Type 2 or Type 1

[Charl]

Had my first appointment with a dietician yesterday by phone, she talked through my details and said she was a bit puzzled as to why on my records I'm down as type 2 ( far as I know I am ) when I'm doing what a type 1 does apparently, taking insulin and card counting, I've requested a face to face appointment as I couldn't really understand what she was on about,
Said she was going to contact my diabetic nurse to discuss the type 1...2 issue , nothing simple.

 

[Proud to be erratic]

The type of diabetes at diagnosis is from the cause, not the treatment.

T1 is a consequence of an autoimmune condition that stops your pancreas from producing insulin. It can start slowly and the initial treatment might be just oral medication, but will invariably lead to becoming insulin dependent and injections or pump delivery. The autoimmune vulnerability can lead to other autoimmune ailments. T1s can eat more or less anything they wish, but must count carbs and measure the insulin they take accordingly.

T2 is a consequence of insulin resistance by your body, for various reasons. T2s make plenty of insulin but their bodies can't manage the insulin they are producing. The treatment usually is oral medications, to help your body manage the insulin better, such as metformin, or even oral meds to boost the insulin production, such as gliclazide. T2s on oral meds will, or should, be carb aware and trying to eat lower carb foods, to give their insulin a better chance of doing its job; hence needing dietary advice sometimes. Some T2s eventually need insulin injections; a few need insulin injections from the outset after diagnosis. Those taking insulin will normally carb count and adjust their insulin doses; some only have a single daily insulin dose and are carb aware but not particularly carb counting.

T3s, particularly T3c are people with damaged pancreas for reasons other than the autoimmune condition. The damage can occur from natural ailments, such as pancreatitis; from excess of steroids or alcohol; from injury; or as in my case from surgery to treat pancreatic cancer. The categorisation of T3c is relatively recent, in comparison to T2 and T1.

T2s are c. 90% of people with diabetes (PWD); T1s are c.10% of PWD; and T3cs are a tiny proportion, but diagnosis as T3c is increasing as medical professionals learn of its existence. Today, many GPs haven't heard of it.

T2s are looked after by GP surgeries, T1s by hospital based teams, usually. T3cs also usually by hospital teams since their treatment is generally as for T1, but the damaged pancreas and other parts of the digestive system often needs extra consideration by Endocrinologists.

The key is that diagnosis of diabetes is from the cause, not the treatment.

 

[rayray119]

T1 is a consequence of an autoimmune condition that stops your pancreas from producing insulin. It can start slowly and the initial treatment might be just oral medication, but will invariably lead to becoming insulin dependent

Sorry to say this but I feel there's a tad of misinformation in there if your type 1 you don't start on oreal medication unless you been misdiagnosed as other type(but that's different) you have insulin steight away.

 

[Proud to be erratic]

Sorry to say this but I feel there's a tad of misinformation in there if your type 1 you don't start on oreal medication unless you been misdiagnosed as other type(but that's different) you have insulin steight away.

I think you will find some T1s caught early enough can start on oral; my great niece needed insulin to recover, is currently on oral, but with insulin in reserve. She has a test meter from the NHS and been warned to expect her pancreas to give up. The English hospital has confirmed her T1 status from C-peptide and GAD antibody tests and she is documented as T1, under a hospital D team.

Slight digression, she was travelling in Italy when she fell ill and very much to Italy's credit that, as well as hospitals with phlebotomy clinics, they have "drop in" pharmaceutical laboratories where you can get a battery of blood tests done for very reasonable prices; it is how my own jaundice was analysed and assessed as Pancreatic cancer. It took an English hospital 6 weeks after my return to confirm the analysis that they were given from the Sicilian laboratory, which was ignored by the hospital who preferred to do it all again and waste valuable time, as well as leaving me untreated, not even having my bile duct by-passed by a stent - for 6 very stressful and worrying weeks. I had no idea jaundice could reduce someone to such a zombie state; it was taking me 2 hrs, with assistance, just to get out of bed, dressed and downstairs, where I was uselessly drifting in and out of sleep in an armchair, rather than bed. I couldn't even answer the phone!

Rant over, I agree it is unusual to not start on insulin. And of course those misdiagnosed T1s have survived on oral meds until they get the more appropriate insulin treatment.

I was more interested that the OP's dietician didn't on the face of what @Charl has stated, didn't understand the fundamentals of D. Perhaps she saw something else on the medical records that triggered her observations.

 

[rayray119]

I think you will find some T1s caught early enough can start on oral; my great niece needed insulin to recover, is currently on oral, but with insulin in reserve. She has a test meter from the NHS and been warned to expect her pancreas to give up. The English hospital has confirmed her T1 status from C-peptide and GAD antibody tests and she is documented as T1, under a hospital D team.

Slight digression, she was travelling in Italy when she fell ill and very much to Italy's credit that, as well as hospitals with phlebotomy clinics, they have "drop in" pharmaceutical laboratories where you can get a battery of blood tests done for very reasonable prices; it is how my own jaundice was analysed and assessed as Pancreatic cancer. It took an English hospital 6 weeks after my return to confirm the analysis that they were given from the Sicilian laboratory, which was ignored by the hospital who preferred to do it all again and waste valuable time, as well as leaving me untreated, not even having my bile duct by-passed by a stent - for 6 very stressful and worrying weeks. I had no idea jaundice could reduce someone to such a zombie state; it was taking me 2 hrs, with assistance, just to get out of bed, dressed and downstairs, where I was uselessly drifting in and out of sleep in an armchair, rather than bed. I couldn't even answer the phone!

Rant over, I agree it is unusual to not start on insulin. And of course those misdiagnosed T1s have survived on oral meds until they get the more appropriate insulin treatment.

I was more interested that the OP's dietician didn't on the face of what @Charl has stated, didn't understand the fundamentals of D. Perhaps she saw something else on the medical records that triggered her observations.

Okay fair enough but don't think that's officiallly or recommended by nice(I've found from experience as well as other peoples story's parts of the NHS don't really understand type 1 diabetes. I know you were trying to explain the difference that's why I commented because I was a bit concerned about misinformation I didn't mean to cause you any upset

 

[Proud to be erratic]

Okay fair enough but don't think that's officiallly or recommended by nice(I've found from experience as well as other peoples story's parts of the NHS don't really understand type 1 diabetes. I know you were trying to explain the difference that's why I commented because I was a bit concerned about misinformation I didn't mean to cause you any upset

All fine @rayray119. I was deliberately trying to stay quite general, yet informative, since some people come onto this site from outside of UK.

You and I are well aware that while NICE Guidance may be the authority for what can and can't be done by the NHS, they are not always up to date and seem sometimes also to be influenced by affordability.

 

[Inka]

Had my first appointment with a dietician yesterday by phone, she talked through my details and said she was a bit puzzled as to why on my records I'm down as type 2 ( far as I know I am ) when I'm doing what a type 1 does apparently, taking insulin and card counting, I've requested a face to face appointment as I couldn't really understand what she was on about,
Said she was going to contact my diabetic nurse to discuss the type 1...2 issue , nothing simple.

Either she’s misunderstood or she has some suspicions you might have been misdiagnosed. I’d think the first of those was more likely but you’ll have to wait and see what she says. Type 2s can and do take insulin and count carbs if needed.

 

[SB2015]

I think you will find some T1s caught early enough can start on oral;

It is possible for T1s in the early stage when diagnosed as an adult to use oral meds, but that will overwork the remaining beta cells and more recently the recommendation for all T1s is to go straight onto MDI which will protect the beta cells that are left. This is why it is important to get the correct diagnosis as early as possible, so I am pleased that they are checking this out @Charl .

let us know how you get on.