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July 7, 2003

Daily Care

Question from a physician in Gujarat, India:

I have a 16 year old girl who had an acute viral infection about a month ago, and during her during her investigation, it is found that she had random blood sugar of 302 mg/dl [16.7 mmol/L]. Her mother is also has diabetes treated with an oral hypoglycemic agents as well as insulin. Detailed investigations showed a fasting blood sugar of 242 mg/dl [13.4 mmol/L] with an insulin level of 29.08 IU/ml. She is currently taking twice daily Mixtard and metformin. Her fasting blood sugar is 140 mg/dl [7.8 mmol/L] and her postprandial blood sugar is about 197 mg/dl [10.9 mmol/L]. Can we shift her to oral agents or do we have to continue with insulin?

Answer:

On the basis of the information provided here it is really not possible to say whether this young woman has type 1A (autoimmune) diabetes, type 1B, idiopathic diabetes, type 2 diabetes or indeed some rarer form of this condition. In any case, it would be wrong to assume that she has autoimmune diabetes simply because she is 16 and therefore would be considered dependent on insulin for the rest of her life.

She needs to have antibody testing for anti-GAD, anti-insulin, and islet cell antibodies (ICA 512). If these tests are not readily available near home the serum sample could be mailed to Quest Diagnostics in the U.S.

The alternative, of course, is to treat her with insulin only long enough to keep her hemoglobin A1c at 8% or less and then to see if the same degree of control can be sustained with oral hypoglycemic agents and attention to diet, body weight and exercise.

DOB