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March 6, 2007

Diagnosis and Symptoms

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Question from Australia:

I believe I was misdiagnosed with type 1 diabetes at the end of September 2006. The diagnosis was based on an OGTT. My fasting level was 9.7 mmol/L [175 mg/dl]; one hour – 14.6 mmol/L [263 mg/dl]; and two hours – 18.8 mmol/L [338 mg/dl]. Also, my A1c at diagnosis was only 5.5., with a C-Peptide level of 0.68. I’m 156 cm (5 feet, 1 inch), 43 kilos (95 pounds), and have been told my diabetes was caught very early, in the pre-clinical stage.

I started on Lantus only after a stay in the hospital a few weeks after diagnosis. My blood sugar at the hospital was 24.4 mmol/L [439 mg/dl]. I was told I had lactic acidosis, but I was treated for DKA. Other medications at the time were Seretide, Somac, and Ventolin via metered dose inhaler, as needed. I stayed in the hospital for four days. A couple of days later, I was admitted to the hospital again. I skipped the Lantus as I was having trouble injecting and again stayed in hospital for four days. Since then, I have only had two episodes of high blood sugars (low 20s mmol/L [about 380 mg/dl]) and ketones. Currently, I take a small dose of Lantus, plus NovoRapid before meals.

All of a sudden, I’m getting low blood sugars. I experimented yesterday by greatly restricting my carbohydrate intake and taking no NovoRapid or Lantus. I went low, 3.9 mmol/L [70 mg/dl] in the late afternoon.

So, is it possible that I was misdiagnosed? Or, is it possible that whatever caused my high blood sugars has resolved now? I still get slightly elevated readings, 10 mmol/L [180 mg/dl] to 12 mmol/L [216 mg/dl], but only when I’m not well, about two or three times a week I get unexplained fevers between 38 and 39 degrees Celsius, muscle/bone pain, basically flu-like symptoms and that seems to be the only time I ever get high readings.

Answer:

From: DTeam Staff

Your oral glucose tolerance test was clearly consistent with diabetes. You may be in a honeymoon phase. This refers to the observation that in patients with type 1 diabetes who have initial treatment and the blood sugars are brought down into the normal range, the surviving insulin-producing cells start to work on their own. Some individuals even go off insulin for a while. This continues until the underlying autoimmune process that kills the insulin-producing cells becomes more generalized and all the cells are destroyed, leaving you with no way to produce insulin. I do not think you were misdiagnosed. However, it is very important for you to keep in touch with your physician so that they can advise you as to the best treatment for the moment.

JTL

[Editor’s comment: Please see our previous questions about the diabetes Honeymoon.

BH]