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June 25, 1999

Diagnosis and Symptoms

Question from Pittsburgh, Pennsylvania, USA:

I was diagnosed with Type 2 D.M. at age 47 (I previously had gestational diabetes). I am one of those lean diabetes. Is etiology and treatment any different for lean diabetics?


You pose an interesting question about the cause and treatment for “lean diabetes”. The problem is, we need more information. Basically, diabetes is either caused by an immune destruction of your cells that make insulin and therefore you become insulin deficient (Type 1 diabetes), or you have inherited “insulin resistance” where muscle and other cells don’t use insulin correctly to move glucose into the cell and you over-produce insulin and eventually have “pancreatic poop-out” (Type 2 diabetes).

You could be lean and have either one of these scenarios, but usually people with type 2 are overweight because they have been making excessive insulin for so long and the insulin makes them hungry and makes them store more of their calories as fat. If you have type 1, complete insulin deficiency, the only treatment is replacement of insulin. If you have type 2, the treatment is: reduce resistance with diet, exercise and eventually oral agents and eventually more than half will require insulin to replace their partial insulin deficiency. You may be a slow onset type 1 which sometimes happens when adults get type 1 and eventually you may become insulin deficient enough to need insulin. Your doctor can do a test called the C-peptide test to see how much insulin you are actually making on your own. The test should be done when your blood glucose is high or “should be” high, such as after a glucose or meal challenge.