February 3, 2000
Diagnosis and Symptoms
Question from New Jersey, USA:
I am an 18 year old female and have a question about what kind of diabetes I have and how it could be tested. I was diagnosed approximately 1 year ago with type 1. I had then switched endocrinologists due to insurance and he said I had type 2 because I am overweight and black, but my problem is, is that I’m just slightly overweight and I’m only 5/8 African American although I appear to be all.
When I was diagnosed I had lost 20 pounds the previous 3 weeks and had a viral infection when diagnosed. I am told that’s classic of type one, when I first switched endocrinologists, he tried oral medications (Metformin, Glucotrol, Prandin, and Avandia), none of them ever worked. My A1c has also never been under 9.5 with my latest at 10.6.
My mom insisted he put me back on insulin after 9 months of consistent 250-300 blood sugars daily. Finally he did; at that time, he also gave us a referral to a new endocrinologist and said he truly didn’t know what was going on and that maybe she could help me. I went to see her yesterday and she increased my shots to 3 times a day. She seems to know what shes doing but also says I might be type 2 but she doesn’t really know. Next time I see her, she says she’s going to do more blood tests.
Are there any that you think I should have her do that might help me? Also I am told type 2s don’t get ketones but I have been in the ER twice since diagnosis because of high ketones and sugars, and almost anytime my sugars stay above 270-280 for more than a day I start to produce moderate levels of ketones. My last endocrinologist which I had for 9 months never seemed to concerned. Is there any hospital you can recommend for diabetes treatment and diagnosis? I am very worried about what may happen if I’m treated wrongly.
Answer:
It can sometimes be difficult to tell whether someone has Type�1 (insulin deficient) or Type 2 (insulin resistance) diabetes. We used to think that everyone who presented with weight loss and ketones would need insulin indefinitely, but now we know this isn’t always the case in some African American and Hispanic teenagers. Some of these teens initially need insulin, but can later on be treated with oral hypoglycemic agents and/or diet. An antibody test against islet cells and a protein called GAD can help.
If these are positive, you probably have classical, insulin deficient diabetes (Type 1) and will need insulin indefinitely. In any case, it is good to try and keep your weight normal and if you are spilling ketones and have a high blood sugar, you definitely need insulin, even if only temporarily.
It is important to work closely with an endocrinologist to work this out. It sounds like you have found one who is on the right track. If you need another opinion, you could call the local ADA to get a referral. Remember, even if you are able to be controlled now on oral medication, you cannot take these medicines during pregnancy and will have to switch to insulin if you want to become pregnant in the future.
TGL
