I was diagnosed with type 2 diabetes about three months ago when an office visit revealed my blood sugar was over 400 mg/dl [22.2 mmol/L]. My A1c was 9.2 and the doctor put me on Amaryl. I immediately changed my diet and started exercising and am currently off the medication with good numbers. I switched doctors and he performed a GAD test, which came back positive. He does not know what to do for treatment and is recommending an endocrinologist. I have found a lot of information online regarding the honeymoon phase for type 1 and also that a positive GAD test does not always mean a person will become type 1. I will be seeing an endocrinologist in a few weeks, but I am really confused with the positive GAD, as well as concerned that I will eventually be insulin dependant, which scares me to death. Has anyone encountered someone like me? My doctor informs me that he never has.

As a practicing endocrinologist, I see many patients like yourself. It seems that the more frequently we look at all patients with diabetes, the more we see that our old stereotypes for the classification of diabetes are less applicable. This does not mean that we throw out the book. However, we are going to find people with autoimmune diabetes later in life than 30 years of age where the onset is going to be gradual and less stormy. In addition, we are finding young people with forms of type 2 diabetes. The bottom line is that you are going to monitor your blood sugars. For you, you will want to maintain a normal A1c without medications. If it rises, you will need to add therapy. To date, there has not been a conclusive study that says that all patients with positive anti-GAD antibodies should be placed on insulin. The reason there is so much dialogue on this subject is that people would like to have a good predictive test to know what to do and I am not sure that is possible. Your physician could measure your insulin secretory reserve with several tests available that have been characterized in thousands of patients. These use either an oral glucose load or a mixed meal load and measurement of your C-Peptide level after the load. This allows you to see how much in vivo insulin production has occurred from your pancreas. In the end, the most important thing is close monitoring with your physician. Whether that is with an endocrinologist or not is likely based on availability to such a specialist.

JTL