May 14, 2000
Diagnosis and Symptoms
Question from New York, USA:
I am a 26 year old male who was diagnosed with Type 1 about 10 months ago. I had all the symptoms and my sugars reading were about 700 when I went to the hospital. At that time, my doctors had blood work done on me and told me that my antibodies came back positive. Over the last 10 months, I have been reducing my intake of insulin to near zero, thinking I was in the honeymoon period. During my last visit to my doctor, I asked him to do a C-peptide test and another antibody test. Today, my C-peptide came back positive (+1) and my antibodies came back negative. My doctor is puzzled and tells me that time will show and that we will know more what's going on in the next couple of years. Have you ever heard of anything like this happening?. Could I be type 2? Should i get a third opinion? I don't want to give myself false hope, but have you ever heard of anyone in my situation? Follow up question: I now have been to a second endocrinologist in order to get a second opinion. The results came back today similar to what my first doctor confirmed. That is, my islet cells antibodies came back negative, my C-peptide came back even higher at 2.2, and my GAD antibodies came back at 1.3 (my doctor told me that 1 was normal, but that 1.3 was so close that he was not worried). My doctor believes that I am neither a type 1 or a type 2, but rather something in between. Apparently, he has been seeing more and more of these cases recently. he wants me to stop completely taking insulin (I was barely taking any anyway, i.e., 3 units once a day) and start on a pill (I can't remember the name) that will help sensitize my pancreas to producing insulin. I can't believe what is happening to me. About a year ago, my life was thrown upside down and now maybe there is some light at the end of the tunnel. My first instinct is not to take any more medicine and let my body work on his own. Do you think it's a good idea to start on pills? can those pills have any adverse effect? If my antibodies are not attacking my insulin producing cells and my pancreas is responding to high sugars, then would a simple transplant of islet cells solve the problem? As you can see, I am very confused and will talk more to my doctor about all this. I would, however, really value your opinion on this matter. Thank you for your help and patience.
In the last few years investigators have come to realise that diabetes is a far more complex affair than something that can be just divided into Type 1 and Type 2. At the beginning it might have been appropriate nowadays to characterise your problem as Late Autoimmune Diabetes in Adults (LADA); but the fact that you now have some C-peptide production and that your glucose tolerance is almost normal is more suggestive of someone who has indeed had a transient autoimmune damage to the islet cells. If this is the case there seems to be a good chance that you will not again become insulin dependant, at least for many years.
There are other very uncommon possibilities, namely that either the first or the second antibody test may have been a laboratory error. The chances of this a very small indeed especially if more than one antibody was tested. If the initial test was wrong then you might be what is called a Type 1B where the onset is like the autoimmune Type 1 but where there is a good chance that insulin dependence could be short lived though other modalities of treatment like oral agents and diet and exercise may still be required. In the long term it looks as though there will eventually be a dependance on insulin again in these instances.
If the second test was wrong you might still be a Type 1 who is still in a prolonged honeymoon period. It would be possible to carry out some elaborate testing to pin this down a little better; but in the meantime I think it best to accept your doctor’s advice and ‘wait and see’ which will not affect what needs to be done to keep blood sugars as near to normal as possible.
Follow up reply:
I think you should takes your endocrinologist’s advice and start on one of the oral hypoglycemic drugs. You might one day be able to achieve control as judged by serial A1c assays with just diet and exercise and on the other hand you might eventually need insulin again. It would be possible to refine the diagnosis with more tests that can be cumbersome, expensive and not always definitive; but in the meantime the goal has to be to maintain normal blood sugars by the simplest means possible. Islet cell transplantation would not be appropriate in your case.