Question on results

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Jonny3012

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Hi all

Would be interested to know people’s opinion. I’m newly diagnosed with diabetes HbA1C of 94. Not significantly overweight, drink occasionally not often, non-smoker and active.

Bloods have come back showing 81% insulin sensitivity and 41% B cell function. Fasting glucose is around 8. Immediately classed as type 2 and been given metformin but cannot get readings below 7. Was told that running between 7-10 was ok but I’m aware that this is not entirely correct (son is type 1). When asked I was told the above tests (HOMA s and HOMA b) were the typing bloods to distinguish between 1 and 2 but I thought the antibody tests (which I haven’t had done) were the definitive tests. Can anyone shed any light? Thanks in advance.
 
Welcome @Jonny3012 🙂 I haven’t heard of those tests being used to determine diabetes type. The tests usually done are the Type 1 antibodies and C Peptide. Those two plus clinical indicators are what are used to determine type, as far as I know.

As your son has Type 1, are you worried you might have it too? Have you had any symptoms like weight loss?
 
Yep weight loss. Lack of sleep, frequent urination. C-peptide result was mid range, wanting the antibody test but diabetes service employed by the GPs seem reluctant. Did take 3 weeks for the consultant to review the tests though!
 
Have you looked up the tests? I just did and they seem to be something from the research lab rather than mainstream diabetes assessment. If so, interpretation might be a bit tricky.

Do you have any idea why your GP (I assume it was your GP) asked for those rather than the standard tests?
 
I have and came to the same conclusion as you. The nurse says you can put the figures into an algorithm but I haven’t been able to find it and It’s been quite difficult to get an answer. On my diagnosis I was referred to a diabetes and endocrinology team (an outsourced private company that my NHS trust uses). They ordered the blood tests, I have queried why the antibody tests weren’t done but haven’t had an explanation as yet.
 
Docb said:
Have you looked up the tests? I just did and they seem to be something from the research lab rather than mainstream diabetes assessment. If so, interpretation might be a bit tricky.

Do you have any idea why your GP (I assume it was your GP) asked for those rather than the standard tests?
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What are considered the standard tests? Oral glucose test, antibody tests, c-peptide, anything else I’m missing?
 
HOMA is an algorithm developed in the 1970s/80s that uses (I think) fasting blood glucose and fasting insulin, and other measures, levels to estimate the level of insulin sensitivity and beta cell dysfunction. It's been updated over the years to take into account other measurements and is used in research. (You see references to it in a lot of papers)

I believe the theory is that it's because the liver may react to a fixed 'basal' level of insulin in order to turn off basal glucose production. As people with T2D have reduced insulin secretion, it takes a while for existing beta cells to secrete at this level so glucose levels rise in order to stimulate the pancreas enough to secrete enough insulin to reach this level. (Some sort feedback loop between the pancreas and liver.)

EDIT: this article is a decent discussion on these measurements and the pitfalls of using them:

diabetesjournals.org

Use and Abuse of HOMA Modeling

Homeostatic model assessment (HOMA) is a method for assessing β-cell function and insulin resistance (IR) from basal (fasting) glucose and insulin or C-pep
diabetesjournals.org diabetesjournals.org
 
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harbottle said:
HOMA is an algorithm developed in the 1970s/80s that uses (I think) fasting blood glucose and fasting insulin, and other measures, levels to estimate the level of insulin sensitivity and beta cell dysfunction. It's been updated over the years to take into account other measurements and is used in research. (You see references to it in a lot of papers)

I believe the theory is that it's because the liver may react to a fixed 'basal' level of insulin in order to turn off basal glucose production. As people with T2D have reduced insulin secretion, it takes a while for existing beta cells to secrete at this level so glucose levels rise in order to stimulate the pancreas enough to secrete enough insulin to reach this level. (Some sort feedback loop between the pancreas and liver.)

EDIT: this article is a decent discussion on these measurements and the pitfalls of using them:

diabetesjournals.org

Use and Abuse of HOMA Modeling

Homeostatic model assessment (HOMA) is a method for assessing β-cell function and insulin resistance (IR) from basal (fasting) glucose and insulin or C-pep
diabetesjournals.org diabetesjournals.org
Click to expand...
Thanks, I have come across this article but it still doesn’t state if HOMA can discern between type 1 and 2 diabetes. It’s a measure of functional capacity rather than a typing diagnostic as it assumes (I guess) that you are type 2.
 
Jonny3012 said:
Thanks, I have come across this article but it still doesn’t state if HOMA can discern between type 1 and 2 diabetes. It’s a measure of functional capacity rather than a typing diagnostic as it assumes (I guess) that you are type 2.
Click to expand...

No, I don't think it can tell the difference between T1 and T2.

Those results appear to indicate quite high insulin sensitivity, though, but it is possible be T2 with good insulin sensitivity, but it's quite a small 'phenotype'.

Yes, I am T2.
 
If it were me I might go back to my GP and enquire why things seem to have gone off piste (i.e not followed nice guidelines, https://www.nice.org.uk/guidance/ng17/chapter/Recommendations#diagnosis-and-early-care-plan) in your case.

They may have sound reasons for doing so based on a deep understanding of the full range of possible causes of poor blood glucose control. On the other hand it could be because exchange of money is involved somewhere or somebody been sold a dummy by "private" healthcare.

Either way up, HbA1c's around three figures need to be taken seriously and a strategy to get it down needs to be devised quickly. Like you, I'm not sure how invoking an obscure test not built into a recognised protocol is going to do that.
 
harbottle said:
No, I don't think it can tell the difference between T1 and T2.

Those results appear to indicate quite high insulin sensitivity, though, but it is possible be T2 with good insulin sensitivity, but it's quite a small 'phenotype'.

Yes, I am T2.
Click to expand...
Thanks for the info. It’s all useful to go back and have a conversation with the Dr if I can get one!
 
Docb said:
If it were me I might go back to my GP and enquire why things seem to have gone off piste (i.e not followed nice guidelines, https://www.nice.org.uk/guidance/ng17/chapter/Recommendations#diagnosis-and-early-care-plan) in your case.

They may have sound reasons for doing so based on a deep understanding of the full range of possible causes of poor blood glucose control. On the other hand it could be because exchange of money is involved somewhere or somebody been sold a dummy by "private" healthcare.

Either way up, HbA1c's around three figures need to be taken seriously and a strategy to get it down needs to be devised quickly. Like you, I'm not sure how invoking an obscure test not built into a recognised protocol is going to do that.
Click to expand...
Thank you for the comments. It’s all useful to aid my conversations.
 
Jonny3012 said:
Yep weight loss. Lack of sleep, frequent urination. C-peptide result was mid range, wanting the antibody test but diabetes service employed by the GPs seem reluctant. Did take 3 weeks for the consultant to review the tests though!
Click to expand...

I think you have a good case to ask for the proper tests: namely, Type 1 antibodies test and C Peptide test. I’d put my request in writing, mention your son and say you’re concerned you’ve been misdiagnosed. Putting things in writing seems to concentrate minds.

Type 1 comes on more slowly in adulthood and is not uncommonly assumed to be Type 2. We now know Type 1 isn’t just a childhood disease. It occurs just as frequently in adulthood.
 
The OP appears to have already had a c-peptide test that was 'mid range' (Whatever that means). A very low reading here can indicate type 1, although I guess as type 1 can come on slowly even that's not going to concrete if the condition is developing.
 
Yeah, that C Peptide sounded a bit vague. The C Peptide helps build a picture rather than be a definitive answer if it’s borderline.
 
harbottle said:
The OP appears to have already had a c-peptide test that was 'mid range' (Whatever that means). A very low reading here can indicate type 1, although I guess as type 1 can come on slowly even that's not going to concrete if the condition is developing.
Click to expand...
Hi all. C peptide was 769 (normal range being 343 -1803 apparently)
 
Docb said:
If it were me I might go back to my GP and enquire why things seem to have gone off piste (i.e not followed nice guidelines, https://www.nice.org.uk/guidance/ng17/chapter/Recommendations#diagnosis-and-early-care-plan) in your case.
Click to expand...

Sorry to hear about the confusion over your diabetes type @Jonny3012 :(

I was one of the lay members on the panel for that NICE guidance, and remember being surprised by how weak the evidence was for antibody and cPep checks, and how often they were either inconclusive, or gave false positive/negative.

T1 was better discerned on clinical grounds - bit that rather puts you at the mercy of any expectations and ways of thinking ingrained in the clinician you happen to be seeing (T1 is a ‘childhood’ disease etc etc).

Your unintentional weight loss and lack of overweight should be a bit of a red flag though?
 
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