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June 1, 2005

Diagnosis and Symptoms, Other Illnesses

Question from Clearwater, Florida, USA:

At 16 years old, my son diagnosed was with type 1 diabetes on a random urine sample, capillary blood sample and a hemoglobin A1c of 11.5. Prior to this, he had mononucleosis. He is currently on an insulin pump and continues with highs and lows and is unstable. He continues to lose weight and has no energy. Could he have been misdiagnosed and have another autoimmune disease? He has chronic hip pain and other muscular skeletal complaints along with drastic weight loss, stomach pain and chest pain. Can you help?

Answer:

If he has a high A1c and high blood glucose levels, then it is unlikely this is not diabetes. You should discuss with your diabetes team if pancreas antibody tests were done or not; if positive, this would be confirmatory of an autoimmune problem involving the islets. Only about 60 to 80% of such antibodies are positive, even with otherwise classical clinical presentation of type 1 diabetes. The symptoms you list would also make me look for other problems, i.e. celiac disease, thyroid problems, adrenal insufficiency/Addison’s disease, as well as rheumatologic problems (Lyme disease, JRA) and perhaps other gastrointestinal inflammatory conditions. Please go back and review with your health care team what has been done and checked and ask if any other consultations may be necessary (i.e. rheumatologist, gastroenterologist, neurologists, etc.).

SB