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April 10, 2005

Diagnosis and Symptoms, LADA and MODY

Question from Kuwait City, Kuwait:

I'm 18 years old. My weight has remained 59 kg (130 pounds) for three years and I'm 176 cm tall (5 feet, 8 inches). I went to my family physician complaining of fatigue for three months. He had me do a fasting plasma sugar which was 12.1 mmol/L [218 mg/dl] and a two hour random plasma sugar which was 12.7 mmol/L [229 mg/dl]. He then did blood tests and told me that I have "low normal" insulin and C-peptide and a negative antibody screen. My A1c result was 8.5%. He told that I might have MODY rather than type 1 because of my family history and negative antibody screen. My mother has LADA and my father died at 65 years with an MI (myocardial infarction). He had been diagnosed with diabetes in his last year. My family physician says I will have to be treated with insulin for life because my body isn't producing enough of it. So, what type of diabetes do I have? If I don't have type 1 diabetes, why should I take insulin for life? Genetic testing for MODY is not available here.

Answer:

I know the pediatric diabetes team in Kuwait City and they are excellent so I would refer you to them for a second opinion. The reason for taking insulin is the need to control blood glucose levels. If insulin levels themselves are low then the oral agents won’t have much to work with. If there is documented insulin resistance, then this would be a different story. All this could be determined clinically based upon frequent blood glucose monitoring. How long a person should take insulin (life?) depends upon glucose control being achieved and the underlying illness. The most important item in your brief history is the family history of diabetes in both parents since this suggest that your risks are very high. Meal planning, exercise, frequent monitoring and then treatment decisions accordingly are the highest priority so that you can be healthy and avoid the complications that have already taken place in family members so that they do not have to happen for you.

SB