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October 5, 2006


Question from Canada:

I am a 22 year old female, diagnosed a few months ago with type 1 diabetes. It runs in my family like crazy, both type 1 and type 2. My father and two of his brothers have type 1 diabetes and one of the brother's daughters has type 1 as well. They suspect his other two children have pre-diabetes. That's five type 1 diabetics in one family and they suspect possibly seven! Some of the cases in my family are rather odd, however. My father was diagnosed way back in the 1970s when he had an eye accident; they thought he might have type 2, but he did not. He was thin and active as are all the type 1 diabetics in my family. He controlled or at least tried to control his diabetes with diet and exercise alone for over ten years until, finally, his sugar went so out of control (perhaps ketones) that he was put on insulin at age 35. I don't know how common such an extended honeymoon stage or such a slow progression of type 1 is. I don't think we have MODY as my little cousin was diagnosed at age three. Also, my uncle, also type 1, wasn't put on insulin until his mid to late 40s. He has to let his sugars run high because he suffers frequent and unexpected hypoglycemic reactions. Apparently, he is still in the honeymoon stage even though it's been a couple years since his diagnosis. I think my other uncle went on insulin when he was younger, perhaps in his 20s, but I'm not sure. My father remembers that when he was as young as 14, he was periodically disorientated and feeling faint off and on, but it never became serious enough to require medical attention or advice from a doctor to go on insulin (maybe he should have?). Since I was about 13, I was off and on hypoglycemic. Is this often a precursor to diabetes? I would have my sugar checked and it would be 3 mmol/L [54 mg/dl]. I only remember having a glucose tolerance test as a young child which came back normal. Right now, I seem EXTREMELY sensitive to insulin. I've been running my sugars high for fear of hypoglycemic reactions, but I'm afraid to do that because my dad is now approaching end stage diabetic kidney disease 18 years after going on insulin. This doesn't seem long to me. If he were on insulin earlier, could this have been slowed? Also, I've noticed that my urine is sometimes a bit bubbly now. It was VERY bubbly before I went on insulin, now, it's sometimes bubbly or foamy. I don't know if I'm being paranoid, but I'm terrified this is protein and I have kidney disease. How likely is this? Could I have had diabetes for years like my dad and not known it? Also, I went to the doctor because my sugars were normal, but I was spilling ketones. I heard the nurse say I had trace protein in my urine, but I was in menses. Will traces of one's menstrual cycle give false protein readings during a reagent stick urinalysis? Any help you could give me would be greatly appreciated as I am absolutely terrified I am developing kidney disease as I heard it is hereditary with diabetes. Finally, at diagnosis my A1c was 15. Does this automatically mean I will have complications?


You have quite a description of your family! Unfortunately, it is related to the diagnosis and complications of diabetes. Some of the descriptions of family members do not all fit nicely into the category of type 1 diabetes, as some of your family have gone for prolonged periods without being on insulin. I am afraid those need to be scrutinized more, in terms of the type of diabetes that is present. You are correct that the propensity to develop kidney disease with diabetes is familial. However, it sounds like your father did not keep his glucose levels under tight control. This is extremely important for avoiding long-term complications. It is true that blood in the urine will give a false test for protein. You should have your urine tested yearly for microalbumin as the most sensitive test for predicting the onset of nephropathy. Just the bubbling of the urine is not a good predictor of protein in the urine.