Type 2 Diabetic Poor Insulin response GAD negative

We present a Male 55 yr old with 12 years of diagnosed diabetes. His condition is slowly going out of control, sugars rising, meds rising.

During Lockdown HBA1C went to 92. Went on a digital program to reduce carbohydrate intake.

4 months later HBA1C was 70. Weight has gone up 1kg in 4 months. But BMI 29 so not morbidly obese. BP is normotensive. His glasses needed a change in prescription.

So an improvement but we were hoping for more. Finger prick glucose in previous few weeks were in the teens.

So why is this? We ordered a GAD antobody test and this was negative. GAD antobodies target the Beta cells of the Pancreas and are a common cause of late onset type 1 diabetes.

He asked to use our insulin measuring service to understand how his pancreas functions under stress? Is it insulin resistance? Or a tired pancreas.

My reading of this is that you can see he came with high fasting glucose which not surprisingly rose after 75g Glucose.

But insulin response was disappointing to say the least. The pancreas seems to be trying but response is poor.

With GAD negative we took the view this is an exhausted pancreas and it needs a rest!.

He agreed to go as low carb as he possibly could throwing in intermittent fasting with one meal a day and even extending this if he can.

The next week he took advantage of the “free” Lifestyle libre offer and put a patch on:

This shows much better control, pretty immediately. The patient put this down to a deeper understanding of what is going on.