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April 14, 2002

Diagnosis and Symptoms

Question from Centerville, Ohio, USA:

My 30 year old otherwise healthy son, diagnosed with type 1 diabetes and hypothyroidism about four months ago, is on a sliding scale of Humalog at meals with Lantus (insulin glargine) at night, and his sugars are always around 90-100 mg/dl [5-5.6 mmol/L], no matter what he eats even though he takes very little insulin. His TSH levels have stayed high and he is now on 1.25 mg/day of Synthroid [a thyroid hormone medication], and his weight has been stable after a 40 pound loss he noticed before diagnosis. He has been told he is type 1 because he had urine ketones, but his doctor thinks he may have type 2 and said to stay on the insulin for now. My son drops too low a lot and feels bad even when his sugar is normal. He has difficulty thinking and experiences headaches that are more annoying than painful because they cloud his thinking processes. He is depressed and worried that something is wrong that the doctors haven't tested. He has four little girls and a very stressful sales job. I had gestational diabetes when I carried him. What studies have been done on mothers with GDM regarding the children they have? I have three other children who are not affected, but I didn't have diabetes when I carried them. My son's antibody tests were significant for thyroid disease but not diabetes. Is there a specific antibody that shows the pancreas was attacked? Can the thyroid cause blood sugars to go up and your head to feel so cloudy? We are desperate to help my son feel better.

Answer:

I empathize with your feelings about your son. Your question is a frequently asked question, regarding the type of diabetes he may have.

Thirty is not too old to develop type 1, and it sounds like your son may have been overweight if he lost 40 pounds. A series of antibody tests rather than a single test have been used to indicate type 1 diabetes, and a variety of tests have been used to measure the ability of the pancreas to secrete insulin. The anti-GAD antibody level has the highest specificity for type 1 diabetes. Since there are number of antibody tests, you should have your son check with his physician as to which test he had performed. An oral glucose tolerance test can be performed with measurement of glucose levels, as well as simultaneous measurement of C-peptide levels, which might indicate endogenous insulin secretion.

Your history of gestational diabetes is a positive family history and puts you at increased risk for type 2 diabetes throughout your life. There is some suggestion that the intrauterine environment may make type 2 diabetes more likely to occur in offspring.

Finally, I would speak with his physician. Frequent low sugars are not acceptable. However, I would not stop insulin until some of the above tests have been performed. Patients who really have type 1 diabetes cannot make enough insulin for them to stay out of DKA [diabetic ketoacidosis].

JTL