Diabetes classifications, T2 subtypes?

[Eternal422]

I had a long discussion with my diabetes consultant who agreed I was a 'one-off' and needed to be treated as T1 and has done so but left me listed as a T2 because I didn't meet the strict T1 classification. There is no strict T2 classification - it's just a dumping ground.

To all intents and purposes I am treated like T1, just not classified as such (and therefore not eligible for pumps and HCL). It I’m happy with MDI as it gives me good control and allows flexibility with regard to eating and exercise.

 

[Eternal422]

Plus the before run/after run tests, before/whilst driving etc.

The good news is the GP said, so long as the hospital say I can have one he'll happily just sign it off from a GP perspective.

The consultant I am seeing is called Dr Marni Greig and a quick google search shows her to have done plenty of research into insulin response etc and has a paper on insulin use in T2 diabetics so she may be a very good person to speak to. My GP said she's one of the best diabetic consultants at the hospital so fingers crossed...

Great news! It seems to be the same here as the GP surgery are happy to go off the DSN’s letter and prescribe insulin and CGM.

It also sounds like your consultant will be good, much better than mine who had already decided I should come off insulin despite me going through my history! I’m just so grateful my DSN is much more pragmatic and supportive!

 

[dannybgoode]

It also sounds like your consultant will be good, much better than mine who had already decided I should come off insulin despite me going through my history!

We will see. I am going to ask her if there is a reason my body has decided to ignore its own insulin but is happy with using injected insulin. Hopefully she will be able to explain it in a way I understand!

I will of course report back tomorrow...

 

[harbottle]

My understanding is that there are no conclusive tests for Type 1.GAD and c-peptide tests should be used for pointers only. However, we all like to work with certainties so some doctors interpret them as such.

I never said they were conclusive.

He had the relevant tests, and the Drs concluded he was T2 possibly with a loss of beta cell function. With a shrug, as they didn't really know for sure.

 

[Eternal422]

We will see. I am going to ask her if there is a reason my body has decided to ignore its own insulin but is happy with using injected insulin. Hopefully she will be able to explain it in a way I understand!

I will of course report back tomorrow...

In my mind you are supplementing your endogenous insulin with what you inject. The body doesn’t distinguish between endogenous and exogenous insulin. So your total insulin “usage” is the sum of the two.

 

[harbottle]

I had chicken pox as an adult just before getting the diabetes diagnosis. I did see a paper from Japan that cited this virus as a possible trigger for the immune system to sort of go into overdrive and end up killing off beta cells.

I have also read a paper from Oxford University that talks about high blood glucose “reprogramming” beta cells causing them to stop producing insulin :

Key cause of type 2 diabetes uncovered | University of Oxford

Oxford Research reveals high blood glucose reprograms the metabolism of pancreatic beta-cells in diabetes.

www.ox.ac.uk

Yes, that paper was posted here a few years ago when the findings were announced. The constant metabolism of glucose leads to the cells stop responding. Something to do with a by-product of glucose metabolising that blocked a pathway? (Most of the highly technical was gibberish to me!)

Beta cells start off as the same cell as alpha cells and 'differentiate' to become beta cells. I think Taylor's 'personal fat threshold' work is based on the idea that the high levels of fat cause them to 'dedifferentiate' and become inert, but removing the fat brings them back to life (At least in some people.)

 

[dannybgoode]

In my mind you are supplementing your endogenous insulin with what you inject. The body doesn’t distinguish between endogenous and exogenous insulin. So your total insulin “usage” is the sum of the two.

Thing is, I stopped for a day and my BG went mental after the first meal and then at night slowly drifted down to 10 and didn't get any lower.

It was like my body used the glucose it needs to function then, when I was asleep and not doing anything it just flat lined at 10.

Within a day and a half I was thirsty and needing to wee lots. I stopped the experiment at that point and got straight back to the injections!

 

[Eternal422]

Thing is, I stopped for a day and my BG went mental after the first meal and then at night slowly drifted down to 10 and didn't get any lower.

It was like my body used the glucose it needs to function then, when I was asleep and not doing anything it just flat lined at 10.

Within a day and a half I was thirsty and needing to wee lots. I stopped the experiment at that point and got straight back to the injections!

Maybe your endogenous insulin is not enough to overcome any insulin resistance, so the only insulin that does anything is the exogenous insulin?

 

[harbottle]

Thing is, I stopped for a day and my BG went mental after the first meal and then at night slowly drifted down to 10 and didn't get any lower.

It was like my body used the glucose it needs to function then, when I was asleep and not doing anything it just flat lined at 10.

Within a day and a half I was thirsty and needing to wee lots. I stopped the experiment at that point and got straight back to the injections!

That makes sense, when it gets around 10/11 your kidneys start expelling excess glucose in pee.
So you pee a lot.
Might explain why it settled around the 10 mark as well.

 

[dannybgoode]

Could be. See what the cons has to say.

Like you I don't need much insulin - 10-11U of Levemir twice a day and c. 1:10 ratio on the NR.

Exercise causes my BG to crash as well. Even today's easy dog walk needed fuelling so at least everything is consistent, reasonably predictable and eminently manageable 🙂

 

[DaveB]

You have made this statement before and it has usually come with the response that the viruses do not kill off the beta cells - they trigger the auto-immune response. If the viruses just killed off the cells, they would "rebuild" (sorry, there is a better term at the end of my tongue but I cannot see it!) or an islet transplant would work. The auto-immune reaction is continuous so beta cells are not able to grow or be transplanted without being killed off.
I wish it was just the virus I had before my Type 1 diagnosis which killed off my beta cells but sadly, they have never regrown.

Yes, I've posted before as the classification problem remains for many of us. I'm fairly confident that a virus caused my DB. If, as you say, they would cause an auto-immune response why are there no antibody tests for the more popular viruses that should be done when trying to pin-point T1. This suggests that the common GAD and IA2 tests are very restrictive. Are you sure beta cells simply 'killed' by a virus would recover?