratios correctly. I’m T2 and that’s exactly the system I use.

Carb counting and ratios are not supposed to work well with T2 on insulin. That's why Dafne courses are irrelevant to T2s. T2s always have some insulin secretion that is declining and fitful. So technically ratios cannot be calculated because the pancreas is always likely to throw a spanner in the works with a dollop of unexpected insulin. You must be lucky.

 

[Lucyr]

Carb counting and ratios are not supposed to work well with T2 on insulin. That's why Dafne courses are irrelevant to T2s. T2s always have some insulin secretion that is declining and fitful. So technically ratios cannot be calculated because the pancreas is always likely to throw a spanner in the works with a dollop of unexpected insulin. You must be lucky.

Using ratios isn't perfect when you're T2 no, because it's random what your pancreas fancies doing, and so bgs are unpredictable, like when a T1 is in honeymoon. However using ratios works a whole lot better than fixed doses of fast acting insulin which is the only alternative. Taking the same dose of fast acting whether eating a salad or a pizza makes no sense whatsoever. You wouldn't advise a new T1 that "taking fixed doses is the only option and ratios won't work because you're in honeymoon". You'd say "using carb counting and adjusting insulin to what you eat is best, but your bgs could still be a bit unpredictable because you're in honeymoon period and pancreas erracticly produces some insulin".

In the same way for T2s, adjusting your dose of fast acting based on what you're eating gets you much closer to good bgs, even if they are still unpredictable because of your pancreas. It isn't that DAFNE "is irrelevant to T2s" it's that it hasn't been researched and proven.

 

[J M Hood]

regards last thread, it shows how easy it is to put a 2 were a 1 should go. For those, including diabetic consultants and GPs, that think it doesn't matter what type of diabetic classification you are given I. If have just been to my first cardiac rehab. I was told that it is crucial to declare your actual diabetic type before commencing rehab exercises. If I had not spent time by proving I am a type 2 diabetic I would still be falsely classified as type 1 and in serious risk.

 

[Lucyr]

Why would cardiac rehab put you at serious risk if falsely diagnosed as type 1?