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January 21, 2002

Daily Care

Question from Beverly Hills, California, USA:

I am 41 years old, I was diagnosed a year ago, and, at that time my blood sugar was 557 mg/dl [mmol/L] with an A1c of 10.5%. I also had "a slight presence of antibodies." I have lost 20 pounds (and kept them off) since then, and I still produce plenty of insulin. Currently, I am taking Actos [pioglitazone] and Prandin [repaglinide ] which seem to be working. However, I just returned from my endocrinologist who reviewed things and did an A1c which was 5.4% (up from 5.1% three months ago). She says that the difference is statistically insignificant, and is very happy with all of my numbers, but I was upset to be informed that I am a "slowly developing type 1" (due to the antibodies) rather than a type 2. Further, she finds me a bit perplexing that I am responding to my medications, and her goal is to preserve my beta cells as long as possible. Basically, she says I am very unique and am likely successful because I eat very carefully and exercise daily. Any observations about my situation? Is insulin going to be a part of my future?

Answer:

You are not unique in that there are a significant number of people diagnosed with diabetes in their 30s and 40s who originally respond to oral hypoglycemic agents, have positive antibodies, and eventually need insulin because of autoimmune destruction of their beta cells. The rate at which you progress depends on a lot of things, some of which you can control (diet, exercise, lifestyle) and others you can’t (rate of autoimmune process). I would agree with your physician that your hemoglobin A1c is not really different over time. It sounds like you have received good information. At this point, close observation with attention to sugars is the best treatment.

JTL