Type 1 or type 2 or both ?

[Stephano L]

Hi everyone , I’m 56 , I was admitted to hospital with pancreatitis in February 2018, I was diagnosed with type 1 in august 2018 ,I inject Humulin M3 twice per day , I recently attended my annual checkup & the nurse told me I was type 2 & type 1, I received a letter to attend the Doctor just after this regarding my blood ( sugar coating around blood cells had came down from 13 to 8 , I think she said )& was told am type 2 now , I’m very confused . I mostly eat & drink healthily ( no alcohol ) , do exercise (plenty of dog walking ),I am overweight , started smoking again 5 months ago after 4 years off them but I’m finishing my first week off the filthy fags .Is this possible ?(being both type 1 & 2 ) , I feel the medical team are as confused as me

 

[rebrascora]

The only way to know is if they did GAD antibody and C-peptide tests. Those would indicate whether you have the autoimmune Type 1 diabetes where your pancreas' ability to produce insulin is severely defunct because it was attacked by your immune system rather than Type 2 which is more to do with the body becoming insulin resistant and not responding effectively to the insulin the pancreas produces. There are other variations on this like Type 1.5 which is known as LADA (Latent Autoimmune Diabetes in Adults) and Type 3c which is where the pancreas has been damaged or wholly or partially surgically removed and some other even rarer forms like MODY, so it is not quite a simple binary situation where you are either Type 1 or Type 2.

I wonder if your pancreatitis has resulted in damage and you might be considered Type 3c. It may also be possible that you are insulin resistant, particularly if you are overweight.... if you are requiring large amounts of insulin to be injected to keep you in range then that might tie in with you being Type 2. If that is the case, losing weight and cutting your carbohydrate intake will help but being on insulin you would have to do it carefully otherwise your BG can drop dangerously low.
I assume you have not been taught to carb count or anything since you are on a mixed insulin? Are you under the care of a consultant/specialist diabetes unit? If so, you would be best asking them for an explanation of your diabetes and if you were tested for Type 1 and the result of those (GAD and C-Peptide) tests.

Good luck with stopping smoking again. It is an important goal not just for your diabetes but your overall health.

 

[Stephano L]

Thanks for the reply , I was told in the hospital that my immune system had attacked my pancreas , the reason they thought was a virus as they couldn’t find any gall stones & I was not much of a drinker .

 

[mikeyB]

If you were in hospital with acute pancreatitis, it is likely that some, or maybe a large proportion of cells that produce insulin were damaged. That would make you Type 3c, which most GPs will never had heard of, never mind seen.

The treatment for 3c is the same as for T1. That is ideally multi-dose, with a long acting basal (or background level) of insulin as a single, or sometimes two injections, and injection of short acting insulin with meals.

All that said, if the acute pancreatitis didn’t lead to chronic pancreatis, and you don’t need to take Creon, it is likely that there is insufficient damage to cause 3c, and you are really T2, particularly as you are overweight. Either way, being overweight will, as @rebrascora says, produce a degree of insulin resistance.

The only way to tell which you are, is a simple blood test to see if you are producing insulin. Or, pragmatically, if you do need to take Creon, then it’s game over, you are 3c.

Smoking, by the way, damages the pancreas, though not as thoroughly as alcohol. It’s not the nicotine, it’s all the other toxins in cigarette smoke. I have chronic pancreatitis, but I vape without any bother to my pancreas. Mind, I was T1 for years before I developed chronic pancreatitis (not alcohol related). And I’ve never had acute pancreatis, nor indeed any pancreatic pain.

 

[everydayupsanddowns]

Welcome to the forum @Stephano L

Sorry to hear about the confusion surrounding your diagnosis. i hope you can get some clarity about your classification - perhaps with the CPeptide and/or GAD antibody tests, or through clinical factors (eg whether or not you need Creon) that @mikeyB mentions.

Getting an accurate classification is very helpful, particularly if you have something like LADA which can change and develop in the early years and for which some medications are entirely unsuited. Different diabetes types have different NHS pathways, and different access to technologies, education and support - so it’s important to make sure that you have a tick in the right box, so that you get the right treatment 🙂

 

[Stephano L]

Thanks for the help , I’ll ask for a test & hopefully get somewhere , it certainly seems like a minefield, I find it very frustrating , eg my first annual checkup at the hospital & I hadn’t smoke for about 3 years I was lectured about how vaping was as bad as smoking ( popcorn lung ) , I vaped for 18 months the stopped ( I’m vaping again to beat cigarettes) , feel like 2 steps forward 1 step back , I’m slightly overweight but it seems that’s as bad as being massively overweight, thanks again everybody