August 13, 2001
Diagnosis and Symptoms
Question from Richmond, Virginia, USA:
My 30 year son who lost 25 pounds in three months (now weighing 145 pounds) and was was admitted to the hospital with a blood sugar of 650 mg/dl [16.1 mmol/L], and, from what information we have been able to find, seems to fit the profile for type�1, but one doctor was treating him for type�2 with oral hypoglycemic agents, and the next doctor, although he agrees with my son that he has type 1 diabetes, has told him to continue these medications and his diet and see what happens.
The best info that I have been able to get suggests that the use of oral medication for type 2 may be effective for a while, but will cause the body to up its attack on the remaining functioning beta cells. Should my son insist on a referral to an endocrinologist? These doctors are internists, and I thought it was standard medical procedure for anyone with diabetes to see a specialist.
Answer:
This is a common question with newly diagnosed diabetes. Without a test for the gene, or dynamic metabolic tests, it is very hard to appropriately classify a patient.
I would recommend that your son see an endocrinologist regarding this issue. It will get your son’s treatment off on the correct beginning. Only about 10% of patients with diabetes see an endocrinologist. It may be that appropriate classification will allow for appropriate therapy and follow-up can continue through your primary care physicians. This is a popular model, and one which I recommend if there is a question regarding classification or therapy.
JTL
