August 20, 2003
Other Illnesses
Question from Texas, USA:
My 37 year old husband, who has had type 1 diabetes for 29 years, has been in declining health for the past several years with pretty much has the full compliment of complications (retinopathy, gastroparesis, kidney problems, peripheral neuropathy, etc.), and the past year has been especially difficult. For the last nine months, he has had increasing fatigue and pain, and testing showed that he has terrible back problems (autofusion of two vertebrae and two additional bulging discs down the spine). He had a nerve biopsy to rule out chronic inflammatory demyelinating polyneuropathy (CIDP) and did not show any signs of a demyelinating process, but he has continued to worsen. Lab work indicates that he has elevated liver counts and moderate restrictive pulmonary function, but CAT scans do not show lymph node involvement or interstitial lung disease. Next week, he is going to have a spinal tap. They have mentioned that he might have sarcoidosis. Does this sound like sarcoid? Do you have any other thoughts? Any suggestions for further testing?
Answer:
Your husband’s medical problems are complex enough that it is not possible to diagnose with given information. Diabetes does not attack the lungs directly. Therefore, looking for a disease that affects the lungs as one of the primary sites requires you to work with his physicians closely. This will probably involve some type of biopsy to look for the tell-tale pathologic findings.
The pathologic material is required for diagnosis because sarcoidosis can look like other things and needs to differentiated from those other things for the purpose of therapy. If sarcoidosis is diagnosed, steroids may be required, which may cause blood sugars to go up.
JTL
