March 1, 2006
Diagnosis and Symptoms
Question from Perkasie, Pennsylvania, USA:
What type of diabetes is this? My daughter was diagnosed with type 1 diabetes in December 2005. Her sugars range from 37 to 365 mg/dl [2.1 to 20.3 mmol/L]. Her A1c is 6.0 to 6.7, Her oral glucose tolerance tests were positive. She has GAD antibodies with normal insulin levels. She has headaches with the high sugars, shakes and weakness with low sugars. Only one family member has a history of type 2 and that is her paternal uncle. She has had positive ketones for the last two days, but her sugars are up and down and no excessive thirst or urination. She is of normal weight and height. She has a history of asthma that went away at age 10, vitiligo, and maybe von Willebrand’s. Her doctors say that this is type 1 or 1.5, but a strange presentation, because of the extreme lows and highs. She does not feel good with the constant unstable sugars. I am concerned that insulin will drop her too low.
Answer:
It sounds like typical youth onset diabetes from your descriptions. It is impossible to make any other diagnosis on the Internet so you should ask these questions to your diabetes team. Perhaps she needs a different insulin regimen. Perhaps a multi-dose insulin regimen with Lantus once (or maybe twice a day) plus prandial analogs. Perhaps an insulin pump if she is so difficult to control so early in the course of her diabetes illness. It is also important to make sure that there is frequent blood glucose monitoring and analysis, appropriate meal planning and carbohydrate counting and no omitted insulin doses. A psychosocial evaluation often will be very helpful in such circumstances of difficult to manage diabetes. But most importantly, go back and discuss with your diabetes team who know you and your child specifically.
SB
