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January 20, 2001

Diagnosis and Symptoms

Question from Greece:

When I was 18 years old (six and one-half years ago) I was diagnosed with type 1 diabetes. My blood sugar level was 450 mg/dl [25 mmol/L] and my HbA1c was about 7.5%. I took insulin injections, but one month later I stopped entirely insulin as I was in the honeymoon period. Since then, my HbA1c is between 5% and 5.5% and my sugar level is totally balanced. I don't take any medication living an extreme life (drink, smoke etc) without anyway putting on any weight. These days I realised that I have to start protecting myself, and my doctor tells me that I should at least take one Glucophage [metformin] tablet every day. I know that my honeymoon period is longer than natural, and I would like to know why. Is it possible that I do not have type 1 diabetes?

Answer:

Your honeymoon period is longer than usual. Most are less than a year. There has been quite a bit of research done in the last ten years trying to identify individuals with a family history of type 1 diabetes who are at risk for developing the disease. As you may know, most people with type 1 diabetes do not have a family member but, this is the best way to identify people with a tendency to develop type 1 diabetes before it begins. What has been found is that those who develop diabetes have markers of autoimmune involvement that can be measured in the blood. Such antibodies include islet cell antibodies, insulin antibodies, and anti-GAD antibodies. Studies have also been done to look at the body’s ability to make insulin on demand. Such a test includes an intravenous glucose tolerance test.

My message is that such tests can be fairly easily performed to give you a better idea of your long-term risk of developing diabetes. If you have the risk, the question then becomes what is the best way to treat you. Should you be receiving an insulin shot to rest the pancreas? Should you maximize lifestyle choices (exercise, diet, antioxidants)? These questions are not clear.

Your questions are interesting, and I would recommend trying to seek out a diabetes care physician in your neighborhood to discuss your case more completely. There may even be a clinical trial you can participate in. If you don’t have type 1 diabetes, you would have to postulate some temporary injury to your pancreas. That seems less likely from your history.

JTL

[Editor’s comment: It is possible that you have type 1B diabetes.

SS]