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January 4, 2007

Diagnosis and Symptoms

Question from New York, USA:

If C-Peptide can be normal or close to it during the honeymoon period and antibodies are positive in type 1 patients only 60 to 80% of the time (as per your other answers on similar questions), what is the gold standard to know what type a patient has? I've been insulin dependent since diagnosis at the age of 19 and my doctor seems to be taking a "wait and see" approach. I want to know if there is any reason I shouldn't be able to try oral medications. Also, are there any studies about the your chances of dying in your sleep from a low?

Answer:

Most patients can be classified as either type 1 or type 2 diabetes along clinical lines. The laboratory tests, including C-Peptide and the antibodies are helpful in cases where there is not a clear indication as to the type of diabetes present. At age 19, I would think you have type 1 diabetes, unless there are other factors not mentioned. In order to use oral medications in a patient with a history of type 1 diabetes, I would have to be very sure you did not have type 1 diabetes as the lack of insulin in patients with type 1 diabetes could lead to the development of diabetic ketoacidosis. As a physician, I would not want to commit a patient to a therapy that may put them at risk.

JTL

[Editor’s comment: See our a web page on The Dead in Bed Syndrome.

BH]