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July 26, 2001

Diagnosis and Symptoms

Question from Austin, Texas, USA:

I am 47 years old and was diagnosed with type 2 in my mid-30s, but I do not exactly fit the typical profile as I'm 5 feet 7 inches tall and weigh around 110 pounds, and my doctors have never been interested in obtaining C-peptide or antibody tests. There are daily variations in blood sugar I'd like to smooth out (less than 50 to 250 mg/dl [2.8 to mmol/L]), but my HbA1c's are in the range of 4.1 to 5.1% using just glipizide. Is it reasonable to ask for this type of testing, especially considering the increasingly varied options for medications?


Not so very long ago, diabetes was divided into type 1 or IDDM (Insulin Dependent Diabetes Mellitus), which was mostly seen in children and teenagers and type 2 or NIDDM (Non-Insulin Dependent Diabetes Mellitus), which usually began in the middle years. However, as recent research has uncovered a great deal more about the underlying mechanisms of both conditions. it has become clear that there are many subtypes. This probably explains why you yourself are not typical of type 2.

In a recent Swedish study of 102 patients of what they called ‘early onset diabetes’ (by which they meant before age 45, but excluding the age group most likely to be type 1), they found that 24% had one of the many forms of what is now called Maturity Onset Diabetes of the Young or mitochondrial diabetes, 17% were antibody positive, and 23% were high risk HLA types.

The problem for those who care for people with diabetes is that precise diagnosis can become very expensive and yet, except for genetic counselling, not have any relevance to treatment. Your own hemoglobin A1c levels indicate a splendid level of control which is by far the most important factor influencing future eye and kidney complications. Narrowing the spread of daily glucose levels is most likely to be achieved by developing a rather comprehensive profile of daily blood sugars and trying to see where high or low levels correspond to changes in diet, in exercise or stress.