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December 2, 2001

Diagnosis and Symptoms

Question from Woodinville, Washington, USA:

A little over three years ago, my primary care physician (internal medicine) diagnosed me with type 2 diabetes and prescribed diet, exercise and glyburide. At the time of diagnosis, I was 39 years old, 6 feet 1 inch tall, and I weighed 163 pounds. My hemoglobin A1c was 14.1%, three months later had dropped to 7.0%. However, after another two months, my glucose levels gradually became harder to control, my HbA1c was back up to 9.9%, which I brought it back down with rigorous diet and exercise, but eventually needed nighttime NPH, and finally Humalogafter meals. Just recently, I went to an endocrinologist who did a C-peptide test which was 0.6 ng/ml so he diagnosed type 1 diabetes. He started me on Lantus (insulin glargine), and when I control my diet carefully, I can go 24 hours with just 20 units, I can have a spaghetti dinner if I take 5 units of Humalog and end up with a two-hour postprandial glucose of 110 mg/dl [6.1 mmol/L]. I wish my primary care doctor had done a C-peptide when I was diagnosed. Do you think I do or ever did have type 2 diabetes and insulin resistance?


I really cannot be sure. These are not easy calls to make and often look similar. There is no real lab test for insulin resistance. What is known is that beta cells fallout occurs and eventually you are left with insufficient insulin production. The slower, less stormy onset is referred to as Late-onset Autoimmune Diabetes of Adulthood (LADA). It sounds like you are back on the road to better results. Keep up the good work!