How do they tell?

[SusieGriff]

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?

 

[Northerner]

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.

 

[SusieGriff]

Ah, I suppose it did come on quite quickly, but I am over 40 and overweight (isn't everyone over 40!!! lol) I was quite expecting them to tell me I was T2... oh well. I think I was hoping that it would be wrong diagnosis and it would all go away..

 

[Northerner]

Ah, I suppose it did come on quite quickly, but I am over 40 and overweight (isn't everyone over 40!!! lol) I was quite expecting them to tell me I was T2... oh well. I think I was hoping that it would be wrong diagnosis and it would all go away..

Sadly not But look on the bright side - you wouldn't have got to know us lot!

 

[SusieGriff]

Sadly not But look on the bright side - you wouldn't have got to know us lot!

Thank god I did!!! you lot here have taught me more, just by reading all your threads than my DSN ever did !! and thanks to you Northie I am soon going to be on MDI and look forward to an easier time.

 

[Northerner]

Thank god I did!!! you lot here have taught me more, just by reading all your threads than my DSN ever did !! and thanks to you Northie I am soon going to be on MDI and look forward to an easier time.

That's good news Susie. Diabetes is never easy, but MDI will make things easier for you than they have been, I'm sure. 🙂

 

[margie]

Speed is one of the factors that leads Drs to their preliminary diagnosis.

Sadly many people with Type 2 find it creeps up on them - the symptoms come on slowly or they put them down to their age. Often they can be living with elevated levels for a long time before diagnosis.

 

[lizabetic]

what about GAD antibodies? Do Type 2 have them?

 

[Mark T]

what about GAD antibodies? Do Type 2 have them?

From what I understand, It's possible to have a few GAD antibodies - my reading was 6.2 U/ml - this is considered to be negative. Strictly negative is less than 5, but positive is > 25.

 

[Mark T]

I did see a document a while back that defined a recommended diagnosis pathway. I suspect very few NHS trusts use it.

Basically it was if at diagnosis you were under a specific age/bmi and had to be treated with insulin or had DKA, then they would assume you as Type 1.

If you were above a certain bmi/age then they would assume Type 2.

If you were in the middle they were supposed to do antibody and c-peptide tests, the results of which were to categorise you accordingly. If they still hadn't sorted it then you got scanned for MODY.

Unfortuantely I can't find it and can't remember where I saw it - I know it was buried in a NHS document somewhere!

 

[lizabetic]

I did see a document a while back that defined a recommended diagnosis pathway. I suspect very few NHS trusts use it.

Basically it was if at diagnosis you were under a specific age/bmi and had to be treated with insulin or had DKA, then they would assume you as Type 1.

If you were above a certain bmi/age then they would assume Type 2.

If you were in the middle they were supposed to do antibody and c-peptide tests, the results of which were to categorise you accordingly. If they still hadn't sorted it then you got scanned for MODY.

Unfortuantely I can't find it and can't remember where I saw it - I know it was buried in a NHS document somewhere!

In that case then why did they not figure out I needed more tests when my antibodies came back negative? Eugh! I didn't really understand the C-peptide results though.. i think it was that part of my pancreas has died?

I'm so angry at the heathcare system back home, not once did they explain whats going on, and certainly NOT correctly. Even my own mother didn't know what Type 1 is yesterday after 2 years of this... :\

 

[Caroline]

Unless pushed my doctor never explains anything, which is why I cam here and decided to educate myself.

 

[Northerner]

In that case then why did they not figure out I needed more tests when my antibodies came back negative? Eugh! I didn't really understand the C-peptide results though.. i think it was that part of my pancreas has died?

C-peptide is something that is produced in equal quantity to insulin by the pancreas, so by measuring it they can tell how much insulin you are producing (if any). artificial insulins don't contain it.

 

[Mark T]

C-peptide is something that is produced in equal quantity to insulin by the pancreas, so by measuring it they can tell how much insulin you are producing (if any). artificial insulins don't contain it.

From my (very) limited understanding,

• for a Type 1 the c-peptide should be very low and they will have antibodies
• for a Type 1.5 it will be higher (depnding on progression), but they will have antibodies
• For a Type 2 the c-peptide should be >1 ng/ml (or >100%)

Someone who is MODY is very likely to have a c-peptide that is in the middle, but they would also test positive on gene screening.

I think you stated back a while ago that your c-peptide was possibly 70% - from a study of MODY families they group of people they tested (all confirmed MODY3) had an average fasting serum C-peptide level of 0.84 ? 0.6 ng/ml.

Unfortunately diabetes is a bit of a postcode lottery, I think I'm fairly lucky where I am. One of the first bits of advice that my GP RGN gave me was to not eat too much starchy carbs! 🙂 Considering the dietry advice others seem to get 🙄

 

[squidge63]

I lost weight (3.5 stones) fairly quickly without being on a diet, although my exercise had increased, I was peeing for England and drank (not alcohol) like a fish, and was very lethargic. I was diagnosed as Type 2, I went for the GTT gave my sample in and had 1st blood test and Dr came out and said we don't need to carry you are diabetic, and from then on I was treated as a type 2. I asked my DSN last year how they knew I was type 2 she looked at my age when I was diagnosed and said because of your age..

 

[SusieGriff]

I lost weight (3.5 stones) fairly quickly without being on a diet, although my exercise had increased, I was peeing for England and drank (not alcohol) like a fish, and was very lethargic. I was diagnosed as Type 2, I went for the GTT gave my sample in and had 1st blood test and Dr came out and said we don't need to carry you are diabetic, and from then on I was treated as a type 2. I asked my DSN last year how they knew I was type 2 she looked at my age when I was diagnosed and said because of your age..

How strange is that? My GP nurse couldn't believe that I was T1, she spoke to the DSN abd she said I was def T1, because how I presented my symptoms,( over 2 wks I developed dry mouth, blurred vision, thirst/peeing and lethargy) I seems those symptoms are the same in T2 too, AND I am over 60!!! and I hadn't lost any weight....I have now (3stones in 4m!) I had tests with keytones and BG at 'hi' - so as Northie says the keytones maybe why.It's still a blurred line to me though.

 

[mcdonagh47]

I had tests with keytones and BG at 'hi' - so as Northie says the keytones maybe why.It's still a blurred line to me though.

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 ?

 

[Northerner]

...If you are still walking round functiuoning almost normally then you are Type 2.
...

May be Type 2, not definitely...the reason why a lot of people get misdagnosed.

 

[everydayupsanddowns]

From the stories I've come across 'diagnosis' almost exclusively to do with age and weight in many clinics. This is sufficient for many, but causes major problems with people whose frame and/or age don't fit the easy template, who then seem to have a major problem on their hands getting an accurate Dx and are often subject to lengthy preiod of completely inappropriate treatment.

You can forgive the gen public for assuming that all T2s are older and heavier, and all T1s are young and slim, but I get a bit frustrated every time I read the story of a person at loggerheads with their team, having to badger them about getting proper tests run to find out what's really up.

M

 

[Mark T]

I think in some of these cases the GP's are only trying to treat the symptoms without trying to understand the underlying cause - I guess because it won't always change the treatment.

That isn't really an excuse though.