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March 21, 2005

Diagnosis and Symptoms

Question from Portland, Oregon, USA:

I am a 31 year old female who was recently diagnosed with diabetes. At this point in time, they think type 2. I am 5 feet, 4 inches and weigh 128 pounds, so I am not overweight. I had a baby one year ago and had gestational diabetes that was controlled through insulin injections. I checked my sugars off and on after the pregnancy and about two months ago, after eating a meal with some carbohydrates, my sugar level was 225 mg/dl [12.5 mmol/L]. I went to my general practitioner, who then did more tests. My A1c came back at 6.0, leading my doctor to believe my case was new. Both my mother and father have type 2 diabetes, as did my maternal grandmother and some other relatives on both sides. There are also some cases of type ones. My mother and father are both fairly active and thin. Given my age and weight, my doctor said I didn't fit the profile for type 2 and, yet, with the family history and gestational diabetes, as well as the lack of symptoms other than thirst here and there, it doesn't seem like type 1. However, after doing more testing, my fasting C-peptide came back at 0.8, my insulin level was lower than the doctor expected, so he is sending me to an endocrinologist to make sure this is type 2. My glucose was 93 mg/dl [5.2 mmol/L]. Also, my urine microalbumin came back at 50, which I believe is the test my doctor was referencing when he said there was some detection of early stages of kidney damage, which also surprised him. I have been taking my sugars regularly each day, and my fasting usually ranges from 80 to 100 mg/dl [4.4 to 5.6 mmol/L], with a few 110 to 130s mg/dl [6.1 to 7.7 mmol/L] here and there, although not often, so far. My two hour post meal readings are usually under 140 mg/dl [7.8 mmol/L] if I eat an extremely low carbohydrate meal, but shoot up to 180 to 220s mg/dl [10.0 to 12.7 mmol/L] if I eat ANY carbohydrates. For example, an apple alone brings it to 200 mg/dl [11.1 mmol/L], and two pieces of bread, even with a protein, bring it to the low 200s mg/dl [around 11.4 mmol/L]. I imagine the levels would spike even higher if I indulged at all! Do those test results seem abnormal? If they mean I might not be producing much insulin, would this indicate type 1? Is it likely I have type 2 in the early stages?

Answer:

You have very nicely provided the details of your case. It is a very common description. Based on your description, I cannot tell whether you have a slowly evolving form of type 1 diabetes or type 2 diabetes. I would recommend having your physician obtain an anti-GAD antibody test. This is a marker for type 1 diabetes. Sometimes, type 1 diabetes can begin as an indolent process, similar to type 2 diabetes. However, there is still concern, with your family history, that you have type 2 diabetes. In the big picture, the most important thing is the control of the blood sugars. Over time, you will be able to sort this out.

It is concerning that your blood sugars rise so precipitously with any carbohydrate. It makes you think that you have insufficient insulin secretion. It has also been helpful to perform stimulation tests that can bring out whether you have type 1 diabetes. These are often done with a test meal with measurement of C-peptide levels following the ingestion of the meal. The meal is usually some form of liquid nutrition drink. Your doctor can explain these in more detail. This might also be helpful in your situation.

JTL