I am 48 years old and have been recently been diagnosed with Type 2 Diabetes. Could you elaborate on how dodors are able to distinguish between Type 1 and Type 2 Diabetes in adults, at the time of diagnosis?People with Type 1 and Type 2 Diabetes mellitus have raised blood sugar levels. In Type 1 Diabetes, there is a problem in insulin production due to the destruction of the insulin producing beta cells found in the pancreas. This occurs due to either autoimmunity or some unknown cause (idiopathic). People with Type 1 Diabetes are usually lean, below 35 years of age and usually have no family history of Diabetes. . In people with Type 2 Diabetes, there is a problem in insulin action due to insulin resistance because of obesity or genetic predisposition. People with Type 2 Diabetes are usually obese, above 35 years of age and have a family history of Diabetes (mother, father, siblings or maternal uncles and aunts have Diabetes).To diagnose Diabetes, fasting blood glucose test and HbAlc are done. For people thought to have Type 1 Diabetes,Anti GAD65 Antibodies and randomc-peptide tests are also done. If antibodies are positive and c-peptide levels are low (<0.6 ng/ml) then a diagnosis of Type 1 Diabetes is confirmed. Fasting c-peptide of> 1 ng/ml confirms a diagnosis of Type 2Diabetes.People with Type 1 Diabetes need lifelong insulin and cannot sustain without insulin even for few days. They often have ketoacidosis (body produces high levels of blood acids called ketones which is life threatening) especially if their blood sugars are uncontrolled. People with Type 2 Diabetes are advised lifestyle modification, oral medications and insulin depending on their blood sugar levels.Dr Shraddha LumpatkiConsulting Physician and Diabetologist.I'm a mother of an 8-year-old girl with Type 1 Diabetes. She has been prescribed to take insulin twice a day. I would just like to know what the normal medication regime is for patients like her.In Type 1 Diabetes meUitus, there is absolute deficiency of insulin in body hence for a person with Type 1 Diabetes the treatment plan involves subcutaneous administration of insulin.The normal physiology of the pancreas is to produce insulin in two phases:• Basal insulin production• Meal-related (also called prandial) insulin productionBasal insulin is secreted by the pancreas for 24 hours continuously, whereas prandial insulin is secreted in response to nutrients to cover the sudden rise in blood sugar levels after meals. Hence the best regimefor Type 1 Diabetes is basal-prandial (also called basal-bolus) insulin regime. Basal insulin includes long acting insulin like glargine/degludec or intermediate acting insulin like Neutral Protamine Hagedorn (NPH) at bedtime or twice a day.Bolus/prandial insulin is short acting regular insulin or short acting insulin analogue which has to be injected before each meal. Now we such rapid acting insulin analogue (bolus insulin) which can be administer just at the start of a meal or within 20 minutes after starting a meal. The advantage of an insulin analogue over regular insulin is that it can be injected just before a meal or evenjust after a meal. Also the dose of such insulin can be adjusted depending on the quantity of the meal. As a parent you need to watch out for symptoms of hypoglycaemia (low sugar feeling) as most kids do not finish their meal. .Insulin pump is also a good option, especially for people with Type 1 Diabetes, as it eliminates four or five times per day of insulin injection pricks. It is a pager-like device that injects insulin 24 hours a day. A small motor pushes the piston which delivers insulin through a tube to an area under the skin. This tube has to be changed in every three days. Advanced models also have the facility of wirelessconnection with glucose monitoring device, which predicts the hypoglycaemia trends in people.Another option is to use AGP (Ambulatory Glucose Profile) for blood sugar monitoring. It is small chip, approximate size of2- rupee coin. It is placed on arm. It monitors sugar level through interstitial fluid for 24 hours. Once applied, it can be used for 14 consecutive days. With help of it reader, any person can check sugar level at any point of time.In your case, as your daughter is taking insulin twice daily, it is likely to be pre-mixed insulin. However, a basal bolus regimealong with blood sugar monitoring would be more appropriate for your daughter. In any case it is best advised that you consult your doctor to help take the final decision.Dr Manish BotllaleConsulting Diabetologist
I am 48 years old and have been recently been diagnosed with Type 2 Diabetes. Could you elaborate on how dodors are able to distinguish between Type 1 and Type 2 Diabetes in adults, at the time of diagnosis?People with Type 1 and Type 2 Diabetes mellitus have raised blood sugar levels. In Type 1 Diabetes, there is a problem in insulin production due to the destruction of the insulin producing beta cells found in the pancreas. This occurs due to either autoimmunity or some unknown cause (idiopathic). People with Type 1 Diabetes are usually lean, below 35 years of age and usually have no family history of Diabetes. . In people with Type 2 Diabetes, there is a problem in insulin action due to insulin resistance because of obesity or genetic predisposition. People with Type 2 Diabetes are usually obese, above 35 years of age and have a family history of Diabetes (mother, father, siblings or maternal uncles and aunts have Diabetes).To diagnose Diabetes, fasting blood glucose test and HbAlc are done. For people thought to have Type 1 Diabetes,Anti GAD65 Antibodies and randomc-peptide tests are also done. If antibodies are positive and c-peptide levels are low (<0.6 ng/ml) then a diagnosis of Type 1 Diabetes is confirmed. Fasting c-peptide of> 1 ng/ml confirms a diagnosis of Type 2Diabetes.People with Type 1 Diabetes need lifelong insulin and cannot sustain without insulin even for few days. They often have ketoacidosis (body produces high levels of blood acids called ketones which is life threatening) especially if their blood sugars are uncontrolled. People with Type 2 Diabetes are advised lifestyle modification, oral medications and insulin depending on their blood sugar levels.Dr Shraddha LumpatkiConsulting Physician and Diabetologist.I'm a mother of an 8-year-old girl with Type 1 Diabetes. She has been prescribed to take insulin twice a day. I would just like to know what the normal medication regime is for patients like her.In Type 1 Diabetes meUitus, there is absolute deficiency of insulin in body hence for a person with Type 1 Diabetes the treatment plan involves subcutaneous administration of insulin.The normal physiology of the pancreas is to produce insulin in two phases:• Basal insulin production• Meal-related (also called prandial) insulin productionBasal insulin is secreted by the pancreas for 24 hours continuously, whereas prandial insulin is secreted in response to nutrients to cover the sudden rise in blood sugar levels after meals. Hence the best regimefor Type 1 Diabetes is basal-prandial (also called basal-bolus) insulin regime. Basal insulin includes long acting insulin like glargine/degludec or intermediate acting insulin like Neutral Protamine Hagedorn (NPH) at bedtime or twice a day.Bolus/prandial insulin is short acting regular insulin or short acting insulin analogue which has to be injected before each meal. Now we such rapid acting insulin analogue (bolus insulin) which can be administer just at the start of a meal or within 20 minutes after starting a meal. The advantage of an insulin analogue over regular insulin is that it can be injected just before a meal or evenjust after a meal. Also the dose of such insulin can be adjusted depending on the quantity of the meal. As a parent you need to watch out for symptoms of hypoglycaemia (low sugar feeling) as most kids do not finish their meal. .Insulin pump is also a good option, especially for people with Type 1 Diabetes, as it eliminates four or five times per day of insulin injection pricks. It is a pager-like device that injects insulin 24 hours a day. A small motor pushes the piston which delivers insulin through a tube to an area under the skin. This tube has to be changed in every three days. Advanced models also have the facility of wirelessconnection with glucose monitoring device, which predicts the hypoglycaemia trends in people.Another option is to use AGP (Ambulatory Glucose Profile) for blood sugar monitoring. It is small chip, approximate size of2- rupee coin. It is placed on arm. It monitors sugar level through interstitial fluid for 24 hours. Once applied, it can be used for 14 consecutive days. With help of it reader, any person can check sugar level at any point of time.In your case, as your daughter is taking insulin twice daily, it is likely to be pre-mixed insulin. However, a basal bolus regimealong with blood sugar monitoring would be more appropriate for your daughter. In any case it is best advised that you consult your doctor to help take the final decision.Dr Manish BotllaleConsulting Diabetologist
