July 10, 2002
Other
Question from Philadelphia, Pennsylvania, USA:
I am a 36 year old male who was diagnosed with type 2 diabetes about two months ago when my blood sugar was 672 mg/dl [37.3 mmol/L], and I had urine ketones. Since then, I have been on twice daily mixed insulin kept my blood sugar in the 130-180 range for the first few weeks. However, for the past two weeks, I have been having a lot of lows even though my doctor lowered my evening dose.
Two nights ago, I missed my insulin dose, and my blood sugar was 107 mg/dl [37.3 mmol/L] in the morning. I didn’t take my insulin that morning, and by the evening I was 98 mg/dl [5.4 mmol/L]. I didn’t take it again that evening, and it was 103 mg/dl [5.7 mmol/L] when I woke up this morning. I still haven’t taken it, and I just checked my sugar which was 89 mg/dl [4.9 mmol/L].
Is this normal for someone with type 2 diabetes? Is there any chance I could have type 1 even though my doctors told me my age precludes that? I read about the honeymoon and wondered if something like that could be happening to me, or could my diabetes have simply come under control.
I have been less strict with my diet and exercise, so I don’t believe my control is responsible for the sudden change, and I am not taking any other medication for my diabetes. I am confused about what to do next and want to see an endocrinologist, but my family doctor feels that isn’t necessary. I’m not comfortable with my doctor taking care of my diabetes because I am not getting direct answers to my questions (like do I type 1 or type 2). He wasn’t sure, but told me my age automatically makes me type 2, regardless of any other indicators. He also told me that I’m better off staying a little high as opposed to going low, which is the opposite of what the doctors at the hospital told me. I’m almost afraid to ask him what I should do now because I don’t trust his answers. Am I just expecting too much from my doctor? I always liked him as my doctor, but I guess I don’t feel comfortable with his indifference towards my diabetes. I assumed he was supposed to run that blood glucose test by now, but he doesn’t seem too much in a rush. Now, I’m afraid to take my insulin until I talk to someone, because hypoglycemia is not pleasant and if I take my usual dose with an 89 mg/dl [4.9 mmol/L] glucose level, I will surely dip low. Could you give me any advice on what I should do or what to look out for?
Answer:
I am not sure if you have type 1 or type 2 diabetes. It is possible for patients with type 1 diabetes to go through a honeymoon phase where no insulin is required. This results from the recovery of the remaining beta cells left functioning. The honeymoon phase lasts for a variable period of time., usually lasting weeks and not months. Individuals with type 2 diabetes can have significant improvement in their blood sugars after the blood sugars are lowered back into the normal range.
As you can see by this description, your presentation is not specific for type 1 or type 2 diabetes. In order to be more sure about your diagnosis, you should have further testing. The tests should include markers for type 1 diabetes, also known as antibody levels. Also, evaluation over time will help.
An additional issue is your relationship with your primary physician. I would suggest you either speak to him/her or decide on another physician. Your need to have your questions answered may exceed your personal relationship with physician. However, I would talk first. It may turn out that you can reach a solution acceptable to both of you.
JTL
[Editor’s comment: The issue of whether to see a specialist is sometimes clouded by finances (who will pay for the specialist — you, your insurance, or indeed in some HMOs, the primary physician), egos, and concepts like patients’ rights. I never saw the harm in getting a second opinion when a patient asks for one, and would encourage you to find a physician who is willing to spend the time to get your questions answered. After all, it’s your diabetes, and your life, that are at stake here.
WWQ]
