My 41 year old husband, diagnosed with diabetes over three years ago, is very active but has a demanding job as a paramedic which means he works 12 hour shifts (days and nights). His weight is okay, but his medication has been increased on a regular basis since diagnosis. He has maintained his blood sugar levels quite well up until a few months ago. They are always high in the morning, coming down slowly through the day. He feels tired all the time and sleeps on and off throughout the day. He says he feels as unwell now as he did when he was first diagnosed. He has never been diagnosed as having either type 1 or type 2. Is there a way you can tell? Is it possible he has type 1 and needs insulin?

This is a good question and one which is commonly asked. Your husband’s presentation does raise the question of whether he has type 2 diabetes or a form of type 1 diabetes called Late-onset Autoimmune Diabetes of Adulthood (LADA).

The common tests used to answer the question include a determination of anti-GAD antibody (high with type 1), measurement of C-peptide levels (low with type 1 diabetes and a reflection of secreted insulin), and a variety of other tests that may stimulate the endocrine pancreas to make more insulin.

Your husband’s doctor can help him to obtain these tests. I must say that even if he has type 2 diabetes, if he doesn’t get better, he needs to be on more potent therapy which may include insulin.

JTL