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December 28, 2002

Daily Care, Type 2

Question from Greeneville, Tennessee, USA:

I am not overweight, I do exercise, I am in generally overall good health, and I was diagnosed with type 2 diabetes about three months ago. After two months, I finally got in to see the endocrinologist and was informed that I have type 1 diabetes. Is this a common mistake to make? Is there a place to find a list of good questions to ask? I seem to have new questions all the time, my levels are wild even though I have a good diet, and exercise now sends my levels all over the place for a week.


I would have to know what work-up has been done by your physician to know whether the decision was based on all the clinical evidence. Anytime that you have a person with diabetes who is not obese and does not have a family history of diabetes, this should raise the question of whether they have the Late-onset Autoimmune Diabetes of Adulthood (LADA). We have characterized people as developing type 2 diabetes before the age of 20, but clearly, that is too restrictive as individuals in their 20s and 30s are presenting with a more insidious form of type 1 diabetes.

Initially, these patients with insidious type 1 diabetes have C-peptide measurements that are not low but fall with time. This indicates less ability to make insulin. There are also immune markers for the development of type 1 diabetes. Anti-GAD antibodies are the levels most commonly elevated with the late-onset form of type 1 diabetes.

When the blood sugars remain elevated it is time to be more aggressive. In other words, I would not be satisfied with elevated blood sugars outside target-range. More therapy needs to be used in that case. I am not aware of a serious of questions to ask. However, the following would be helpful:

Do you have a family history of type 2 diabetes? Patients with a family history of type 2 diabetes are more likely to have type 2 diabetes.
What is your antibody status?
Do you have other components of the insulin resistance syndrome? These would include hypertension, obesity, elevated lipids, and Polycystic Ovary Syndrome. If you do, these are more likely to occur with type 2 diabetes.