March 29, 2000
Diagnosis and Symptoms
Question from Harrisonburg, Virginia, USA:
I'd actually like to respond to a previous question. It is from a mother in Pittsburgh, whose 9 year old daughter was diagnosed as a pre-diabetic and is producing insulin at high rates. This is a rare condition, but it happened to me. I was 19 at the time and I was severely hypoglycemic for several weeks and a HBA1c test was done and resulted in a 3.8 or an average glucose of about 50-55. I was hospitalized in a university hospital for tests to rule out an insulin producing tumor in the pancreas. This involved a 72 hour fast and frequent glucose tests. When it came back negative, I was prescribed Acarbose [a medication usually used for treatment of Type 2 diabetes] to help prevent lows. In the next year, my sugars rose steadily and I was put on insulin injections as my pancreas shut down about 12-14 months after the initial problems. If it is any comfort, I feel much better now, because I have some control over my situation, and I did not when my pancreas was producing excess insulin on its own. I had no control over lows and frequently had 2 snacks during the night to maintain numbers over 70. I've been on insulin now for 18 months, and got on an insulin pump about 8 months ago. My best advice is this: start low doses of insulin as soon as medically safe, because this extended my honeymoon phase and my doctors credit this early insulin start with increased control now. Also, seriously consider a pump as soon as you can, if your daughter becomes Type 1. It gives you a normal life and great control. I'm extremely happy with the pump as are 2 other friends that have them. Good Luck!
I think what is being described by this correspondent is extremely rare. I have not seen this at all.
However, it is fairly common, perhaps 20-40% of all teens who present with classical type 1 diabetes have, on history, something that sounds like intermittent hypoglycemia for short periods of time — maybe a few weeks or months — prior to the actual diagnosis of type 1. So, if this might indicate a period of time when damaged beta cells can incorrectly or for too long a time period send out insulin, maybe it could happen as this person describes in a more extreme prolonged sense. The University that the present writer utilized has good adult and pediatric endocrinologists and the workup she describes is obviously the correct one.