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August 11, 2003

Diagnosis and Symptoms

Question from Ottawa, Ontario, Canada:

I have been taking insulin for 11 years, and last week, my family doctor (who did not diagnose the diabetes) was reviewing my files and noticed that I had never been screened for type 1 or type 2 diabetes. So, he did a blood test which showed that I do produce insulin. He prescribed oral medication, halted the insulin injections, and my blood sugars are fine. Is there any other method of testing for type 1 or 2 diabetes other than a blood test?

Answer:

I think it depends on what “blood tests” your doctor ordered. Perhaps the most specific (although not necessarily the most sensitive) testing to help distinguish type 1 from type 2 diabetes are the various pancreatic antibody tests. Type 1 diabetes is typically an autoimmune process whereby the body’s own immune system produces antibody proteins that “attack” the pancreas and interfere with insulin production. Several labs measure these various pancreatic antibodies – although not all labs do a very good job. In addition, people with type 1 diabetes often are easily predisposed to the development of serious ketone formation, which can be fatal.

Another blood test used in the past is called the C-peptide level. C-peptide is more or less a “by-product” of the production of insulin. If the pancreas produces insulin, it will also make C-peptide. Synthetic insulin that you inject yourself with has no appreciable C-peptide.

To me, while there are certainly many advantages to various oral hypoglycemic agents, and while many people like to shy away from insulin if they can with their type 2 diabetes, insulin remains the best, cheapest medication with the most benign side effect profile. If you were doing well with shots, I don’t know why you would change, other than the overall “shot experience.”

DS