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Type1 or Type 2

J

JillFearn

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Good morning

I recently posted regarding my 56 year old husband being admitted to hospital as his blood sugars were unreadable. They are treating him as type 1 until blood tests come back to determine which it is. My question is that when he went into hospital is HbA1C was 111, his predicted HbA1C on the Libre App is now 61, he is on Novomix 20 in the morning and 18 after dinner, would that indicate that he is type 2? The HbA1C is really confusing us.
Many thanks
Jill
 
JillFearn said:
Good morning

I recently posted regarding my 56 year old husband being admitted to hospital as his blood sugars were unreadable. They are treating him as type 1 until blood tests come back to determine which it is. My question is that when he went into hospital is HbA1C was 111, his predicted HbA1C on the Libre App is now 61, he is on Novomix 20 in the morning and 18 after dinner, would that indicate that he is type 2? The HbA1C is really confusing us.
Many thanks
Jill
Click to expand...
Good morning @JillFearn,
Sorry to hear about your husband’s hospitalisation. I am not able to provide the answers to your questions directly, but I am sure someone will offer some help in this regard.
Best wishes for your husband’s health.
 
Welcome @JillFearn
Like others on the forum, I have no medical training and recommend you speak to a doctor to get a full understanding.
That said, it is not easy to determine type of diabetes and HBA1c will not indicate either way - it is just an indication of how much glucose you have in your blood over the last 3 months which is the case for both Type 1 and type 2.
There have been multiple discussions on this forum about the estimated HBA1c from CGMs like Libre and the general conclusion is they can be no more than estimates and an estimate of the last 3 months based on a few weeks of data will not be accurate. Plus, the CGM does not use blood so it is using a different method to make that estimate.

My advice is to use the Libre estimated HBA1c as an indication of overall progress but not a substitute for a blood test and a blood test is only worth doing once every 3 months.

Has your husband had any other blood tests to determine the type of diabetes?
The usual tests are c-Peptide and GAD to look for antibodies associated with Type 1.

How is your husband doing? is he feeling better on the insulin?
Is there any discussion about changing his insulin? A mixed insulin like NovoMix is restrictive - it requires a fixed amount of carbs in meals to be eaten at pretty fixed times. Basal- Bolus is a more modern insulin regime which allows much more flexibility but it is not usually taken as a fixed dose so requires carb counting and dose calculations.
 
It isn’t possible to diagnose type from an HbA1c test. All that shows is how much glucose has stuck to the red blood cells over the past few weeks and months. The insulin he is on will be helping mop up the glucose in his bloodstream and enable it to be converted into energy, so his glucose levels will fall, whichever type he is..
@helli types faster than I do, and has given you a good overview of the Libre estimate!
 
Hi @JillFearn as others have said from the Hba1c test alone, distinguishing between T1 & T2 (or other types) isn’t possible
However the important thing is he was before in hospital and insulin is at the currently part of his treatment, plus obviously you’ve got the Libra to help you understand his levels currently and monitor how he responds to certain foods

Hopefully soon he will get further tests to find out more, when your husband was admitted to hospital was that at the point of his initial diagnosis ?
 
Hi

Thank you for your reply, yes he was diagnosed whilst in hospital, they have sent off a GAD blood test
Many thanks Jill
 
Aish said:
Good morning @JillFearn,
Sorry to hear about your husband’s hospitalisation. I am not able to provide the answers to your questions directly, but I am sure someone will offer some help in this regard.
Best wishes for your husband’s health.
Click to expand...
Good morning, thank you for your kind words x
 
helli said:
Welcome @JillFearn
Like others on the forum, I have no medical training and recommend you speak to a doctor to get a full understanding.
That said, it is not easy to determine type of diabetes and HBA1c will not indicate either way - it is just an indication of how much glucose you have in your blood over the last 3 months which is the case for both Type 1 and type 2.
There have been multiple discussions on this forum about the estimated HBA1c from CGMs like Libre and the general conclusion is they can be no more than estimates and an estimate of the last 3 months based on a few weeks of data will not be accurate. Plus, the CGM does not use blood so it is using a different method to make that estimate.

My advice is to use the Libre estimated HBA1c as an indication of overall progress but not a substitute for a blood test and a blood test is only worth doing once every 3 months.

Has your husband had any other blood tests to determine the type of diabetes?
The usual tests are c-Peptide and GAD to look for antibodies associated with Type 1.

How is your husband doing? is he feeling better on the insulin?
Is there any discussion about changing his insulin? A mixed insulin like NovoMix is restrictive - it requires a fixed amount of carbs in meals to be eaten at pretty fixed times. Basal- Bolus is a more modern insulin regime which allows much more flexibility but it is not usually taken as a fixed dose so requires carb counting and dose calculations.
Click to expand...
Hi
He is doing ok, yes we are still waiting for the results of the GAD blood tests, they said between 2 and 5 weeks.
At the moment they have said to continue with the novomix but he is struggling with what to eat and having to eat 3 times a day.
Thanks so much for your reply
Jill
 
Robin said:
It isn’t possible to diagnose type from an HbA1c test. All that shows is how much glucose has stuck to the red blood cells over the past few weeks and months. The insulin he is on will be helping mop up the glucose in his bloodstream and enable it to be converted into energy, so his glucose levels will fall, whichever type he is..
@helli types faster than I do, and has given you a good overview of the Libre estimate!
Click to expand...
Thanks for your reply, we are waiting for the results of the GAD blood tests
Many thanks
Jill
 
Echo what others have said and would add that getting the GAD result is the key to planning a way forward. You will need to be patient but in the meantime it would be a good idea to read around the forum and the main site to get clued up so that when the results arrive you will be better able to engage with the pros.

One thing you might pick up is that getting an insulin regime optimised is something that takes a bit of time with a bit of trial and error, at least that is what I have gleaned from reading members stories. Getting a bit of understanding of the principles invoked will help you get things in place should the need for permanent insulin treatment prove to be necessary.
 
JillFearn said:
Hi
He is doing ok, yes we are still waiting for the results of the GAD blood tests, they said between 2 and 5 weeks.
At the moment they have said to continue with the novomix but he is struggling with what to eat and having to eat 3 times a day.
Thanks so much for your reply
Jill
Click to expand...
Has he been advised how many carbs he should have for the dose of novomix he is having, if not then he could ask and then you can work out the carbs for what he wants to eat. He should be able to have protein and veg and salads and add some carbs for what he has been told he should have, together with plenty of testing and keeping a food diary with those readings should help the Dr or Diabetic nurse advise on dose changes if needed.
 
helli said:
Welcome @JillFearn
Like others on the forum, I have no medical training and recommend you speak to a doctor to get a full understanding.
That said, it is not easy to determine type of diabetes and HBA1c will not indicate either way - it is just an indication of how much glucose you have in your blood over the last 3 months which is the case for both Type 1 and type 2.
There have been multiple discussions on this forum about the estimated HBA1c from CGMs like Libre and the general conclusion is they can be no more than estimates and an estimate of the last 3 months based on a few weeks of data will not be accurate. Plus, the CGM does not use blood so it is using a different method to make that estimate.

My advice is to use the Libre estimated HBA1c as an indication of overall progress but not a substitute for a blood test and a blood test is only worth doing once every 3 months.

Has your husband had any other blood tests to determine the type of diabetes?
The usual tests are c-Peptide and GAD to look for antibodies associated with Type 1.

How is your husband doing? is he feeling better on the insulin?
Is there any discussion about changing his insulin? A mixed insulin like NovoMix is restrictive - it requires a fixed amount of carbs in meals to be eaten at pretty fixed times. Basal- Bolus is a more modern insulin regime which allows much more flexibility but it is not usually taken as a fixed dose so requires carb counting and dose calculations.
Click to expand...
Hi

Thank you for your reply

He is ok but still getting used to it
At the moment they are keeping him on novomix and we are waiting the results of the GAD tests

Many thanks
Jill
 
Leadinglights said:
Has he been advised how many carbs he should have for the dose of novomix he is having, if not then he could ask and then you can work out the carbs for what he wants to eat. He should be able to have protein and veg and salads and add some carbs for what he has been told he should have, together with plenty of testing and keeping a food diary with those readings should help the Dr or Diabetic nurse advise on dose changes if needed.
Click to expand...
Hi

He hasn’t been given advice on what carbs he should be having, perhaps we need to contact the diabetes nurse who he has had one phone call with
Thank you
 
JillFearn said:
Hi

He hasn’t been given advice on what carbs he should be having, perhaps we need to contact the diabetes nurse who he has had one phone call with
Thank you
Click to expand...
I think that would be a good idea and it would give him more confidence about eating.
 
Leadinglights said:
I think that would be a good idea and it would give him more confidence about eating.
Click to expand...
I did not realise he had any problems with eating.
To be honest, as someone who started with a mixed dose and little information about how many carbs to eat, in the first few weeks, I already had information overload.
The insulin dose was conservative to reduce the risk of hypo (and to bring BG down slowly) so I didn't have a fear of eating.

We are all different but I think it is important on this forum to provide our personal experiences, especially as we have no medical training.
 
JillFearn said:
Hi

He hasn’t been given advice on what carbs he should be having, perhaps we need to contact the diabetes nurse who he has had one phone call with
Thank you
Click to expand...
I think it would be useful to keep in touch with the nurse.
Maybe you could start with calculating the carbs he is having with his meals to provide some background and put his BG readings into context.
This probably sounds intimidating but it becomes second nature for most of us with Type 1. Most packets contain information about carb content although you may need to take note of whether the nutritional information is for cooked or raw contents. The advice I was given was to focus on the "big hitters" - pasta, bread, rice, potatoes and desserts as this will be most of the carbs eaten. Kitchen scales are useful.
 
Docb said:
Echo what others have said and would add that getting the GAD result is the key to planning a way forward. You will need to be patient but in the meantime it would be a good idea to read around the forum and the main site to get clued up so that when the results arrive you will be better able to engage with the pros.

One thing you might pick up is that getting an insulin regime optimised is something that takes a bit of time with a bit of trial and error, at least that is what I have gleaned from reading members stories. Getting a bit of understanding of the principles invoked will help you get things in place should the need for permanent insulin treatment prove to be necessary.
Click to expand...
Thank you. It is definitely a mine field, I should be used to it by now as my son in law and granddaughter are both T1 (not related by blood to my husband) so it was just the HBCa1 confusing us
 
helli said:
I did not realise he had any problems with eating.
To be honest, as someone who started with a mixed dose and little information about how many carbs to eat, in the first few weeks, I already had information overload.
The insulin dose was conservative to reduce the risk of hypo (and to bring BG down slowly) so I didn't have a fear of eating.

We are all different but I think it is important on this forum to provide our personal experiences, especially as we have no medical training.
Click to expand...
Thank you, I think he is so worried about eating the wrong thing but we will learn as we go along
 
JillFearn said:
Thank you, I think he is so worried about eating the wrong thing but we will learn as we go along
Click to expand...
If he is found to have Type 1, there is nothing he cannot eat - Type 1 is managed with insulin, not diet.
Many people with type 2 reduce the carbs that they eat. However, doing so whilst they are still confirming type may hide any Type 1 symptoms and risk hypos whilst he is on a fixed dose.
 
helli said:
I did not realise he had any problems with eating.
To be honest, as someone who started with a mixed dose and little information about how many carbs to eat, in the first few weeks, I already had information overload.
The insulin dose was conservative to reduce the risk of hypo (and to bring BG down slowly) so I didn't have a fear of eating.

We are all different but I think it is important on this forum to provide our personal experiences, especially as we have no medical training.
Click to expand...
I took this to mean he was having problems eating as the OP said 'but he is struggling with what to eat and having to eat 3 times a day.'*
 
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