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October 11, 2004

Diagnosis and Symptoms, Other

Question from Irmo, South Carolina, USA:

My daughter was diagnosed at 24 with type 2 diabetes. Oral medicine did not help; strict diet and exercise did, for a while. Pregnant at 32, she went on insulin during pregnancy. Afterward, her sugars remained normal without insulin. Pregnant again at 34 her sugars started to climb, so she resumed insulin. She miscarried and now her sugars are normal, but her C-peptide test shows her pancreas has shut down. She is not taking insulin and now is classified at type 1. Her doctor is totally at loss because she was ready to recommend her for a pump, but cannot explain why her sugars are so low. She is at a loss as what to do, where can she go for help as the only explanation the doctor has is that she is a good example as to why we have not found a cure for diabetes and that some other hormone is affecting her health.

Answer:

The overall course of your daughter still appears to be consistent with type 2 diabetes. Type 1 diabetes requires insulin. The low C-peptide may have been inappropriately interpreted. For instance, if the glucose is low, a low C-peptide does not mean type 1 diabetes. The C-peptide should be measured with a meal stimulus to see if it appropriately climbs. If her sugars are intermittently normal, she may benefit from oral drug therapy during this time. I would suggest she see an endocrinologist with expertise in diabetes for a second opinion.

JTL