Over the past few days a few of us have been in a discussion about C-Peptide and anti-body tests and some may be wondering what the heck we are going on about.
So I'll try and give the 10 Cent explanation about some of the tests that can be used particularly if our diabetes gets a little out of hand or doesn't exactly react the "expected" way when the Doc is treating according to the guidelines that work for "most".
First we have the A1C test - I'm sure each one of us has had at least one of… read more
As far as the anti-body tests, if I was between 20 and 40 when diagnosed I would ask for them.
And if the Doc said "why" I would suggest they check out the NHS guidance (UK) which found that nearly 25% of those in that age group diagnosed with Type 2 actually had LADA and the sooner you know the sooner the Doc will be able to react when it progresses.
It is treated as Type 2 in the beginning because it moves way slower then Type 1 (months or a couple of years instead of days or weeks) but if the Doc doesn't know it is LADA and your sugar goes through the roof they will piddle around trying to figure out why the meds are not working when, if they knew it was LADA would have you on insulin "right then" which could possible save you a trip or two to the ER with numbers over the moon.
I would suggest that most primary care/family Doctors are not even aware of LADA - most of them have a minimal understanding of Diabetes at all and simply follow the guidelines.
That works perfectly for about 90 to 95% of the cases - for most of us there is nothing that specialist could do for us that the regular Doc can't, unless we are not "typical" but certainly seeing if they will buy off on a couple of the alternate tests will give (you) a little more insight then a simple A1C which only tells you what your average blood sugar was over the last 90'ish days.
It doesn't tell you if your fasting or after meal numbers are a problem. It doesn't tell you high or low you are swinging around that "number right in the middle" - if you are going low at night and not alerted to it that will keep your average "down" artificially and you may be "hurting yourself" with high numbers that are getting averaged out by those super lows - A1C doesn't tell you that but an OGTT would.
Unless you wear a CGM we are only capturing a handful of blood samples a month - not enough to really understand what is going on if we are simply relying on a couple of stick tests and an A1C even a couple times a year.
I'm not willing to completely hand over "my future health" to an A1C test once a year...
I order c-peptide tests in the states through labs where i do not need a dr's script and pay for it myself. It cost $69.00 for a test here in Maryland.
I will always say how very grateful I am for being a part of this Diabetic Family. I have learned so very much & it has helped me on so many levels! thank you, Graham!! You are such a profound help. I am taking notes so that I may discuss more with my doctor.
Thank you for keeping us informed <3
The FBS (lab) and OGTT were the standard tests before A1C came along.
But as I noted they both test different things where the A1C kinda rolls them all together (which is probably why the doctors like them - gives them one number - look up on the chart and it tells them what to do).
When I did my A1C test in Feb my kidney numbers looked bad - wasn't surprised, I have been really pushing it physically for about 7 weeks so the "muscle waste" (creatinine) numbers were jacked right up.
A couple days ago I asked her for the lab order (wife had an appointment) and asked instead of another "useless" A1C test if she would request the FBS and Fasting C-Peptide.
Because I had the same pair of tests done when I first achieved an A1C of 5.4 (Feb 2017) I have a baseline for comparison so will be able to see (at least as accurately you can compare two tests 5 years apart) whether my insulin production has degraded a bit (wouldn't be surprising - stuff breaks down), if my insulin resistance has gotten worse (again, can blame old age) or if both of them are "pretty close" to what they were, then my liver may be starting to party a little harder.
But mostly I want the numbers so if say next year my FBS average takes just a little more of a bump up and I go to the Doc and say "ok, it's time for low dose metformin even though my A1C is still very well controlled" I can point to the tests to show her that "yes", I have a fasting problem that could take a few years to show up in the A1C but I don't want to do damage (because high fasting numbers cause damage as well) waiting for that A1C to get up to the medication line.
The OGTT is also a good self management test but it does take about 4 hours to complete - but there is a fun part as well. You have to prep for 2 days. 2 days before you wolf a ton of carbs (ya pizza), then the day before you fast for like 12 hours.
You go in and do a "glucose shooter" - depending on the lab it's either 75 or 100 carbs worth of pure glucose - then they do venous draws at one, two and three hours.
It gives you a good picture of how quickly your number shoots up, what your system does with it at the normal two hour interval but also what it does by that 3rd hour - if you "ride high" for 3 hours then you know maybe you should be really vigilant about spacing out your meals or snacks or "not" - maybe you can eat again at hour 3.
But it does give a great "profile" to see if maybe your insulin use is just delayed a little.
CGM's are mostly making the OGTT kinda redundant because they show you what's happening every 15 minutes, but the OGTT is going to be far more accurate and if they combine that with a C-Peptide test at the hour 2 or 3 blood draws that would really show you what the pancreas is doing while trying to deal with "mealtime sugars".
Here in UK,oral glucose tests are falling out of popularity,but very hard to persuade most docs to order a C-peptide