November 28, 2004
Diagnosis and Symptoms, Hypoglycemia
Question from Silverdale, Washington, USA:
I was diagnosed one and a half years ago with type 1 diabetes, after an initial diagnosis of type 2 and a try at oral medications. At diagnosis, my A1c was 13; now, it is 8.2. I currently take two injections a day of Lantus and NovoLog with each meal. For the past week, I have had constant hypoglycemia, dropping into the 40s mg/dl [2.2 to 2.7 mmol/L], despite altering my insulin dosage. As of today, I lowered my morning Lantus to only 10 units, have chosen to not take any NovoLog with my meals. Although they have been less than 30 grams of carbohydrates, I have not had a spike in my blood glucose.
Despite the test results over the past year and my endocrinologist’s assurance that I have been correctly diagnosed, should I consider that I have been misdiagnosed? I was 28 at diagnosis, had lost 32 pounds in two and a half months, and had all clinical symptoms. I have been practicing intensive insulin therapy for the past year and am scheduled to be placed on the pump in two weeks. Could there be another cause for this unexpected improvement or, do you believe it likely that I was misdiagnosed?
Answer:
This is a common question in clinical diabetes medicine. There are indicators of type 1 diabetes, in addition to poor response to oral medications. They include a low C-peptide, thin body habitus, and positive antibodies. What happens is that when good control is instituted, you may allow optimum performance of any remaining insulin-producing cells that are left. You have several options. You can delay the initiation of the pump therapy. You can invest in additional testing to prove the type 1 status. Finally, you can go ahead with the pump therapy as this is still an acceptable treatment.
JTL
