01-05-2012 05:13 PM
My father was just recently diagnosed with diabetes. He is 65 years old, and diabetes does run in his family. But is age 65 too old to have Type 1? He is not overweight and eats a (fairly) healthy diet, and does exercise. He was experiencing all the classic symptoms including extreme thirst, urinating all the time, weight loss and fatigue.
My question to those more experieced with this type of diagnosis: are there any type of tests he should make sure his doctor does in order to confirm a correct diagnosis? It sounds like his doctor just did a very basic test. He is in a very small rural town so I'm worried that the doctor would not be so experienced with Type 1 in adults.
Thanks so much.
01-05-2012 07:15 PM
Hi Shannon, I am in no way an expert, but recently diagnosed with adult onset diabetes. I was hospitalized with acute pancreatitus when it was discovered. At first they said Type2 but when they did a c peptide test they changed my diagnosis to Type1 because they said that my pancreas was producing very low levels of insulin and I began taking insulin right away. I think there was another test (I apologize because there have been so many tests that I don't remember them all) but I remember one of the doctors saying that I showed antibodies and I again I apologize for not knowing. I'm pretty sure it was the c-peptide test that they based my diagnosis on however. I hope this helps.
01-06-2012 12:27 AM - edited 01-06-2012 12:30 AM
There is no conclusive test for type 1. a c-peptide blood test will tell how much insulin he is producing. If he produces a lot, he is type2. If he produces a little, or none he is probably type 1( especially if he needs very little insulin) . but he could also be type 2 and produce very little c-peptide, in which case he would need very large amount of insulin (Type 2 is insulin resistant, type one is insulin sensitive). both types initially produce insulin, but type 1 kills your insulin producing cells,either an autoimmune response , or in some cases unknown causes); and type 2 wears out you insulin producing cells from overuse. The antibody tests can confirm, but not rule out, type1. If you look long enough in these threads, you will find people in there 70's being diagnosed t1.
01-06-2012 07:59 AM
I'd recommend that the doc do the antibody test and c-peptide.. antibody more important, Many doctors will say t2 just because of his age. but t2s are not all fat... they too just have bad genes and many face unfair criticism for bringing this on...
I'd also recommend that you get your dad on the appropriate t1/t2 board... it is refreshing to share with others that live this.. so you can only provide so much support.
01-06-2012 02:30 PM
Simply NOT being overweight is not enough by itself to diagnose type 1 diabetes.
The others have already explained the c-peptide and antibody test that can be used to confirm that a person has type 1, but even those tests can be inaccurate.
Frankly, most doctors, most of the time, are not going to do extra tests to rule type 1 diabetes in or out. After all, 90% to 95% of all people with diabetes do have type 2. I've heard that the average age for diagnosis of type 1 is about 14 years old. Small town, or big urban medical center, the average doctor might not even see one new diagnosis a year of adult onset type 1 diabetes out of a thousand patients. The tests are expensive, and most of the time they give no new information. It becomes clear enough over time, when the usual treatments for type 2 just don't yield the expected results, and blood glucose levels continue to rise. At that point, the extra tests will help confirm what is going on.
The only real problem is when a person does everything they are asked to do, in terms of reducing carbs in their diet, exercising and and oral meds, and it just doesn't work, but the doctor ignores that and decides that the patient has been "noncompliant". The doctors are so used to patients who don't follow directions that they can overlook those who are doing their best to follow directions. Even worse, we all know we are not absolutely perfect, and if management tactics give less than perfect results, we can blame ourselves and fall for the same noncompliance story.
The best protection against that kind of problem is for the patient to be very clear about his efforts, and not put up with being blamed for poor results, or poor results becoming even worse. It helps if the patient is testing often enough to be sure himself that his efforts are not working and if he doesn't meekly wait for months until the next appointment to report what he sees.
Doctors need our feedback to do their jobs well. If they don't seem to be listening, we may need to be more insistent, and we need to have confidence in our own observations. Waiting to see what happens doesn't mean that the doctor is incompetent. It may be the best strategy. On the other hand, if a doctor doesn't listen when there is a problem, it's time to be more insistent, or to get another opinion.
01-06-2012 06:43 PM
I raised a diabetic kid, now 52 so was well aware of diabetes. When she was diagnosed I was told to watch the rest of the family. This I have done. I have peripheral neuropathy which I now know is not diabetic related. But it made me more cautious. In my mid 60s my sugar began to be a little higher than it had been so I did the things I should have, such as watching my diet. I am not over weight. As time went on watching my diet was not sufficient. I went on orals which worked very well. Reading sites such as this I ran across LADA, (latent autoimmune diabetes) and found that insulin is the preferred method of treatment. ( ADA now advocates this which help preserve insulin production.) So I asked to be tested. A positive GAD 65 test is considered to confirm LADA. This is not the only test. I tested positive for this. I am now on insulin, age 78. My Cpeptide test indicate I am still making insulin. My insulin production has diminished very slowly and I have been able to maintain good control. Reading these posts I have concluded I am one of the older ones diagnosed but it is not all that rare. I think catching it early has helped a lot. My doctors, eyes and kidney, says I have no diabetic damage.
He should be tested for the antibodies, which is a basic test. If positive he should be treated, as per the ADA, as a type 1 and put on insulin. You are right to question this.
01-06-2012 06:47 PM
That is the million dollar question. My endocrinologist put me on metformin four weeks ago and at the time she said that it would limit the amount of glucose my liver was producing. I assumed it was because my morning numbers where so high and another doctor during my hospital stay was concerned about my liver (I went because of a severe abdominal pain and fever which was caused by pancreatitus) and had many tests done on my digestive system. The diabetes was almost the secondary concern at the time because they couldn't find a cause for the pancreatitus and I am not a drinker and I was actually told I was a T2 until I met with the endo and she ordered more blood tests.
I met with 4 or 5 different doctors about the abdominal pain and the severe swelling in my pancreas one of whom showed me on a sonogram or ct scan? that there was excess fat in my liver. I'm a pretty healthy guy, I just turned 45 a few weeks ago and before I discovered this board I didn't know that it was a T2 drug normally and I simply did what my Dr said to do without question.
I now have a million questions for her at my next appt in three weeks. So, I really don't know. I have read many articles since Maddie first brought this to my attention and discovered that it is given to some newly diagnosed T1's and some T1's who have had to greatly increase their basal doses, but it seems to be an experimental treatment and there are questions to long term viability. On the bright side, my morning numbers are dramatically lower (120's-130's) and my nightly Lantus injection has been reduced by 15 units. On the not so bright side, the drug gives me morning nausea, diarhea (although that finally seems to be going away) and a light rash on my face. So.... I really don't know. I am really new to this.
01-06-2012 08:47 PM
I am LADA also and am still trying to figure this whole thing out. I am actually making a lot of insulin at this point (I'm 64). I am on metformin and prandin....plus insulin once in the morning. I'm curious, are you saying that by going totally on insulin that you are still able to produce insulin thus fending off all the bad side effects of diabetes? If you had remained on orals, do you think that would have happened?
01-06-2012 10:00 PM
a Very simplistic & general Infro. approach?
when I was Diagnosed at age 45, I didn't relly care what type I was, All I knew at first , that after tgrying Pills and Eating a Very low Carb plan for about a week, I still was thru the roof ( 300's-400 ) and I had to take Insulin, period.. ( later to find out I had my Mother's T-1 ) and yes, i was Normal Weight and Very Active as well..
In Range BG's & called Fasting BG's ( or 4 hrs after eating) > 90-140 max
Assuming he is on Medicare, get a Prescription for a Test meter and Test strips..
-For starters, A Meter called One Touch is fine and try to get at least 120 strips a Month script ( 150-300 is even better ) to test at least 4x a day, B/L/D and Bedtime
-If he has A Supplemental Ins. Plan, call them for what Meter and Strips they will pay for..( most may do Mail Order )
1. if , after following a Strict Type 2- very Low carb Diet plan, Exercise and taking Maximum doseage of Pills and their BG's are still not In Range?
2. Then they will start the patient on a Long lasting Insulin- either Called Lantus or Levimire..this can last upto 24 hrs
3. If that isn't enough? Then they will add takng a Bolus/Injection for Meals Insulin, called Either Humalog or Novalog.. taken Before Meals and per A Sliding scale per the Tot Carbs they eat.
A. Try a Low Carb Diet meal Plan.. They Type 2 boards has alot of Help for more Indepth Meal Plan for B/L/D and Snacks.
B. I just use Health Choice Dinners for my Lower Carb Melas, Max 35 carbs per Meal
C. For Bkfts, a "0" carb of Just Microwave Eggs and Sausage Patties..No Toast and only Diet Orange Drink of Hot Tea.
D. Lunch is just a Max 36-40 Tot Carb of A Sanwhich/Subway type and Diet Drink of Some type.
If has to use a Bolus/Injection Insulin of one of the Logs for eating?
I would Get the Book, Titled : THINK LIKE A PANCREASE to further help him understand the complexities of all that has to be done..
If you are willing? You get the Book and read it 1st and then send it onto him and then you can relate to it alot better..
If he does not use A PC/Email etc? ( alot of Senior men don't ) Then you will have to print out All the Courses and mail it to him..
If he a Veteran? If so, Go to his nearest VA as well.. Their Test meter is Called a Precision and Strips cost $9/mo for 120 strip supply
Diabetes Boards to check out:
American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
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