April 26, 2001
Diagnosis and Symptoms
Question from Mesa, Arizona, USA:
My 15 year old son was diagnosed with type 2 diabetes at age 12, and was on oral hypoglycemic agents for over a year before his endocrinologist realized that he was type 1 and needed insulin. He had all the classic symptoms of diabetes, but he was very underweight, and everything I have read lately says that most adolescents with type 2 are overweight.
My son has been seeing a new pediatric endocrinologist for about eight months who was totally shocked when she read his medical records and found out he was diagnosed as type 2 originally. Is this common, for a teenager with type diabetes 1 to be diagnosed as with type 2? How many months of oral agents (increasing dosages when his sugars didn’t drop) should have passed before he was started on insulin? Could he have had less problems with his health if he was diagnosed properly to start with? He was hospitalized twice with DKA, and on the second stay, his original endocrinologist finally told me that he knows nothing about adolescents with diabetes and recommended a pediatric one. Shouldn’t they have told us that months before?
Answer:
It would be unusual to make a diagnosis of type�2 diabetes in a child who was not overweight without, at the same time, doing an antibody test to positively exclude type�1A (autoimmune) diabetes, which is by far the most common form in Caucasian children in North America. Clearly. it should have been considered at the time of the first episode of DKA [diabetic ketoacidosis].
If his future control is meticulous and he can maintain a hemoglobin A1c less than 7.4%, it may well turn out though that little harm has been done.
DOB
[Editor’s comment: If indeed the physician had admitted that he didn’t know about the care of kids or teens with diabetes, he should have referred this patient promptly.
WWQ]
