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Am I suffering from type 1 or type 2 diabetes?

Q: I am a 25 years old female weighing 75 kg and 5 feet and 7 inch tall. I am suffering from diabetes for the last 6 years. I was on insulin from then but my diabetes could not be controlled. I had to change insulin type every 3 to 4 months. Three months back I tested my c peptide test and the result was 1.93. Am I type 1 or type 2 diabetic? For the past two months I am taking tablet Galvus 50 and Glycomet gp2 before breakfast and dinner and my fasting blood sugar levels are 80 to 100 and pp is 140 to 160. Should I continue this treatment?

A:In summary you can still have type 1 diabetes but most likely you have type 2 diabetes. It’s very important to know some patients with type 1 diabetes may not need Insulin for short period and we call that honeymoon period. Please check your sugar on regular basis. In case you are unwell for any reason you must check your Ketones and you should have low threshold for contacting doctor, if in case you do have Type 1 diabetes you may end up with diabetic ketoacidosis. We are not aware your presentation and ketones and blood acid level at the time of presentation and degree of weight loss, etc, and it is very difficult to tell you through email but you can go through the information as below.
Type 2 versus type 1 diabetes
On occasion it is difficult to label some patients with either type 1 or type 2 diabetes in patients with mixed features. Some patients with diabetes can present like type1 diabetes and they have Ketones positive at the time presentation. The management of Type 1 and type 2 are different and it’s prudent for patients and doctors to know about the diagnosis.

The factors like presentation, history, and laboratory studies can help to differentiate between the two diseases, in some patients it may very difficult to distinguish with Type 1 or Type 2 Diabetes. (adapted from uptodate.com)

  • Body weight or body mass - Patients with type 2 diabetes are generally overweight with body mass index is more than 23 or 25. (You have body mass index 25.1, which is high)
  • Age - Age of presentation of type 1 disease is bimodal with a peak between 4 to 6 years of age and a second peak before the onset of or in early puberty, 10 to 14 years of age and usually young patients present later at around 14 years. You being 19 does not mean you cannot have type 1 diabetes.
  • Evidence of other features of Insulin resistance - Patients with type 2 diabetes usually have clinical features associated with insulin resistance such as acanthosis nigricans, (darkening of skin around the neck) and can associated raised blood pressure, high cholesterol and in case of polycystic ovary syndrome, these features are not seen at presentation in young patients with type 1 diabetes.
  • Family history - Patients with either type 1 or type 2 diabetes can have an affected close relative; however, it is more common with type 2 diabetes.
  • Ethnicity Asian Indians have more type 2 diabetes.
  • Ketoacidosis — Patients with type 1 diabetes are somewhat more likely to present with ketoacidosis (ketones in the urine due to extra acid in the blood) due to insufficient insulin production, but this presentation is not uncommon in type 2 diabetes. (We have do not have this information with us regarding your history)
  • Antibodies and C peptides - In patients with type 1 diabetes there is presence of pancreatic (islet) autoantibodies like insulin (IAA), islet cell cytoplasm (ICA), glutamic acid decarboxylase (GAD), and tyrosine phosphatase (IA-2). Type 1 also is usually suggested by reduced insulin and c-peptide levels. C peptide alone may not be very helpful.
  • Honeymoon period in type 1 diabetes - In some patient after few weeks to month treatment with Insulin they may go into a honeymoon period in which they may not require insulin for weeks and sometimes a month and ultimately they need insulin again as before.

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