May 2, 2001
Diagnosis and Symptoms
Question from Corpus Christi, Texas, USA:
I am a 28 year-old physically fit, diet conscious, white male, career military officer with no family history of diabetes and no personal history despite frequent physical exams through the course of my five year career. However, following a short food poisoning episode, I began experiencing symptoms of diabetes, and within two months, was admitted to the emergency room with a blood sugar of 600 mg/dl [33.3 mmol/L]. I strongly believe that the food poisoning was a trigger for my autoimmune response, since I have tested positive for islet cell antibodies. At the time of the onset of symptoms, I was under considerably high stress as I prepared for my final “check-ride” before I got my wings in Navy Flight Training. As I have already said, I (and some of my buddies) got food poisoning (by eating chicken soup).
In brief, my treatment plan consisted of:
Getting things normalized with insulin (which took about three days)
I was slowly (too slowly in my opinion) weaned back to Prandin [repaglinide] inside of a month.
Within two months I was completely off medication and showing a considerable increase in endogenous insulin production (C-peptide up from less than 0.7 to 1.0 to 1.4) and A1c down (from almost 9 to 5.6%).
Now I am on a low sugar diet and working hard at getting back in shape with fasting blood sugars less than 110 mg/dl [6.1 mmol/L] and two-hour postprandial blood sugars less than 125 mg/dl [6.9 mmol/L].
Things appear “normal” and my one “specialist” believes me to be in a honeymoon phase. I see the signs of a honeymoon perfectly described in front of my face, but I refuse to believe that I have diabetes. My blood sugar is under tight control (without too much effort on my behalf), and my C-peptide has increased further (2.4).
Is it possible that I had an “episode” resulting in very high blood sugar for a short period of time and yet have had a complete relapse now that my pancreas appears to be healing? Is the fact that I had a positive test for antibodies a fair indication that I have diabetes? How long is it likely to be that my blood tests show residual amounts of antibodies?
Answer:
I am sorry to give you hard and bad news, but to the best of our current knowledge, the presence of islet cell antibodies is consistent with type�1A (autoimmune) and not type�2 diabetes. No diabetes specialist I know of takes people off insulin during the honeymoon phase since we have evidence to suggest this hastens the demise of remaining beta cells by making them work harder. However, the evidence is not as solid as all of us would like.
At your age, you could go into a very long honeymoon, and nobody can tell you whether or not resuming insulin would do anything more than get you a medical discharge (honorable) from the service. Only Israel and Switzerland allow people with type 1 diabetes in the military and only in noncombatant roles.
It is unlikely that the food poisoning was anything more than a coincidence in “causing your diabetes” — just a temporal (time related) association. Most important would be to keep close track of your blood glucose levels so that when and if the blood glucose values change, you will not get sick, dehydrated, etc.
You should also have hemoglobin A1c testing done at least every three months to know if there is any trend upward indicative of higher glucose levels over four to six weeks previous to the testing. Staying in close contact with a knowledgeable endocrinologist will be crucial, but sometimes very difficult in the service depending upon where you are stationed.
It is not impossible that this is only transient hyperglycemia, but the initial blood glucose of 600 mg/dl [33.3 mmol/L]is extremely elevated and most transient high sugars generally are in the 140-180 mg/dl [7.8-10 mmol/L]range not this high.
SB
