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November 28, 1999

Diagnosis and Symptoms

Question from Chicago, Illinois, USA:

I am a 31 year old Caucasian male, average weight. I was diagnosed almost two years ago with a blood glucose of 500. Since about three weeks after diagnosis, I have taken no insulin. My morning blood glucoses are always in the normal range (with a rare 125), but I do check two hours post-meals occasionally and have had readings in the low to mid 200's a few times. I have been told I have type 1 and am in the honeymoon phase. I have read a lot about this and can understand the diagnosis. However, I still have a few questions. First, does it sound like the honeymoon phase to you? If so, how long do you think this could last? Could I just have glucose intolerance that got temporarily out of control two years ago?

Answer:

The story you relate is not entirely incompatible with Type�1A (autoimmune) diabetes of late onset. You may have had some unrecognised infection at the time of the onset two years ago which precipitated a transient glucose intolerance and still be in a honeymoon period; but the time frame is rather pushing the limits for this diagnosis. It is perhaps more likely that you have Type�1B diabetes which is insulin dependant at the onset; but in which insulin may no longer be needed after a few weeks or months. This form comprises less than 5% of new onset cases in Caucasians although in Hispanic or African American families it can be over 50%. You might think to ask your doctor about getting an antibody test which could still be positive if you were Type 1A and would indicate that your are ultimately almost certain to need insulin again. A number to call for more information is 1-800-425-8361.

From the point of view of management, however, an exact diagnosis is not all that important, what is needed is to monitor blood sugars occasionally and to keep your Hemoglobin A1c test somewhere near the upper limit of normal or below.

DOB