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February 20, 2004

Diagnosis and Symptoms, Type 2

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Question from Canada:

I have had type 1 diabetes for close to three years. Approximately one year after I was diagnosed I developed fairly bad acne and some hair growth on the side of my face. This problem developed after I began using oral contraceptives. Prior to that, I had moderately bad acne and some hair growth on my face, but it became worse in the initial three months I was on the pill. I had had extremely irregular periods prior to my diagnosis with diabetes. I got my first period when I was 14 years and seven months. Following that I had three very heavy periods at three month intervals. After that, my periods just stopped. When I was 17, I went to my family doctor, who, from my recollection, did blood work. I also had an ultrasound and I was given progesterone tablets for 10 days, which induced a very heavy painful menstrual period.

When I was 17 and eight months, I began to have symptoms of diabetes. I went to the bathroom frequently and was thirsty all the time. I had several abscesses on my groin etc. My worst symptom was the severe cramping in my legs that woke me in the night. My symptoms were terrible, but I slept all the time and never did anything about it. I was symptomatic for 10 months. I lost over 60 pounds, but I had been about 50 pounds overweight. Three months prior to my diagnosis, I got my period again and after that I had periods at three-month intervals.

When my acne and hair growth developed a year later my family doctor did more blood work. When I came back, he said my blood work was consistent with PCOS and I also had an elevated cortisol level. I am now 5� 11 inches and weigh 160 pounds. My endroconologist said the cortisol level was, in her opinion, a result of the birth control pill. Does that make sense? She also said that we can�t really accurately assess whether I have PCOS because the tests were done when I was on the pill. I have several questions. How common is PCOS in people with autoimmune diabetes? What are the implications of my insulin doses? Does the fact that I was symptomatic for so long and never went into DKA indicative of anything? My A1c was 16 something upon diagnosis. My blood glucose was 19 something mmol/L [about 450 mg/dl] and I had trace serum ketones. I have had my C-peptide level tested, but my current endorinologist has never seen it. I remember my family doctor reading it to me and he said I had antibodies and no insulin resistance. I think I am a freak with freaky diabetes, because I used to stop taking my insulin all together to lose weight and nothing really bad ever happened. I went a whole month once.

Answer:

From: DTeam Staff

Type 1 diabetes is associated with an inability to produce enough insulin to keep you out of diabetic ketoacidosis. Polycystic ovary syndrome (PCOS) is associated with insulin resistance and type 2 diabetes. When you lost the extra weight, the insulin resistance improved and may have allowed you to have some ovulatory periods. Whether you truly have type 1 diabetes or type 2 diabetes is still open to debate and needs to be settled by your endocrinologist. The fact that you stop your insulin for months at a time suggest you may not have type 1 diabetes, but I would not advise it. You probably have very poor blood sugars when that occurs. You would only be hurting your long-term health.

JTL