November 7, 2006
Diagnosis and Symptoms
Question from El Segundo, California, USA:
Thirty months ago, I had an elevated fasting glucose reading come back on a life insurance exam. I was 33 years old, male, Caucasian, 155 pounds. The insurance company ran an A1c in addition, because of the elevated reading, and it came back at 10.1. I went to the doctor and they suspected type 1 and ran antibody tests. While waiting for the results, I was put on Amaryl, which brought my consistent fasting blood sugar from over 250 mg/dl [13.9 mmol/L] down to under 130 mg/dl [7.2 mmol/L] consistently within a week. At this same time, I adjusted my diet to watch carbohydrates (mainly just eliminating obvious sugars such as sodas, super high carbohydrates, limiting serving sizes, etc.) and added moderate exercise (four days a week for 30 minutes). The antibody tests came back negative.
For the past 30 months, I have had 10 A1c tests, all of which have ranged from 5.1 to 5.7. My fasting blood sugar is consistently between 115 mg/dl [6.4 mmol/L] and 140 mg/dl [7.8 mmol/L]. Two hours after dinner, I am typically under 150 mg/dl [8.3 mmol/L], though can occasionally (once or twice a month) go as high as 300 mg/dl [16.7 mmol/L]. I have not gained or lost any weight and feel great. At my last blood draw, my LDL was 79 my HDL was 50 and my triglycerides were 88. My blood pressure is consistently under 120/80.
Any thoughts from the about what may or may not be going on with me? What type of diabetes do I have?
Answer:
You still could have type 1 or type 2 diabetes. The sugars were high enough that I do not doubt you have diabetes. Those things in favor of type 1 diabetes include age of onset and lack of body obesity. Those things in favor of type 2 diabetes include response to an oral agent, response to lifestyle changes, and time since diagnosis without worsening of glucose control. You still could have LADA, a form of type 1 diabetes that has a slow onset, in terms of loss of beta cell function. The negative antibody tests does go against this. You will have to wait and see. Continue to stay healthy. The most important thing is that your glucose levels have remained well controlled. Given the total picture, your history is most consistent with type 2 diabetes.
JTL
