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December 2, 2006

Diagnosis and Symptoms

Question from Michigan, USA:

I am currently in Phase 3 of the TrialNet study. I have very high levels of three of the four antibodies they are looking for in type 1, however, I have not been diagnosed with any form of diabetes. My mom and son have type 1. My maternal grandfather has type 2 and I had gestational diabetes with two pregnancies. Today, I had a two hour oral glucose tolerance test (OGTT) for the TrialNet study, which I do once every six months. Each time, my fasting level is in the 110 mg/dl [6.1 mmol/L] range, which I know is pre-diabetic. Each time I do the test, my two hour range keeps climbing higher and higher. Today, at two hours, a fingerstick said I was at 175 mg/dl [9.7 mmol/L]. I know the diagnosis for diabetes is over 200 mg/dl [11.1 mmol/L] at two hours after the OGTT (or 126 mg/dl [7.0 mmol/L] or higher fasting). And, the diagnosis criteria says anytime you have a random reading of over 200 mg/dl [11.1 mmol/L] with symptoms, you are diagnosed. I don't have the results back yet of all of the numbers, but my question is this -- if my one hour OGTT results were over 200 mg/dl [11.1 mmol/L], but yet I don't have any symptoms of diabetes, am I diagnosed with diabetes? If so, what type? I am 30 years old, thin, eat quite healthy, and exercise daily. I have all the antibodies for type one, but all of the "warning signs" of impending type 2 diabetes. Is there anything I should tell my doctor or anything I can do now to better my chances of not getting diabetes?


This is the good or bad part about being in a study. You come across situations for which there are no rules written as to how to proceed. Most clinical investigators of ethical standing would say that you proceed with the principals of good clinical practice. It is not surprising that you are not symptomatic. There is a suggestion that there is progression towards diabetes. If you develop diabetes, according to the criteria, the question is still whether you have type 1 or type 2 diabetes. I would say you are likely to have type 1 diabetes. Once you develop type 1 diabetes, the question is: at what point do you receive treatment? Since you are a member of TrialNet, there will be potential for participating in their studies for new-onset diabetes. You should talk to your TrialNet investigators for more about this if you are interested. It is not clear you should be on insulin yet since there is a narrow therapeutic window for treatment and this makes hypoglycemia more likely. I would definitely discuss this with your physician. They may have strong thoughts about this and you would want to talk more with them. There is not a standard of care for this scenario. Some people have even been treated with oral agents for a while with this scenario.