What numbers on CPeptide and GAD tests would prompt the doctor to immediately start insulin therapy?
These tests were never offered to me before and I have been diabetic 50 years.
Answer Summary
Members discussed what C-Peptide and GAD test results might prompt a doctor to start insulin therapy, with one member providing a helpful... Read more
The GAD test is to check for anti-bodies that would detect L.A.D.A. (Latent Auto-Immune Diabetes in Adults) - kinda like the "adult form" of Juvenile Type 1 Diabetes
The C-Peptide test will tell the Doc how much insulin you are producing compared to the standard benchmark which rates it in (maybe) 3 ranges -
Severe - producing under 2.0 nmols or 0.6 ng/ml = requires insulin from now on
(Grey Zone) - producing 2.0-6.0 nmols or 0.6-1.8 ng/ml = Early LADA or Advanced Type 2 that still may be treated orally but some supplemental insulin MAY be necessary
and finally,
Better Numbers than those above = oral meds or dietary/weight managment
The GAD test could also detect Type 1 but you would not have survived 30 years without supplemental insulin if you were Type 1
But it's very possible that you have LADA and were misdiagnosed as Type 2
Not initially a problem because they are managed and treated "exactly the same with the same meds" until suddenly as "Type 2" does respond properly to the medication any more (which is the point they have progressed to insulin dependence)
There used to be a term called IDDM or Insulin Dependant Diabetes Mellitus which was used to describe Juvenile Diabetics (Type 1's) AND any Sugar Diabetics (Type 2's) that regularly used insulin
PS - neither the GAD (or GADA) and the C-Pep tests are routinely ordered IF you are well managed with existing available meds - it's when the "prescribing/treatment guidelines" no longer work and it doesn't make sense "why" would you be sent to an Endochronologist who would run the tests - a GP/Family Doc wouldn't know what to do with the results so would never order them...
@A DiabetesTeam Member So we have Hkc an alien and Graham a closet AI bot. Whatever next! 😁
@A DiabetesTeam Member what you describe is called Brittle Diabetes, or Labile (street names for Glycemic Variability) and it effects a miniscule percentage of Auto-Immune Diabetics
And the the Doc is testing you for Auto-Immune LADA (purpose of the GAD test)
So it sounds like the Doc suspects Brittle Diabetes
It really sucks and the treatment is usually "reactionary" because they almost never can determine the actual cause of the blood sugar swings
I only know one person with Brittle/Labile and her whole life has been a roller coaster - sorry, lets hope that is not what you are experiencing...
@A DiabetesTeam Member thanks for that information! I do have extreme Glycemic variability now it moves quickly now there has been a change in the last year and can drop very low suddenly too. I hope they can figure me out!
I haven't had either test. I saw an endocrinologist. I've had genetic testing. I've had my cortisol tested. My insulin resistance was sky high.
In fact the results from every test my endocrinologist gave me scripts for were exactly opposite of what he expected.
I was injecting about 200 units insulins daily, with metformin, and Jardiance. I was eating only 2-3 net carbs per meal. My numbers only came down to 6.1(110 USA) to 8.9(160 USA) with all of that.
He wanted to lower my insulins loading. I was concerned about injecting that load of insulins. I was afraid of overdosing on insulins. So I fingersticked at least 12x a day for my safety.
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So I took things into my own hands. I applied engineering, Japanese Science, and Medicine, and past experience.
Since I've fasted at least 8 times a year for at least 72 hours each. I have that history and so fasting is easier for me than most.
So I began intermittent fasting. 19 hours and eating only during the next 5 years. I started eating 2 meals daily. That cut my insulin loading by 35 units fast acting insulin daily.
A week later I cut back to 1 meal a day. Cut another 35 units fast acting insulin daily. I began by titrated down long acting insulin to 1 time daily. So 45 units less long acting daily.
Then I slowly cut long acting insulin and fast acting insulin. I cut out the metformin.
I sat there for 3 days, then reduced my insulin to nothing.
I believe that injecting the insulins for 5 months... gave my pancreas a bit of a rest. So it healed a bit.
I stayed there for 3 weeks then began titrating down on the Jardiance. Down to half a dose a day.
I know I could cut the Jardiance out completely in 2-3 weeks. But my endocrinologist wants me to remain on Jardiance for its CAD and heart protection.
So I will. For now.