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Re: [IP] initial diagnosis
From: krisb <email @ redacted>
>Reading the discussions about people who are treated as Type 2 because
>physicians are unwilling to recognize the possibility of Type 1 in older
>individuals raises a question in my mind: Why isn't a C-peptide run
>routinely when patients present with symptoms consistent with diabetes? It
>still doesn't answer the Type 1/Type 2 question definitively but it does
>answer an immediately important questions about insulin production. I
>know about you, but if my body isn't making insulin, it's really quite
>irrelevant to me if that is a result of an autoimmune disorder, a
>infection, a reaction to steriods or other medications, physical trauma to
>the pancreas or because it's "worn out" from a lifetime of fighting insulin
>resistance. You need insulin and you need it now.
The reason is that doctors are trained to look for the routine first -- the
saying is "if you hear hoofbeats, think horse, not zebra". So, if it isn't
obviously Type 1 (i.e. no ketosis) they ASSUME it's Type 2.
In some adults, Type 1 comes on slowly -- and in the beginning, even though
it IS an auto-immune disorder, the pancreas is still secreting insulin, and
a C-peptide might be entirely within normal limits. So what would it really
Type 2's CAN be making a lot of insulin, and yet not have enough to meet
their own physiological needs -- C-peptide might be HIGH, and yet if the
person is very insulin-resistant, they may need exogenous insulin.
In other words, C-peptide has such a broad normal range, and individual
requirements vary so much that the test really has very little value, unless
to convince Medicare you need a pump.
There are some doctors who are now suggesting that Type 2's be put on
insulin in the beginning to get good control immediately, and after the BGs
are in good range, consider playing with the oral meds. The tip-off there
would be if BGs are well-controlled on insulin, but deteriorate on oral
meds. You don't need to go into crisis to know that oral meds aren't
As an unusual Type diabetic, I couldn't agree with you more that the
treatment should be the one that WORKS -- and that we don't all fit into the
same box -- but docs aren't dealing with individuals, they're following
protocols, and there will always be some who fall through the cracks.
As one who FELL through the cracks, I regret the suffering I went through
BUT I understand why the docs treated me as they did. I'm just glad I came
out without any permanent damage, and that my endo listened to me!
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