A year ago, my 14 year old niece was diagnosed with type 2 diabetes, and she is thin and athletic. My daughter (her cousin) was diagnosed with type 1 seven years ago so I am very worried about this situation. She is seeing an endocrinologist (the one and only at the nearby Children’s Hospital) who initially treated her with a diet only, but very shortly afterward put her on Glucophage [metformin, a pill for Type 2 diabetes],. and they recently switched over to a generic brand.

I am worried if my niece’s diagnosis is correct because I spoke to my daughter’s endocrinologist who believes she was misdiagnosed. I have spoken to my brother about this, but they really don’t know enough about diabetes and believes in the doctor. How can we find out for sure which type of diabetes she has?

Sometimes the only way to tell the difference between type 1 and type 2 diabetes is to observe closely over time. Some general rules:

Type 1 is usually in younger folks, kids and usually in thinner people. Often with higher sugar levels at diagnosis and usually, but not always, with ketones present.
Type 2 would be associated with obesity, acanthosis nigricans, hyperandrogen states, and hypertension, but these are not always present in younger patients.
Type 1 would usually have positive islet cell or GAD antibodies, while type 2 patients would be antibody negative.

However, all of these things are not absolute. Over time, someone treated incorrectly with oral hypoglycemic agents, who really needed insulin. would have sugar levels that did not respond so nicely. Therefore, blood glucose levels and patterns would be helpful to decide whether the diabetes is type 1 or type 2. Any good pediatric endocrinologist or diabetologist should be able to figure this out even though it may take some time.

SB