I am 15 years old and was diagnosed with type 1 diabetes at age 12 1/2 when my blood sugar was 1200 mg/dl [66.7 mmol/L]. As I got somewhat better, my blood sugar got lower than 15 mg/dl [0.8 mmol/L] so I started taking one unit a day. My new doctor now (who seems to know a whole lot more) said I have type 2 diabetes and took me off insulin completely two years ago.

I am being hired as actress and model (I decided that’s what I want to be), and I know there are worse things than having diabetes. I want to know if I’m going to get like another onset. Will I have to take the shots again or can I just control the blood sugar level with diet?

In view of the age of onset of your diabetes, it is quite possible that you have what has come to be called type�1B diabetes. The onset is usually acute, but in around half the cases, it becomes possible to do without insulin.

If you had a negative antibody test at the time of diagnosis, it would support this idea. It is however uncommon in Caucasian families and occurs in about half of new onset Hispanic and African American people with diabetes. From the rather little that is known about this type, it does seem to involve an underlying insulin deficiency and as such may recur in later years. type�2 would have presented at age 12 without your being overweight and there being a family history, but it is possible to distinguish between the two. So, you might ask the doctor about getting a serum insulin level, and if this was low it would suggest Type1B. There are more elaborate tests, but the distinction is not all that important from the point of view of care. In the meantime, I would go ahead with your career, but try to take lots of exercise and be careful of your weight.

DOB
Additional comments from Dr. Jim Lane:

I think there is enough interest in your story to discuss whether you have type�2 diabetes, in contrast to type�1 diabetes. However, I would want to know more about your blood sugar control to know how to treat you.

I think the best thing you can do is discuss this issue with your physician. Remember, it is important to continue to follow your blood sugars by monitoring them and recording them on a regular basis. If, for instance, you choose on your own to treat only with diet, and that is not enough, you can become sick and feel bad because your blood sugars are elevated. Although it would be optimal to treat your diabetes only with diet, this may not be possible. In fact, many people who say they are diet controlled are, in reality, poorly controlled. This decision has to be made with your physician involved.

JTL
Additional comments from Dr. David Schwartz:

While the story is not typical of type 2 diabetes, I think I would recommend various pancreatic antibodies (GAD 64, ICA 512, and maybe insulin autoantibodies) to confirm autoimmunity that would occur with type�1A (autoimmune) diabetes.

In an academic setting, I might even consider an intravenous glucose tolerance test to assess first phase insulin secretion in this seemingly atypical case.

DS