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Type 1 or Type 2? Patients and HCPs need to know the difference!

May 26, 2015

I am so surprised that patients many times do not know the type of diabetes they have. Are we, as healthcare professionals, not making the distinction clear to patients? If this isn't disturbing enough, I think that some healthcare professionals are also confused about type 1 and 2. I  still encounter healthcare professionals  who are under the impression that if a person with diabetes uses insulin, the patient is considered insulin dependent.

We must address some of the misconceptions regarding diabetes diagnosis and make sure that everyone who delivers care to the patient understands the types of diabetes and the differences in the care they receive.

One of my colleagues was seeing a patient recently who came in for a post hospital follow up after being hospitalized with pancreatitis. The patient stated she was told she had type 1 diabetes and admitted she had not been checking her glucose levels and was self-titrating her insulin. My colleague had a valid question regarding if the patient had been correctly diagnosed. The patient was Hispanic, had a family history of diabetes, and had a BMI >25. A detailed history is crucial in correctly diagnosing individuals with diabetes.

In patients in which I suspect type 1 diabetes, I check a plasma c-peptide and insulin level, and insulin antibodies. An ADA Diabetes Care Supplement has a more detailed description of laboratory tests conducted to diagnose type 1 diabetes. In someone with type 1 diabetes, the c-peptide and insulin levels will be very low or undetectable. Patients with type 1 diabetes are usually diagnosed in the emergent care setting as a result of DKA.

Patients with type 2 diabetes are easier to diagnose because we have time to trend their A1C levels. I don’t usually measure c-peptide levels in these patients but I measure insulin levels in those who present with signs of hyperinsulinemia.

Do you clearly reinforce the type of diabetes a patient has when he/she is diagnosed? Do you explain the difference? How do you make sure that all staff and colleagues know the difference between the types and know how to deliver care accordingly?

3 comments

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  1. Apr 15, 2011

    I congratulate you on your efforts in this. I see this problem a lot and I too feel very frustrated about it. We have the tools needed to distiguish between the two but yey they are rarely used and a diagnosis is made based on vague assumptions. I have been asking the question about testing protocols for diagnosis and risk assessment for quite some time and the common answer has been either medical necessity and cost issues. In my opinion all the reasons that are not patient focused! When I as an Exercise Physiologist work with individuals with a new diagnosis or pre-diabetes they always ask why wasn't this found until now, I frequently see my MD. Looking back in their electronic medical record it is very evident their blood glucose measured at the lab has been elevated. Why not address it then or use the different tests such as insulin levels for those at risk. I think we all know what might be more "expensive and cost effective". Prevention or treatment? No brainer! Thanks for the post!
  2. Mar 24, 2011

    Barbara, The patient was uninsured. She could not afford the testing so she was kept on insulin because she could not buy oral medications anyway. She gets insulin samples in our clinic and has attended DSME classes. And, yes, you are correct about the belief that insulin cause complications, especially among many Hispanics
  3. Mar 24, 2011

    I encounter many uninsured people who are not able to afford the cost of additional testing at our clinic. In this situation, many are diagnosed Type2 until BG trends and ketone tests hint otherwise. A good number of Hispanic people who need insulin resist it because of misconceptions that insulin causes DM complications. There are quite a few who do want to know which type of DM they have, however, if they need to take insulin, their interpretation is they have Type 1.

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