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Re: [IPk] Type 1 v Type 2

Thanks for all the replies! 
I was put on the pump because of unpredictable lows, and also because my
husband and I wanted to start trying for a baby.  Since then, my hba1c levels
dropped from 7.3 to 6, and I have a lot fewer lows.
It seemed to me that the only reason the doctor was concerned is because my
dad is type 2 and I didn't have ketoacidosis when diagnosed.  He said that it
was odd to have type 1 and type 2 in the same family (although I've been told
before that it happens a lot).  I am a bit overweight now, but was average
weight when I was diagnosed.  I haven't had any insulin resistance, either.
I'm going to look into the links provided, and make sure that I'm educated
before seeing him again.  I've had several doctors in the past who decided
they had the right answer and then refused to consider other options.  I think
that is what worried me about this situation - that he latched on to one or
two pieces of information and then seemed to decide that all my previous
doctors had been treating me incorrectly.
About the infusion set problems, I've actually managed to solve that one on my
own (although I have an appointment with the diabetic nurse on Thursday as
well).  I've just started changing my sets every two days instead of every 3
days, and I'm fine.
From: Melissa Ford <email @ redacted>
To: "email @ redacted" <email @ redacted>
Sent: Monday, July 4, 2011 9:34 PM
Subject: [IPk] Type 1 v Type 2

Hi all

Just to throw a spanner in the works, the the autoantibody levels tend
to be quite low in longstanding type 1, so the anti-GAD test may not
really say much at this stage:

Ralph, I appreciate your point on MODY. You're right that it's a
clinical possibility in many people who initially appear to be type 2.
However, one of the interesting things about MODY is that a lot of
patients require very little insulin around meals, even years after
diagnosis, and maintain a low A1C. The fact that Diane's previous
healthcare team saw her as a good candidate for a pump may mean that
Diane didn't fit that profile (Diane, what were you and your team
looking to achieve with pump therapy?). I would also hope that a
physician who was looking for MODY would not refer to it as type 2
when talking about it with a patient.

Diane, is it possible that your consultant at UCL is working on a
research project on "double diabetes" (where someone has both type 1
and type 2, it can happen) and could be seeing it where it doesn't
necessarily exist. It's also possible that there's something in your
case history that points to insulin resistance as a precursor to your
diabetes onset. What was your conversation like with the consultant up
to the point that he mentioned type 2? Have you ever been
significantly overweight? Simple absence of DKA at diagnosis is really
not enough of a reason to suspect type 2, as you point out.

There's nothing to worry about in terms of having the tests - either
they will show clinically relevant findings or they won't. Did the
consultant give any indication of what changes he might make to your
regimen if he did determine you were type 2? If your diabetes control
is good on the pump, it could be a case of "if it ain't broke, don't
fix it," whatever the results of the test.

Also, to address your real problem at the moment, what sorts of issues
are you having with your infusion sites? We may be able to help.

All best

Type 1 18+ years; MiniMed pumper 7.5 years; Animas pumper 6.5+ years

On Monday, July 4, 2011, Nanette Freedman <email @ redacted> wrote:
&gt; Hi Diane,
&gt; It certainly seems odd that this new doctor suddenly took it into his
&gt; head to question the diagnosis of type 1, but presumably the tests
&gt; (probably anti-GAD antibodies and c-peptide which measure antibodies
&gt; characteristically present in type 1 and not type 2, and presence or
&gt; absence of residual insulin production) will confirm that it is type
&gt; 1, and that will be that. It is annoying and probably a waste of your
&gt; time, and I thought the NHS was trying to cut back on unnecessary
&gt; tests not to do more, but once you have the tests done you will be
&gt; able to quote the results to any doubting doctors in the future.
&gt; I also have a family history including both type 1 and type 2, and
&gt; confused matters further by developing diabetes at the ripe old age of
&gt; 48, but I was deeply into ketoacidosis at the time, and shortly after
&gt; the diagnosis was tested for anti-GAD antibodies, which confirmed the
&gt; diagnosis of type 1. Apart from occasional ignorant doctors who tell
&gt; me that I must be mistaken and anyone who gets diabetes at age 48 must
&gt; have type 2, no one serious has ever questioned the diagnosis in my
&gt; case.
&gt; Best of luck with the tests
&gt; Nanette
&gt; On 4 July 2011 17:12, Diane Silva &lt;email @ redacted&gt; wrote:
&gt;&gt; Hi,
&gt;&gt; I was diagnosed 15 years ago with  Type 1 diabetes ( I was
14) at Joslin in
&gt;&gt; Boston, which is one of the world's top diabetes research
hospitals.  Both
&gt;&gt; Type 1 (my cousin and uncle) and Type 2 ( my father and
&gt;&gt; run in my family, but this never seemed to confuse my
doctors, until my last
&gt;&gt; appointment.  I just switched to UCL, and the doctor I met
with (who couldn't
&gt;  &gt; even give me advice on a problem I was having with my
infusion sites - told
&gt; me
&gt;&gt; to talk to the nurse) has decided that I must be a Type 2,
based on the fact
&gt;&gt; that there are Type 2 diabetics in my family and I did not develop
&gt;&gt; ketoacidosis when I was diagnosed (because my family
recognized the signs and
&gt;&gt; tested my blood sugar before it reached that point).  He now
wants me to go
&gt;&gt; for tests to see if I am a Type 2 diabetic.  Has anyone ever
had this happen
&gt;&gt; to them?  Should I be worried?
&gt;&gt; Thanks,
&gt;&gt; Diane
&gt;&gt; .
&gt; .
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