Type 2 to Type 1?

[barbscooter]

Hi Everyone,
I have a question that has been nagging me for a while....
Can someone diagnosed as Type 2 12 yrs ago all of a sudden become a Type 1 diabetic??
I have been on Lantus for 9 months and am now up to 70 units a night...and Actrapid for 3 months now 12 units before each meal and my morning readings are still around 11.....and around 15 after meals....before meal readings are still around 12....
I have heard there is a blood test to determine which type you are...
Has anyone else had this problem?
Barb

[Helen]

Hi Barb

Type 2 never turns into type 1. However most people with type 2 diabetes will eventually progress to needing insulin and due to the nature of insulin resistance in type 2 diabetes, can end up needing large doses of insulin.

Some people with type 2 are also misdiagnosed initially as type 2, but it is later found they have a form of type 1 called Latent Autoimmune Diabetes in Adults ( or LADA). These people have a slow progression into type 1 diabetes and usually do not respond so well to the oral medications but once on insulin, do really well.

Yes there is a simple blood test. I would suspect in your case however that it is more likely that your insulin regime is just not right yet. There are faster acting insulins that can be taken with meals, such as Novorapid and Humalog - it may be that Actrapid is not cutting the mustard for you with your meals, so could be something to ask the doc about. Also I have had people on more Lantus than 70 units, so perhaps this also needs lifting a bit yet.

The fact that you are 12 mmol pre meals is why you are going up to 15 mmol after meals - we need t get the fasting and pre meal levels down, which will help settle those post meal levels.

Who is helping you with insulin doses at the moment?

cheers
Helen

[barbscooter]

Thanks for explaining that to me Helen!
I am having some issues still.....I forget to take my readings before meals...I have been full time work for the last two weeks and its difficult to do this....next week will be back to normal!
The dr first started me on Novorapid before meals, but it made me really funny and spaced out...so another dr put me on Actrapid...I don't feel like that on this one....
My reading this morning was 11.7......maybe due to a sleepless night with a toothache.....yesterday it was 9.3...
Perhaps I should have another go with the Novorapid? I am having huge cravings for chocolate, cakes etc....is that usual?
I also haven't been eating well because I don't get home from work til dinner time and I just grab whatever I can!
No one is helping with my doses at the moment, I can't get onto the educator most of the time, so I am just winging it on my own with Avril helping me....it's very frustrating...I feel so alone sometimes...
I have a drs appt mid September so maybe I will see some results then....my last Hba1c was 9.1% so I am hoping that the next one will be a lot lower!!
Take care,
Barb

[Helen]

HI Barb
oh yes I remember that now about the Novorapid - ok so the first thing is you do need to be working with a diabetes educator or doctor as your insulin regime is not right yet -so you need to go back to the doc and/or call the educator at least to try and sort out if you can -- I know it can be hard but we want to make sure you have the support to get the doses right.

The second thing is that it is likely to be the Lantus that needs to be higher still as the fasting level is still too high - you may want to set the alarm for a few nights ( if you are up for it!) and check around 2 - 3 am to see what is happening as some people occasionally go low overnight and then rebound higher on waking - I dont think this is the case for you, but worth checking before upping the dose some more.

The third thing is that you can get support if you register with the Lantus Navigator programme - here Toll Free Number from within Australia: 1800 526 887
E-mail: LantusNavigator@sanofi-aventis.com
Then you can speak with a nurse about your doses if you can not get to anyone else, and/or for back up.

In terms of Actrapid vs Novorapid I guess it really depends on how you feel - if you are up for another change right now, or prefer to work on the fasting level and the Lantus dose first? Then see what next?

It would be great for us to see what is happening pre meals, if you can manage a few checks. Also trying to eat regularly is important, especially with the faster insulins on board. I know you know this and doing is harder, but it is worth a go if you can.

Finally, there are other insulin choices, such as pre mix insulins, which have recently been shown to work well in type 2 diabetes, depsite less flexibility - so if this does not work out then there are options. However I suspect you need a little more support, a little more time and a little more consistency with food and doses of insulin

we will get there!

Helen

[barbscooter]

Thanks Helen,
I am really excited, I had a morning reading of 9.3 yesterday and 8.8 today!!!! AND my reading before dinner tonight was also 8.8! Does this mean things are starting to happen for me?
I must admit that the night before both readings I went to bed early, would that make a difference to readings?
I went onto the Lantus Navigator email and registered for it, but never got a reply....that was 7 months ago.....maybe I should ring them instead? My educator gave me a brochure with the details....but like I said I never got any acknowledgement from them....
You also mentioned to me before about setting the alarm for thru the night and taking my sugar then, which I did, but it was up in the low teens each time, that was ages ago tho ....like you, I really think it's a matter of adjusting my insulin time and time again....it's very frustrating tho.....
I have just finished two weeks full time work, and it was really difficult to take readings...but now I can concentrate on them better....I will try to remember them before each meal....and dr wants 2 hrs after as well just to see how I am coping with the doses....
My dr was quite happy with me regards not taking the Actrapid until I am about to eat, in fact he told me not to take it any earlier....!
I eat as regular as possible, having a husband who likes his meals at 12 midday for lunch, 5pm for dinner, really helps!!
I try to eat the proper amount of carbs each meal, but I did have a hypo on the dance floor last Friday night because I didn't have enough at dinner and was bopping around all night, lol......luckily I was with friends who are also insulin dependent and were a great help!
I feel like I am starting to get there, but am wondering if I have late nights again will my readings go back up? I am somewhat of a night owl! .....time will tell...
At my drs appt in Sept I will have results from the next hba1c, so maybe it will be a lot better.....
Do you think I should up my dose of Lantus again before then?
Thanks again for all your help!
Take care,
Barb

[Helen]

Hi Barb
those readings may mean things are settling!

A good night's sleep has been shown to help balance blood glucose - lack of sleep certainly can add to high levels.

Bummer re the Lantus Navigator people - maybe try a call if you really want to use the service. I will give the company some feedback re this.

I do think your levels are not likely to be related to going low overnight, it is just something to check, but you dont need to do that given what we know about your diabetes and current situation.

Yes you can take Actrapid when you eat, it does tend to take up to half an hour or so to kick in, so is better taken a bit before a meal, but not a huge drama.

I cant really advise directly re upping doses - you need to follow up with your usual educator

fingers crossed this is getting close to where we want things!

cheers
Helen

[barbscooter]

Thanks Helen,
I am really pleased with my readings of late! Seven out of the last nine days I have had fasting readings under 10!! Most of them are in the 8's...I am so happy it's FINALLY happening for me!
I have had a couple of late nights during that time tho, but it's still good!
I will try the Lantus Navigator people again...I was disappointed when I didn't hear anything from them....
I am still having issues regarding taking the Actrapid before my meals, sometimes lately I forget it and don't take it until after I start eating, lol.....it's something I am going to have to work on myself, I have an alarm set on my phone but I haven't been eating at the normal times in the last couple of weeks which puts me off....lol...I will eventually get it right!
I have decided not to up my doses until I see the dr in September..my educator doesn't suit me...She is a nice caring person but doesn't make me feel comfortable.....will let you know how I go!!
Take care
Barb

[Helen]

that is all great Barb and good decision re the Lantus - things are starting to settle, so fingers crossed and what determination and perseverance you have shown!

[Alan S]

Thanks Helen,
I am really pleased with my readings of late! Seven out of the last nine days I have had fasting readings under 10!! Most of them are in the 8's...I am so happy it's FINALLY happening for me!
I have had a couple of late nights during that time tho, but it's still good!
I will try the Lantus Navigator people again...I was disappointed when I didn't hear anything from them....
I am still having issues regarding taking the Actrapid before my meals, sometimes lately I forget it and don't take it until after I start eating, lol.....it's something I am going to have to work on myself, I have an alarm set on my phone but I haven't been eating at the normal times in the last couple of weeks which puts me off....lol...I will eventually get it right!
I have decided not to up my doses until I see the dr in September..my educator doesn't suit me...She is a nice caring person but doesn't make me feel comfortable.....will let you know how I go!!
Take care
Barb

Barb, I'm a little late to the discussion, but I have a question on a subject you haven't mentioned in your posts.

What do you eat over the course of a day? I'm not implying you eat too much - far from it - but the nature of those meals in relation to carbohydrates, fat and protein.

As a separate issue, T2 never becomes T1, but it is possible to actually have both types; it's called double diabetes. That occurs when an auto-immune-induced type 1 also suffers from insulin resistance or the signalling pathway problems of a type 2 - or vice-versa. Just to confuse it further there are variations such as LADA and MODY which are effectively forms of late-developing type 1.

However, your situation looks like a type 2 with poor blood glucose control leading to a need for dietary or medication change. Sorry if that sounds blunt - but the good news is that changes, especially to your menu, can slow or halt that progression.

[barbscooter]

Hi Alan,
I am probably eating the wrong stuff of a day, but I try to keep it under control when I can.
I always have 1 boiled egg on 1 slice of white toast for breakfast with a decaf coffee...I have 2 raw sugars in the coffee as it's the only one I have all day and I want to enjoy it!
I have a sandwich with some sort of filling for lunch when I am home, when I am not I grab whatever I can.
For dinner I am not eating well, some nights I have 1/2 grilled chicken breast with 1 small potato and lots of other vegies, all steamed! Other nights I have a rice dish, or pasta..
I don't have morning or afternoon tea, but I do have supper/dessert of a night, usually a banana sliced with lite ice cream...or similar...sometimes a handful of cherries...
I have been to a dietician who told me how many carbs to have in regards to my insulin.....but nothing seems to help me get my readings down...
I am now on 72 units of Lantus at night, with 12 units of Actrapid before each meal....
I have however developed a craving for chocolate and during the last two weeks have been having it continually!!!
I know, I know, I have to control myself, but it's harder said than done, lol....
I have also missed a couple of lunchtime insulins in the last two weeks due to me forgetting to take it with me.....silly....
My fasting readings are still in the 10's, I only had 8's for about 5 days.....
I have to get my head around what I can and can't eat...more discipline is needed lol....
Where can I find out about this 'late developing Type 1'? I would be interested in finding out about it, altho I'm just looking for other excuses and in actual fact it's my own bad control.....
Barb

[Helen]

Hi Barb
just a quick reply - as we have discussed earlier - it is not sounding like LADA (late onst autoimmune diabetes in adults) - but you can get a simple blood test for this. In the past we have agreed that diet and regular insulin and blood glucose checks would be the best way forward and most likely cause of things not behaving is the need to address these things. Of course none of this is easy! That is why we are here to give support where needed.

cheers
Helen

[Alan S]

Hi Alan,
I am probably eating the wrong stuff of a day, but I try to keep it under control when I can.
I always have 1 boiled egg on 1 slice of white toast for breakfast with a decaf coffee...I have 2 raw sugars in the coffee as it's the only one I have all day and I want to enjoy it!

Actually, the raw sugars, subject to the size of your teaspoon, may be less of a problem than the toast; it doesn't matter much to blood glucose levels whether it is white or brown or multigrain.

Try something for me. Test about 60 minutes after breakfast to see if that is significantly higher than your fasting reading. How did you or your doctor decide on the 12 units of Actrapid dose size?

I have a sandwich with some sort of filling for lunch when I am home, when I am not I grab whatever I can.

Pretty much the same comment. It's likely to be the bread in the sandwich that is a problem, rather than the filling.

For dinner I am not eating well, some nights I have 1/2 grilled chicken breast with 1 small potato and lots of other vegies, all steamed! Other nights I have a rice dish, or pasta..

The foods to watch are the potato, rice and pasta; the chicken and veges are not a problem at all. Same comments on testing and meds.

I don't have morning or afternoon tea, but I do have supper/dessert of a night, usually a banana sliced with lite ice cream...or similar...sometimes a handful of cherries...
I have been to a dietician who told me how many carbs to have in regards to my insulin.....but nothing seems to help me get my readings down...

In that list the foods to watch are the banana (I cannot eat them any more - and I'm surrounded by them in the Tweed), lite ice cream (I eat full-fat, but less of it; lite is high in carbs) and my cherry limit is about six at a time.

I do not use insulin, so I'll bow to the experts and not suggest doses.

But I do use logic. It's pretty basic really. You need sufficient insulin, either injected or self-made, to transport the glucose the foods you eat cause to appear in your blood. The most significant food item causing your blood glucose to rise is the carbs - starches and sugars - in your menu. So, logic says that to reduce excessive blood glucose levels you need to do one (or all) of three things:

1. Reduce carbs; and/or
2. Reduce insulin resistance (that usually requires exercise); and/or
3. Increase insulin doseage in consultation with your medical advisors.

That list isn't all that may help but I think it covers the major items.

I am now on 72 units of Lantus at night, with 12 units of Actrapid before each meal....

I have however developed a craving for chocolate and during the last two weeks have been having it continually!!!

Chocolate, in moderation, can be very beneficial. However, the key is moderation and selecting low sugar/high cocoa chocolates. I enjoy a square or two of Lindt's 85% every night. Each square is only 2gms carb.

I know, I know, I have to control myself, but it's harder said than done, lol....

I'll add more on this at the end. It is amazing how much easier it is to control yourself if you make a rule to check your blood glucose level at your peak time after every meal and snack. Seeing numbers that you know are slowly killing you can reinforce your resolve.

It is amazing what I learned to like - and to dislike - after I finally accepted that my life actually does depend on the food I eat.

I have also missed a couple of lunchtime insulins in the last two weeks due to me forgetting to take it with me.....silly....

When you forget your insulin it may be wise to more strictly restrict the carbs at that meal.

My fasting readings are still in the 10's, I only had 8's for about 5 days.....
I have to get my head around what I can and can't eat...more discipline is needed lol....
Where can I find out about this 'late developing Type 1'? I would be interested in finding out about it, altho I'm just looking for other excuses and in actual fact it's my own bad control.....
Barb

I very much doubt that you are a late-developing type 1. If in doubt, ask your doctor for GAD and C-peptide testing.

I'll post a link at the foot. After you read it, if you decide to follow the suggestions I make there, please go cautiously because you take insulin. If you decide to change your menu, make small changes, test the results, then another small change until you achieve good numbers. Do not make sudden dramatic changes; you do not want to go from hypers to hypos. If you are in any doubt discuss these suggestions with your doctor - remember I am a diabetic, not a doc.

Having said all that, please read this (click on the coloured text): Test, Review, Adjust

[Helen]

Hi Barb, Alan and all

I agree with Alan in that a small amount of raw sugar is not an issue for most people - we now know that sugar itself is not the "bad guy" and that is is more related to the type of carbohydrate we eat, amount of carbohydrate we eat, timing of these meals - along with corresponding insulin levels (either your own or injected), activity and a range of other issues related to the endocrine and hormonal systems of our body.

So in simple terms, along the same lines as what Alan is saying - it is about things like the amounts of bread eaten at once and the types of carbs, such as starchy foods like potatoes.

Alan I do disagree about the type of bread not making a difference - that may be the case for you personally, but for me it certainly makes a big difference. I also know from a range of research and other people's stories that it makes a difference for them. In addition the benefits to the body of more fibre in the grainy breads is important for more than diabetes control. That said, large amounts of any bread will raise the blood glucose and cause a spike. I think this depends on the type of diabetes, stage of diabetes, size of person, whether on insulin etc.

Regaring the Actrapid dose, there are standard ways to work out insulin doses based on the person's body weight and whether they are new to insulin or not. In many cases (type 1 in particular) dose is adjusted to suit the amount of carbs eaten and whether the BGL needs bringing down.

I am still not sure the current insulin regime is right for you Barb but I know there were issues with Novorapid. There are also premixed insulins which some people find work better too. Standard doses with meals do not always work that well as the amount of carb with each meal will likely be different.

Barb you said for dinner you are not eating well - 1/2 a grilled chicken breast with 1 small potato and lots of other vegies, all steamed is fantastic! A small serve of low GI rice or pasta should be ok Barb.

Alan your ideas really fit well with the research around carbs and the way they work in our body and I think there is a lot to be taken from your methods of management.

I will also say that for some people, this way of managing would not be right for them. Some people are happy to take certain foods out of their diet or severely restrict them, but for others, they want to have the bannana, breads, pastas and rice in their diet.

It is important to remember that type 2 diabetes does progress and that you can slow this down. If you are on insulin then it is a whole new ball game as you do not have as much, or any of your own insulin to do the job anymore. So the way people manage may depend on the stage of diabetes they are at.

Some people find the full fat versions of dairy foods do have less impact on their blood glucose as the fat slows the digestion of the carbohydrates down and often in the lite version they add more sugars! - however choosing low fat foods for heart health and weight management is also part of the picture - so again a personal choice.

Barb you said you have been to a dietician who told you how many carbs to have in regards to insulin - what we atually want to get to is matching insulin to food, not the other way around. There is no need to inject a certain amount of insulin and then have to eat a certain amount of carbs to make sure you do not go low - this is how things used to be, we called it "feeding the insulin"! As I said pre mix insulins work like this and can be helpful for some people with less needles!

Barb I still think a review with an Endocrinologist would be a great idea for you to make sure we get the insulin regime right. Have you seen one yet?

I agree with Alan that the basic prinicples are to
1. Reduce carbs; (meaning if you eat 4 pieces of bread at once, you cut this to 1 or 2 at a time for example)
2. Reduce insulin resistance (that usually requires exercise) - yes exercise is a huge factor in this. Medication is also part of this picture for many with type 2. And remember this does progress ( yes you can slow it, but it will still progress for many people)
3. Increase insulin doseage in consultation with your medical advisors - yes we have talked about this Barb - I still think Lantus dose is not right and feel a standard dose at each meal of Actrapid is not all that helpful - this needs review too.

I am totally in agreeance about the chocolate!! Dark in particular, in moderation, can be very beneficial. Love my Lindt's too!

Barb if you want some more support to change the way you are managing please contact us for personal support too - it can't hurt!

bye for now and great discussion!
Helen

[barbscooter]

Hi Alan and Helen,
Thanks so much for your fabulous advice! I will have to read your posts again and again just to get it all set in my head! You both make a lot of sense...thank you!
I will admit to one thing, I do not do any exercise besides linedancing on Tuesday nights for 2 hours.....I have a desk job which prevents me from doing much exercise altho I am up and down all day....but in saying this my job is only a couple of days a fortnight! My social activies, namely bingo and scrapbooking are also not very good for movement....I realise I must do more but I am having huge issues with my back at the moment, more than usual, and I think this is because I have put on weight due to insulin....
With regards to bread, I only ever have 2 slices at the most at a time, 1 for breakfast, of white bread, I really don't like the grain and wholemeal breads, I have tried them but just can't eat them...
I am pleased to hear about the raw sugar too!
That is really interesting about 'feeding the insulin' too! That is exactly what I am doing! Unfortunately I have not been referred to an endo....I was hoping the dr would refer me but to date hasn't done so....should I ask to be referred? I know there are no endos here and I think maybe Orange would be the closest....
I am also concerned about my Lantus dose as I am now on 72 units a night, but my dr keeps putting it up to get lower readings! I have not upped my Actrapid dose for quite some time now...I am waiting to see what the dr says in September...
Every time I see my educator she harps on exercise and how I must do this walking for 1/2 hr every day, I explain to her that I can't walk like that because of my back, she insists that I am just making excuses and I end up leaving in tears....
I really appreciate both your advice and will take the time to sit and soak it all in and try to organise myself better...I think I will contact you via the counselling as well.
Thanks so much,
Barb

[Alan S]

Helen, on the points of difference, such as GI/GL of breads and eating for heart health, I will leave those for a future, separate discussion. I have personal expereince as well as cites to support my views on that, but I do not want to detract from helping Barb.

Barb, at this stage all I will ask is that you read that link I offered, find your peak timing after meals and start doing some tests at those times to see what is going on.