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January 30, 2006

Diagnosis and Symptoms

Question from Nashville, Tennessee, USA:

My daughter is ten and was diagnosed with diabetes in September when we took her for a check up and a rash on her arm and back. Her glucose level was at 440 mg/dl [24.4 mmol/L]. She was very overweight, but not obese according to physicians. Her stomach looked like she was pregnant and she was short. Additionally, she was in the beginning stages of puberty. Her A1c was 8%. Initially, she was taking a small does of Lantus, five units, and two units of NovoLog following meals. At certain times of day this helped and others she still ran 300 to 400 mg/dl [16.7 to 22.2 mmol/L]. We have kept her on a diligent meal plan and she has lost about 20 pounds and grown about four inches, which has made an unbelievable difference in her appearance. Lately, she has had lows, as many as three or four in one weekend. She still has a little of a tummy around the middle but it has deflated significantly. When I took her for a second opinion to my primary care physician, he felt certain she was type 2 and told me he was 99% sure that this would come down to losing the weight, diet and exercise. I was also taking her to Vanderbilt where they were only 75% sure that she was type 1. She does have some positive antibodies and they said something about a C-Peptide test that I don't understand. Also, at diagnosis, she had a very slight trace of ketones which vanished when given the smallest dose of insulin. For the first three months, they were reluctant to tell me which type. Now the doctor says that since she needed more insulin as time goes on, that makes her think type 1. Then they said that since she has the antibodies, she is most likely type 1. These are the only things that fit type 1 criteria about my daughter. She was fat, she never went into a coma, and she was fine the day of diagnosis like a type 2 person. I feel that they are so used to seeing kids with type 1 that they cannot open their minds to the possibility that she is type 2. Everyone I know feels she is type 2 because of her weight. I need help. I feel certain my child is type 2 and am afraid she may have had it for a couple of years. Could you please give me an opinion?


No such diagnosis is possible on the Internet. Obese kids can have type 1 diabetes and the accelerator hypothesis from England suggests that obesity pushes the diabetes to develop sooner in such children. If antibodies are positive, this is most likely type 1, even with a slower onset at diagnosis. Treatment should be based upon blood glucose results. The more obese, the more likely she will need one or several pills. Over time, the pancreas will lose its ability to keep up with the demands of the fat cells and insulin may also be needed. A lot depends upon weight loss, increasing activity, improving food/snack plans and following blood glucose levels. The reason that your doctors cannot decide definitively is that our tests are just not as good as we would like them to be.

I would suggest listening to the specialists and not the generalists on this one. Join the ADA, join the JDRF, and keep reading/learning. Learn how to avoid the lows and prevent the highs and how to respond to them since treatment is difficult.