c-peptide with concurrent fasting glucose question

Chell has had her insulin pump for just a bit over two years.

Now two years later as insurance is getting more complicated, Chell now has Illinois Medicaid, Iowa Medicaid and now Medicare.

According to MM & the paper work that I have seen from insurance...in order for Chell to even get any of her current pump supplies right now and in the future to qualify for a new pump...Iowa laws and Medicare laws requires a c-peptide with concurrent fasting glucose.

What is so particular about the C-peptide with concurrent fasting glucose? What does that tell Insurance companies? The test has to be within the past 24 months for that to be valid for insurance companies to accept.

Let see..her one and only one was done May 2004, when she was first diagnosed. So that one is no longer good.


Thanks for any insights!

Michelle

 

It's not really anything to be concerned about... it's just to show that she's not making any insulin on her own. Regardless of what her BG is, the c-pep will be at most, almost non-existant.

 

I'm not concerned about it....I'm just wondering WHY they want it..what does it really tell them?

 

From what I understand C-peptitide, waxes and wains WITH insulin production from the pank. But with T1 it ets distroyed also from the autoimmune responce, but we do not replace c-peptide just insulin.

So, c-peptide is a good inticator of the total auto immune reaction, since we can "control" bg with insulin and have a relatively good A1C.

 

We had c-peptide tested with concurrent fasting glucose and it came back as 0.2, which we were told meant little or no insulin production.

Then we were told that you have to eat carbs before the c-peptide test, otherwise the body will produce little insulin and a low c-peptide is expected.

So I'd go for it. The fasting will help prove that she has D, if that's what they are looking to prove.

 

So question for you Darryl

If a fasting blood sugar is over lets say 300....how does that impact the c-peptide...and then what if insulin is giving to bring down the bgs how does that impact the c-peptide.

As you know we can't predict what diabetes does..and at this point I can't predicted that the gastroparesis does to Chell either.

 

C-peptides are a direct, proportional, by-product of insulin production and has no real correlation to actual blood glucose levels. It's simply how actual insulin production is measured.

From what I've seen, many insurance companies tend to treat type 1 and type 2 diabetes the same. My guess would be that the insurance company may vary levels of coverage for a type 2 based on their current insulin production levels that, more than likely, can and do vary. That's not the case with a type 1, so the test is really unnecessary, but they just don't differentiate coverage protocols for the two different types.

 

I have no idea! But my guess is that if BG is 300, the hyperglycemia would suppress any insulin production
even if some beta cells were active. Leah's c-peptide was ZERO at diagnosis with a BG of 550.

I bet the c peptide is only detectible in people with substantial remaining beta cell function, and even then,
only when BG is in the nondiabetic rage.

 

One of Brendan's C-peptides was drawn for a research study (SEARCH) and they required fasting. At that point, Brendan appeared to be completely out of the honeymoon and was using quite a bit of insulin. His BG wasn't the greatest that morning either (130 at time of test and had been in the 200's often the weeks prior, due to increasing insulin needs we were having trouble staying on top of). But his C-peptide was in normal fasting range. He was 1.18 ng/ml and the reference range we were given 0.5-3.0. I found it strange that he was still producing that much C-peptide when he needed so much insulin. They tested his antibodies and the IAA was sky high. So, he must have been under a pretty substantial autoimmune attack.

A few months later, he went back into a the honeymoon, and his C-peptide after uncovered carbs was pretty high -- 3.4 about 20 min after eating 25 g. His BG went pretty high from not being bolused. But at that point, he was using half as much insulin as he was during the fasting C-peptide test.

 

I could be wrong, but from what I understand, unless they're doing a full glucose tolerance test after overnight fasting and no IOB, then the standard c-peptide blood test only gives a "snapshot" of what your peptide levels are at that precise moment, and is not considered to be very accurate in determining actual insulin production. It's accurate enough to distinguish between T1 and T2 though... :cwds:

 

I really doubt that c-peptide production is lowered by a short term high blood sugar.
My proof? I had my c-peptide measured with a blood sugar of 450. The c-peptide was 1.7 (with this lab, bottom of normal was 2.3).
I had my c-peptide measured two days later with a blood sugar of 190. The c-peptide was 0.0.

It is assumed that a high blood sugar will go along with a higher c-peptide if the body is capable of making c-peptide. While ketoacidosis will suppress insulin production, and long term hyperglycemia will destroy islet cells, I doubt that one night of hyperglycemia will do anything to the body's ability to make inulin.

 

I suspect it is Medicare that is wanting it. Medicare requires it for all patients on insulin and wanting or using insulin pumps. It is pretty standard.

 

Actually its both..Medicare, and Medicaid of Iowa that's requesting the c-pep