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C-Peptide results

Inka said:
. Do you have any close relatives with diabetes?
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My paternal grandmother and my mother, although both were not diagnosed until late in life. My paternal grandmother was on insulin but that was years ago so presumably lots of the current T2 drugs were not available then (1970s).
 
@Eternal422 this must be very stressful - after so long taking insulin to manage your diabetes now there is threat of it being taken away - seems strange that they would do a C-Peptide test and antibodies after all this time as it sounds like you have got it all under control - maybe something more sinister going on regarding funding etc. for HCL as @rebrascora has suggested earlier (that wouldn't surprise me) - the results of them do suggest T2 rather than T1 though (Did you have similar tests done when 1st diagnosed?)
 
Inka said:
There’s a MODY risk calculator here
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Thanks, just tried it and it says : 4.6% (a 1 in 21.7 chance of having MODY), but also If the patient has a C-peptide >200pmol/L, then the probability of MODY will increase substantially. So a possibility?
 
That would be for a medical professional to decide @Eternal422 but it would be worth noting and writing/printing out your answers so they have the information in front of them and all together on your records.
 
@mashedupmatt - I had nothing done at diagnosis, the GP assumed T2, I suspect because of my age. I never had C-Peptide but some years after diagnosis, just after starting on insulin (about 5 years after diagnosis) I had a GAD test which was “inconclusive”.

They have done this referral to the consultant and these tests now because I was asking about the possibility of HCL and my DSN (who was treating me as T1) said as I didn’t have this on my medical record they needed a consultant to confirm. I wish I had said nothing and left things as they were!

I guess it’s looking like T2 more than anything, but even so I still feel as though I want to continue with insulin as I am pretty stable with it, especially after so much practice over the years!
 
Eternal422 said:
In some ways, not having to carb count, inject, make corrections, etc., etc. may be nice. As long as I could continue to eat whatever without worrying (as I do now as I just give myself enough insulin to cover the carbs).
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Could you negotiate perhaps a trial of keeping basal insulin to minimise DKA risk as you always have insulin working then, and rapid insulin to be used only for corrections 2hrs after a meal if needed perhaps? Or for meals over x grams or carbs and you don’t inject below that amount, as a starter for the trial. And you assure them you’re confident reducing doses if there are hypos with addition of the tablets.

That would give you the 2 jabs a day for libre, and the reassurance you need perhaps?
 
Lucyr said:
Could you negotiate perhaps a trial of keeping basal insulin to minimise DKA risk as you always have insulin working then, and rapid insulin to be used only for corrections 2hrs after a meal if needed perhaps? Or for meals over x grams or carbs and you don’t inject below that amount, as a starter for the trial. And you assure them you’re confident reducing doses if there are hypos with addition of the tablets.

That would give you the 2 jabs a day for libre, and the reassurance you need perhaps?
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Thanks for this suggestion. I’ll add that idea to my list of questions / discussion points. I wasn’t aware of a T2 criteria for Libre that you seem to suggest? I thought Libre, or equivalent CGM, was just for T1?
 
If you are on multiple daily injections and have been advised to test a certain amount of times - I think it's eight, but don't quote me on that! (regardless of type) you are entitled to CGM from what I understand (which is very sensible - one of the few NICE Guidelines I agree with!)
 
@dannybgoode and @mashedupmatt - thanks for that, comforting to know that if I remain on insulin or return to insulin if I don’t get on with the drugs then the Libre is still an option. Certainly being on insulin with CGM has been a game changer for me so I would be very sad at losing it. Having to self fund would be a bit of a strain, but I might have to go that route if it ever came to it, let’s hope not!
 
Eternal422 said:
I wasn’t aware of a T2 criteria for Libre that you seem to suggest? I thought Libre, or equivalent CGM, was just for T1?
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T2 can have libre if injecting 2+ times a day and if meeting other criteria such as needing to test 8+ times a day (which you would be if you’re keeping rapid insulin with you in case of needing any corrections)
 
Lucyr said:
T2 can have libre if injecting 2+ times a day and if meeting other criteria such as needing to test 8+ times a day (which you would be if you’re keeping rapid insulin with you in case of needing any corrections)
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Thanks @Lucyr !
 
Eternal422 said:
Just got my C-Peptide and antibodies results - C-Peptide is 642 and antibodies are negative.
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Congratulations.

rebrascora said:
the idea of coming off insulin is frightening.
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Exactly, that is the main problem when taking people off insulin, people are very very scared to stop taking it. In the Netherlands doctors even get death threats if they try to take people off insulin, thanks to all the scaremongering also.

Diabeter, a specialised diabetes center which has the very best care in Europe, took more than 200 of their patients off insulin and they are doing fine, in fact much better than before. Just trust your doctors.

Here the director of Diabeter explains this can be done from 51:05 till 51:22 (in Dutch, but it’s only 17 seconds): Differences between type 1 diabetes
I could translate it word for word if somebody is interested.
 
After a restless night thinking this all over, I now wonder at the wisdom of using Metformin. I had 5 years on it when it did nothing to reduce my HbA1c but gave me an intermittent upset stomach. Can’t think it would be any different this time around. I accept that the Dapagliflozin may well reduce any high BGs, but Glibenclamide didn’t stimulate any more insulin when I was on that for a year along with Metformin.

I guess it’s more questions for my DSN when I have an appointment.
 
Eternal422 said:
I now wonder at the wisdom of using Metformin. I had 5 years on it when it did nothing to reduce my HbA1c but gave me an intermittent upset stomach.
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Ask for the slow release if it was regular previously
 
Just got a face to face appointment with my DSN at the hospital on Monday to discuss. She said that she understands my concerns and fear of coming off insulin but did stress that there was no pressure for me to come off insulin, but that there were benefits of oral meds which she will discuss with me.

I need to keep an open mind and hear both sides, maybe a trial is worth doing to prove one way or the other which treatment is best for me. Still not sure about coming off insulin but at least there is no pressure and they seem to be genuinely caring about my health and quality of life.
 
I've been down similar route but my C-Peptide was a bit lower than yours. Bear in mind the C-Peptide test isn't that accurate. I use quite high levels of insulin and tests at the gym show my insulin resistance to be low. I believe the results of GAD are irrelevant as viruses can cause beta cell damage so the C-Peptide tests are the deciding factor. I was on 360mg of Gliclazide and Metformin before going onto insulin and they were having no effect any more. I certainly couldn't go back onto tablets. My thoughts are for you to stay on insulin but it's your choice. The Bolus enables you to cope with occasional high carb meals; with tablets you would be stuck.
 
@DaveB - very interesting to hear. Can I ask what your C-Peptide was out of interest? I had chickenpox just before original diagnosis at age 42 which did make me wonder if it had either over triggered my immune system causing beta cell decline or as you say that the chickenpox virus itself caused beta cell decline? The consultant said she had never heard of chickenpox causing this, but I still wonder if an auto immune attack was triggered from having the virus, but it appears not all beta cells were destroyed? Who knows, especially after such a long time now!

Like you the Metformin and Glibenclamide (a sulphonylurea agent similar to Gliclazide) had no effect, in fact my HbA1c climbed from 71 to 144 in the 5 years I was on these oral meds, which is what precipitated the move to insulin.

I am feeling more inclined to stay on insulin for the fact that it works well for me with no side effects (other than the odd hypo if I am too heavy-handed) and gives me the flexibility to eat what I want at any time I want and cope with variable amounts of exercise. As you say, oral meds would not give me this flexibility. So for me it seems a bit of a backward step.

I am so grateful that my DSN is understanding and has gone out of her way to arrange a face to face appointment with me on Monday to discuss all this. She has also said that there is no pressure for me to come off insulin, so this has given me some reassurance. Whether I am T1 or T2 is almost irrelevant to me, if I need insulin to keep my HbA1c and TIR in good control and it allows me to live my life as I wish then this is more important and is the deciding factor as far as I am concerned.
 
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