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March 21, 2005

Diagnosis and Symptoms, Other

Question from Columbia City, Indiana, USA:

I have PCOS, endometriosis, uterine fibroid tumors and now diabetes. I used to have lows sugars before I was diagnosed with type 2 in 2000 after my first pregnancy. I now know that I could have had Syndrome X. I had my diabetes under great control. My A1c was 5.3% and I went on a low carbohydrate diet/weight lifting lifestyle and got nice and trim and slender. I got pregnant again in 2002. The pregnancy was very hard and complicated. Now, according to the C-peptide test, my endocrinologist says I have type 1. My diabetes is very, very hard to control and I am often sick all the time. Is all this somewhat common with type 2s who get pregnant? Do they also stop producing insulin? I am also extremely insulin resistant. I am on the pump and take Glucophage daily. I have never met another diabetic even close to myself. The weakness is often overwhelming and, no matter how hard I try, I can't live a normal life. Next week, I have to get blood drawn for TSH, T3 and T4 thyroid test. The TSH came back normal one other time, but I have most all the symptoms of hypothyroidism. This will be my first T3 and T4 test.

Answer:

You may have a form of diabetes where you have both insulin resistance (consistent with type 2 diabetes) and late-onset type 1 diabetes where there is an autoimmune component to your disease. To determine this, your doctor can order blood tests that look for markers of immune destruction of the beta cells. These are known as anti-GAD antibodies. Your ability to secrete insulin should also be looked at with C-peptide levels in response to some challenge (oral glucose, mixed meal challenge, or after a usual meal). If your insulin response is not adequate, you may indeed have a form of late-onset type 1 diabetes and also have a component of insulin resistance manifested in your PCOS, syndrome X symptoms.

JTL