My 39 year old friend was recently diagnosed with diabetes. His lipid level was over 7000 (no not a typo), he was in the middle of recovering from an acute pancreatitis attack, and his A1c was elevated to 16%. The doctor, who isn’t a specialist, and insisted that my friend has type�1 diabetes and that he will need to be on insulin the rest of his life. He wouldn’t even consider oral agents, and also told him to eat only two meals a day of 1400 calories a piece and then wean himself down to one meal a day in order to control his lipid levels. My friend and I were not comfortable with this and insisted on a second opinion by an endocrinologist. What do you think of this doctor’s advice?

It is not uncommon to have a patient with new-onset diabetes have elevated triglyceride levels and pancreatitis. I have seen it several times in my career. The type of diabetes is a secondary issue. Whether your friend has type�1 or type�2, I would place him on insulin because of the superior glucose-lowering effect of insulin and its ability to help lower the triglycerides (there is no time to mess around). After the triglycerides and the glucose are improved, you have time to contemplate the type of diabetes your friend has. There are tests which can help with this classification. On the other hand, I feel that patients are always entitled to have a second opinion and feel comfortable about their medical care.

JTL
Additional comments from Stephanie Schwartz, diabetes nurse specialist:

In accord with Dr. Lane, the decision to use insulin right now seems sound. However, it appears to me that your friend should seek counsel from an experienced diabetes team, including an endocrinologist and Certified Diabetes Educators such as nurses and dietitians.

SS

[Editor’s comment: See When should a person with diabetes be referred to an endocrinologist? for some other thoughts about referral to a specialist.

WWQ]