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Lazza 09-12-2019 21:12

How worried should I be?
 
A few months back I was shocked to learn my a1c was 5.5; six years (and 20 lbs. lighter) it was 4.8. So now half way to losing 20 lbs. I decided to get my C-peptide level checked just to see how insulin resistant I might be. Well my C-peptide level was 0.63, which is actually lower the lab's reference range is 0.8 - 3.85). Not what I expect at all.

So should I be worried that I might be on the early road to type 1.5 diabetes? I see the reference range for C-peptide varies, with some labs having the reference range 0.5 - 2.0. So maybe I am actually okay?

At the end of the year, when I hope to lose all my excess weight, I will have my a1c level tested again. If it goes down a bit I will be comforted. But if it stays the same or even inches up I will ask to see an endocrinologist.

Thanks.

itissteve 09-12-2019 21:39

I'm no expert in C-peptide levels at that degree of difference but I would offer two suggestions:

- that you evaluate your confidence level in the test itself (is it so out of whack that you think you should take it again?); and

- you consider the effects of actively losing weight on test numbers. Just as an example, cholesterol levels, in individuals who are losing weight on low-carbohydrate/high-fat eating plans, can vary to the point where they are advised to not respond pharmaceutically to "high" cholesterol levels until their body weight stabilizes. Perhaps you'd be best off to wait until you've lost the remaining weight (it's only a few months from now) and test again.

VeeJay 09-12-2019 22:08

You could always get a glucose meter and do some testing now and then to keep track of trends. An A1c of 5.5, while higher than what you tested before, is by no means alarming - in fact, most of us diabetics would be happy with that level.

Also, there is a more definitive test for T1/1.5 which measures antibodies, which are what separates T1 from T2 (which, while can result in lower insulin production in some individuals, isn't an autoimmune attack).

Lazza 09-12-2019 22:55

With my a1c being 5.5 back in June and having lost weight since then, even if I have some sort of autoimmune situation (LADA, aka type 1.5 diabetes) it is unlikely my blood sugar level will shoot up dangerously before I get my a1c retested in December. Yes, there are antibodies tests that can definitely say whether my beta cells are being attacked. But I suspect a doctor would not order such a test unless my a1c indicates I am clearly diabetic.

Again I am hoping my a1c drops a little in December. Perhaps I will get my C-peptide level checked again at that time in case there was a lab error. If my C-peptide level again low I will get a glucose meter. My FBG has typically been 90-ish. The minute it ticks to 100 I will push to get an endocrinologist visit, get the antibodies tests and take it from there.

Data out there on LADA is pretty sparse. Folks diagnosed with LADA are typically under 50, much younger than me (63). But having an existing autoimmune condition is also a common factor; I have psoriasis. Also there are people diagnosed with LADA who have a C-peptide level much higher than 0.63. <sigh>

mbuster 09-13-2019 01:29

Have you been eating low carb? Or at least just prior to the C-peptide test?

Lazza 09-13-2019 11:37

I am not good at carb counting but for the past ten years I believe my carb intake has been moderate, perhaps 100-150 grams daily, because I stopped eating gluten and dairy. I also avoid processed (packaged) foods and I don't eat sweets. But in an effort to lose weight I have pared back specifically on carb rich foods, like starchy vegetables, and choosing foods with a lower glycemic index. Yet even now my carb intake is probably about 100 grams per day.

At my current trajectory I should be at my optimum weight within the next several weeks. If my a1c doesn't respond favorably I will be most unhappy, but I won't give up the fight. I will cut my carb intake in half and see if that helps.

Oh, I should one more point. I have noticed for the past several years often when I do eat something sweet, like someone shoves a piece of cake in my face and says "EAT!", I get a rather unpleasant reaction. Besides the overly sweet sensation in my mouth I get what I call a sugar rush, a weird overall sensation that is hard to describe. It passes before long. But is this sort of reaction normal??

mbuster 09-13-2019 11:55

Good for you on your healthy eating changes for your health and personal weight loss goal. I think further carb reduction would be a step in the right direction if your A1c is not where you want it. I try to stay at or below 30 grams of carbs per day.

I can't answer your question, t would probably bite the fingers of the one shoving the cake in my face.

itissteve 09-13-2019 13:34

Quote:

Originally Posted by Lazza (Post 1322279)
I get what I call a sugar rush, a weird overall sensation that is hard to describe. It passes before long. But is this sort of reaction normal??

It's hard to analyze this from a distance, but are you talking about something like an adrenaline ("fight or flight") rush? Increased heartbeat, heightened mental acuity, maybe a little stomach upset?

As a person eats simple carbohydrates (like white flour and sugar), the body calls for insulin. Eating those same food quicker causes a faster insulin response. Sometimes, too much is supplied and the body has to deal with that imbalance.

Another possibility is that it's a learned response. I didn't quite realize for a long time how bad I felt after eating certain foods (or quickly eating quanitities of those same foods). That bad feeling went away when I went LCHF. But I can still feel a twinge of it these days even if I eat smaller quantities of those same foods. I believe it is my brain remembering the previous experience. It's one of the things that helps keep me on my chosen eating plan.

Lazza 09-13-2019 17:15

Yes, that is the type of response I get to eating sweet foods, especially when consumed on an empty stomach. When I was young this didn't happen. I could eat very sugary foods in quantity w/o issue. But now my body freaks out. I'm hoping that it is just due to my body not used to having to deliver insulin so quickly versus not having enough insulin on hand (.. based on my low C-peptide level).

I can still eat things like potato chips and white rice, no problems. But typically these foods are consumed with other, more protein/fat -rich foods. So I don't get any sort of sugar rush.

itissteve 09-13-2019 18:42

Quote:

Originally Posted by Lazza (Post 1322289)
But typically these foods are consumed with other, more protein/fat -rich foods. So I don't get any sort of sugar rush.

Yup. That's kind of in the same ballpark as not getting drunk so fast if you're eating at the same time. Fat and fiber and protein make a difference compared to just eating the sugary stuff.

You know, our bodies always change over time. Allergies develop (or go away); digestion changes, and it's possible that the markers you're seeing are signs of T2 or LADA -- or just getting older. Your A1c looks fine and your C-peptide is close to (or within) range depending on how the test is conducted. I would not let stress damage your health any more. You're on the right track in losing weight and watching carbs. I'd give it some time before retesting.


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