February 20, 2004
LADA and MODY
Question from Atlanta, Georgia, USA:
I am 33 and was diagnosed with Type 2 diabetes one year ago. I was put on 15 mg of Actos. I already exercised three to four times a week doing cardiovascular exercises and weights, so the only thing I really changed was my diet. I had recently married and had put on some weight, which I lost by changing my diet. I switched to more cardiovascular exercises rather than weight training so I also lost some muscle mass, in all, about 35 lbs. My A1C was at 8.3, but is now down to 5.9. My cholesterol was at 215 LDL. Diet changes didn't seem to bring it down, so I was put on 20 mg of Lipitor and it is now down to 69. HDL was, and still is, around 65. Triglycerides are at 65. My general practitioner now wants me to take a blood pressure medication, 160 mg of Diovan (134/90 at last visit). I have no "known" family history of diabetes, bad cholesterol, or high blood pressure in my family. My Dad is type 1 after a lifetime of drinking alcohol and an attack of pancreatitis 6 years ago. He has since quit drinking, by the way, changed his life and keeps good control. My question is--what the heck is going on here? I'm going from no medications a year ago to three a day. I was overweight as an adolescent, but lost it going into puberty. Since then, I've always spent time keeping an eye on my weight as it has been fluctuating up and down. I worked out before work while attending school at night to get my MBA. My friends always joked with me for eating things like veggie burgers before my diagnosis. I have suffered from bouts of anxiety/depression in the past and have seen some articles saying depression may be a precursor to diabetes. I have also seen some information on Syndrome X, but like the diabetes articles, they talk about overweight sedentary lifestyles, which I didn't think I had. In the end, I am confused about why I seem to be getting to know the shift schedules of my local pharmacy so well after doing what I thought was right and having little concern for these conditions considering my family history and my age.
You are correct that the majority of individuals who have type 2 diabetes are overweight, but that is not exclusive. One can be relatively thin and have MODY–Maturity Onset Diabetes of the Young. It appears from your description that you may also have Dysmetabolic syndrome which has as its components: high blood pressure, elevated lipids, diabetes and possible heart disease. The cause at present is not always known. There may be a genetic component. You may have to consider several generations, not necessarily your father only. As far as depression, I am not aware of any research to indicate depression leads to diabetes but have numerous patients who are treated or counseled for appropriate anxiety or depression. This is generally from “battling” a chronic disease. If you are following a diet, maintaining good glucose control and having close monitoring by your physician or specialist, I would discuss with them where you can obtain help with coping with this chronic illness.