Diabetes misdiagnosis?

kowloon

Just curious, is it easy to misdiagnose type 1 diabetes?
I was diagnosed about 8 months ago and took it fairly seriously for about 2 months after my initial hospital visit, had a few blood samples taken there and have visited the nurse specialist (but not in about 3 or 4 months).
I dont follow the diet anymore and i dont use the fast acting insulin anymore, i can go for a few days without the slow acting.
I take the Slow acting anyway as i get headaches and tingly feet after a while without it (withdrawal?) , but im not suffering like i would expect a real diabetic to.
Is it possible im not diabetic at all?

mike65

Hmmmm. There is a phenomena the "honeymoon period" during which time it appears you have stopped needing insulin or being watchful about your carb intake however this usually occures in the first few months and it does'nt last but yours maybe prolonged, it can happen.

Mike.

ps found a linky http://www.diabetes123.com/dteam/1997-07/d_0d_1xe.htm

robinph

It is normal for people to seem to not have diabetes a few months after being diagnosed but can happen to varying degrees. If your unsure about anything though then go back to the specialist nurse again for a chat, I would have thought they'd have told you to expect this to happen though.

tbh

yeah - you're probably on your honeymoon. For me it lasted 18 months or so, and I was like you - I thought they'd got it wrong. Dr Indy can probably explain better, but I think once you start injecting insulin, it makes the load on your pancreas lighter, so it can make some of it's own - don't quote me on that. It passes, and now if I miss insulin, I feel sick pretty much straight away.

DrIndy

Insulin requirements change, but if it confirmed that you are type I diabetic with glucose monitoring, fasting glucose and with auto-antibodies, then it is hard to say that you are not.

There are two different subtypes of type I diabetes (and indeed a number of other subtypes again). Classically, people with type I diabetes discover they have this around age 10 when they lose weight, drink a lot, get dehydrated and end up in a paediatric hospital in DKA.

The other (smaller) subgroup have "Latent Autoimmune Diabetes in Adults" or LADA or colloquially - Type 1.5 diabetes. This is a DIFFERENT immune disease which shares some commonality with true type I diabetes (main antibody is GAD). People can get this from teenage years to late adulthood and the antibody is different. They appear to have type II diabetes if they present late, but are almost always thin and fit people. What age were you diagnosed at? What antibody test results do you know?

If the pancreas is in the compensated phase, then the few islet cells remaining are running in overdrive, churning out insulin as fast as possible to compensate for the destruction of the rest. This overdrive actually results in pancreatic failure on its own. Type II diabetics who have huge insulin resistance will eventually get insulin dependence when tablets fail, this is because the pancreas eventually fails from overwork. c-peptide, a marker for insulin production will tail off eventually. In fact type II diabetes becomes apparent when pancreatic failure has become irreversible, although those who have IGT or impaired glucose tolerance (pre-diabetes) can fully recover with appropriate life style change.

Back to the topic! If your blood sugars seem in better control, it is unfortunately not going to last, starting insulin may have taken the overdrive off the pancreas, but the autoimmune disease will progress and destroy the islet cells.

Regarding your use of long acting insulin - you state you get headaches and tingly feet without it. Do you also get thirsty and need to go to the toilet much more? Nausea? This is NOT withdrawal from the insulin, it is high blood sugars causing these sensations. I also suspect that you are not checking your blood sugars very often. Am I incorrect?

While your pancreas still has some function, it is able to generate the basal insulin requirement for your normal metabolism (around 12 units a day or so). And although it cannot correct the post meal surges in glucose, the minimum to keep cells loaded with glucose and prevent ketoacidosis occuring is still present.

This is the reason you are not in DKA from stopping your insulin for a day or two.

Go back to your clinical nurse specialist, they are really sound, understand everything and can help you. They are also easier to access than a doctor.

tbh

nice one DrI, thanks - and interesting reading.

Can I be cheeky and ask a question?

While your pancreas still has some function, it is able to generate the basal insulin requirement for your normal metabolism (around 12 units a day or so). And although it cannot correct the post meal surges in glucose, the minimum to keep cells loaded with glucose and prevent ketoacidosis occuring is still present.

the 12 units - are they the same as the units of injected insulin? (pardon the stupid question) - like, would that be like taking, say, regular injections of humulog over a 24-hour period, so that the total dose would be 12 units?

DrIndy

By 12 units of insulin, it means the standardised international unit of insulin as by the injections.

Insulin requirements vary between people - notably body weight or ideal body weight. A lean 60kg person needs around 36 units in total per day, yet a lean 80kg person needs 42 units. If you have insulin resistance, then this can go up significantly, I admitted someone recently who had significant insulin resistance where she needed 240 units a day to maintain a blood sugar of 15! We spent 5 days aggresively managing her sugars before it normalised again.

As a rule, you give half the daily requirement as long acting and the remainder split into 3 for post meal surges. then you start the fine tuning depending on when the main meal is, exercise, hypos, morning fasting levels, illness, other drugs etc...... hence the critical importance of a regularily filled blood sugar diary.

When calculating the basal dose, it is the needs for 24 hours without post meal surges and is the long acting insulin. The minimum as a general guide (depending on the other factors listed above) is usually 12 units or roughly 0.5 units per hour. This is if you eat next to nothing and maintains the metabolism. Most people need more than that (closer to 20) as the long acting insulin is used to offset the need for post meal insulin (eating starchy foods maintains a slow release of glucose). This is what staves off DKA and then the short acting insulin works on the post meal surges.

tbh

DrIndy wrote:

.

I really appreciate you taking the time to post that - very helpful. I know this is the sort of thing I should be asking my own doc, I just never think of it at the time. Thanks Doc.

robinph

Thanks for that from me too.

I didn't realise that there was actually a recognised difference between when you get type 1. I just thought I was a freak.

kowloon

Cheers for the info Indy, will see if i can get an appointment with the nurse.

mike65

I weight 82 Kgs and my total insulin intake is (approx, depending on the weather which direction the wind is blowing...etc!) 48 units but I use a fairly high basel level (28 units) and smaller quick acting injections. Maybe I should see about adjusting the balance.

Mike.

DrIndy

Discuss with Diabetic CNS depending on the blood sugars you are getting and the HBA1C. Peoples insulin requirement has to be tailored and the breakdown of long acting and short acting is completely up to the lifestyle.

As a general rule, 24 insulin needs are 0.6xlean body weight (kg), or more accurately if overweight, ideal body weight is (height(cm) - 100)x0.6. However, this must be individualised but the rule of thumb is very helpful when starting someone off on insulin.

But 82kgx0.6 = 49 units, so you are not too far off.....

I also realised I wrote 42 units for 80kg - was meant to be 48units!:o

mike65

Ooops! Internet poster drops dead after following online advice - "DrIndy" charged with bad typing

Mike.

Fiona123456

DrIndy wrote: »

Discuss with Diabetic CNS depending on the blood sugars you are getting and the HBA1C. Peoples insulin requirement has to be tailored and the breakdown of long acting and short acting is completely up to the lifestyle.

As a general rule, 24 insulin needs are 0.6xlean body weight (kg), or more accurately if overweight, ideal body weight is (height(cm) - 100)x0.6. However, this must be individualised but the rule of thumb is very helpful when starting someone off on insulin.

But 82kgx0.6 = 49 units, so you are not too far off.....

I also realised I wrote 42 units for 80kg - was meant to be 48units!:o

Hi
My partner was put on insulin injections a few months ago, Novarapid 10 units x 3/day, Lantis 16 units at night, he started on tablets when he was 30, now 37.
We have got such conflicting advice from diabetes nurses & Gp about everything
My main worry is when he goes too high & becomes delirious & confused what do I do?
G.P. said no don't give more insulin
Diabetes nurse said let it pass....
Its pretty scary & I don't know what to do
Any advice would be really appreciated

cocker5

Fiona123456 wrote: »

Hi
My partner was put on insulin injections a few months ago, Novarapid 10 units x 3/day, Lantis 16 units at night, he started on tablets when he was 30, now 37.
We have got such conflicting advice from diabetes nurses & Gp about everything
My main worry is when he goes too high & becomes delirious & confused what do I do?
G.P. said no don't give more insulin
Diabetes nurse said let it pass....
Its pretty scary & I don't know what to do
Any advice would be really appreciated

OP you need to confirm if he is type 2 now insulin dependant ?

Type 1 and type 2 are two very different issues with different advice