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December 7, 2004

Diagnosis and Symptoms, Type 2

Question from Montpelier, Vermont, USA:

I was recently diagnosed with type 2 diabetes. I had a slightly elevated fasting blood sugar, 114 mg/dl [6.3 mmol/L], so my doctor followed up with a GTT which was 216 mg/dl [12 mmol/L] at two hours. My A1c was 5.2 and pancreatic antibodies were negative. So far, I am controlling it with diet and exercise. By cutting out bread, grains and refined carbohydrates, which wasn’t a huge change as I have always eaten a very healthy diet, I am generally able to keep my blood sugar below 140 mg/dl [7.8 mmol/L] at all times. Fasting levels remain sightly elevated, but generally below 125 mg/dl [6.9 mmol/L].

I don’t fit the usual profile for type 2. I’m 34, very thin, physically active, have normal lipids and blood pressure, and don’t have any relatives with type 2 (or type 1). I do have another autoimmune endocrine disease, Grave’s Disease, for which I was also antibody negative, but a scan confirmed autoimmune hyperthyroidism. I was diagnosed with Grave’s four years ago after my daughter was born. I had a normal pregnancy and a healthy baby, seven and a half pounds at term. My thyroid levels have been normal since I began anti-thyroid drugs.

I have read that hyperthyroidism can raise blood sugars, but only when thyroid levels are uncontrolled. Based on symptoms I had experienced for a long time before my diagnosis of hyperthyroidism (irregular periods, shaky hands, etc.), I believe I actually have had thyroid problems since age 19. Could long-term thyroid hormone elevation have burned out my pancreas? Is this a known way to become diabetic? Or, could I actually have type 1.5 as I already have another autoimmune disease? The reason I ask is that my doctor said that I should start metformin if my A1c goes up, but I worry about taking that drug if my issue is really insulin deficiency.


From: DTeam Staff

Elevated thyroid hormone levels are not known to “burn out the pancreas.” The other possibility, an autoimmune cause to the diabetes, is not out of the question. It is possible you had relatives that had diabetes but did not know it because it was not looked for. At the same time, autoimmune diabetes with a more subtle onset is a possibility that needs to be considered. You indicated your pancreatic antibody status was negative. Some tests are better than others. It appears the anti-GAD antibody tests goes up and stays up and is a good test for the autoimmune diabetes status. If this is negative, you can only follow over time while trying to lead a healthy lifestyle.