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February 23, 2002

Diagnosis and Symptoms

Question from Hart, Michigan, USA:

I am 19 years old, I take Viokase for pancreatic insufficiency, and, while I don't think I have diabetes, my doctor and my family do. I do have an aunt who has diabetes, and and my cousin died from diabetes. My fasting blood sugars are always normal, and have had a few non-fasting tests that were above 350 mg/dl [19.4 mmol/L]. (That is what my doctor is worried about I guess). I have Hashimoto's, and he thinks my high blood sugar is related somehow. I have dizziness which I know isn't a symptom of diabetes, but my cousin had it before she was diagnosed. My doctor has me following a diabetic diet which I really don't see the need for because I'm thin, and I like to eat a lot. My mom is always complaining that I eat too much (like last night when I had a whole 8 ounce chocolate bar) and that I'm going to cause myself to get diabetes. I don't ever gain weight especially if I don't take my enzymes. Do I really have to worry about diabetes? If I do, is there any way to prevent it? Does eating chocolate cause diabetes?

Answer:

First of all, I don’t think that eating chocolate is a specific trigger of any form of diabetes, and I agree that dizziness does not indicate diabetes either, although it may need investigation on its own. On the other hand, random blood sugars of more than 350 mg/dl [19.4 mmol/L] are definitely abnormal.

My advice would be first to ask your doctor about a blood hemoglobin A1c which s measures the amount of glucose attached to hemoglobin and in turn is a measure of the average degree and duration of abnormal blood sugars. If this is above normal, as I suspect it may be, then the next step is to find out why. The first step, in view of the fact that you have Hashimoto’s disease [an autoimmune thyroid disorder], would be to do an antibody test to see if you have type 1A (autoimmune) diabetes which is often linked to thyroid problems in the Autoimmune Polyglandular Syndrome. It would also be important to know what kind of diabetes your aunt and your cousin had.

Since you are also taking Viokase, it is possible that you are not producing enough insulin because of another form of destruction of pancreatic tissue. This would not lead to a positive antibody test; but could be revealed by a serum insulin level or more accurately by an intravenous glucose tolerance test that measures plasma insulin at one and three minutes after a standard load of glucose.

Finally, yes, I do think that you need to get these tests done because if you do not there is a risk that you could all, of a sudden, become really quite sick as a complication of some minor infection.

DOB