January 4, 2005
Diagnosis and Symptoms, Meal Planning, Food and Diet
Question from Winnipeg, Manitoba, Canada:
My 21-year-old son was diagnosed with type 1 diabetes in August and I do not understand why. Last Spring, he had a series of respiratory infections and blood tests done at the time showed an abnormally low blood sugar. The doctor noted that an abnormally low blood sugar had been recorded in December 2003 at the time of his annual physical. (The doctor at that time did not tell us this and has since left the practice). He was sent for a fasting blood glucose test. The glucose load was 75 grams. The readings were
Time
Blood Glucose
0 minutes
5.2 mmol/L [94 mg/dl]
30 minutes
12.4 mmol/L [223 mg/dl]
60 minutes
6.1 mmol/L [110 mg/dl]>/td>
90 minutes
3.6 mmol/L [65 mg/dl]
120 minutes
4.1 mmol/L [74 mg/dl]
After this, he saw an endocrinologist who diagnosed him with type 1 diabetes.
He has adjusted his diet and no longer drinks pop. He tries to make sure he has protein at every meal and tries to go no longer than three hours without eating. He is 5 feet 10 inches and maintains his weight at 145 pounds. He has chronic asthma and takes Tilade daily.
He has not been taking insulin or any other medication. His A1c in November was 3.9.
The dietitians and diabetes educators we have met with have all shown some surprise at the diagnosis. When we questioned the endocrinologist, she said it was definitely type 1, not type 2, and that he was in the honeymoon phase and would definitely need insulin in the future. I asked about a definitive blood test to differentiate type 1 and 2 and she said it was not available in Manitoba. I asked about anti-viral treatments to disrupt the course of type 1 diabetes and she said there was a high risk of cancer with that treatment.
My understanding of type 1 diabetes is that it hits like a freight train. The honeymoon is a period when control of blood sugar is more easily maintained, but insulin is always necessary. I am concerned that there are treatments he could have that he is missing. I am also concerned about the impact of the diagnosis on his life and career. Type 1 is very different that type 2. Which one does he have and why?
Answer:
There are no definite tests of type 1 diabetes. The diagnosis sometime comes on quickly and dramatically. With attention to mild symptoms or through screening, rarely is type 1 diagnosed when few or no symptoms occur. In any case, the only definite tests could be positive antibodies: islet cell antibodies, GAD 65 antibodies and very sensitive insulin antibodies. If this is not available where you live, they can be sent to specialty laboratories such as those of Endocrine Sciences or Quest Diagnostics in California. If you have some questions about the exact diagnosis, you certainly should feel comfortable asking these to your endocrinologist since nobody could answer such questions without a much more detailed analysis of initial blood glucose levels and current glucose levels. Distinguishing the honeymoon period from early type 1 diabetes versus type 2 diabetes would also be very difficult. Time helps to sort a lot of this out. as does a review of family history. Concomitant thyroid or transglutaminase antibodies (suggesting other autoimmune disorders) would also tend towards type 1 versus type 2. Best advice: go back and discuss this thoroughly with your diabetes team so that you can be satisfied. If you need to get a second opinion, this also can be arranged in Calgary, Vancouver, Toronto, Montreal, etc.
SB
