October 23, 2004
Diagnosis and Symptoms
Question from San Jose, California, USA:
I have a perplexing case and am curious about your thoughts. During a routine physical four months ago, it was found that my fasting blood sugar was 180 mg/dl [10.0 mmol/L]. I am 32 years old, 5 feet 10 inches, Caucasian, 155 pounds. I have never had any health problems.
Initially, it was thought that I had late onset type 1 diabetes. However, simply changing my diet and adding exercise immediately brought my fasting blood sugar down consistently to 100 to 120 mg/dl [5.6 to 6.7 mmol/L] and my post meal fasting blood sugar to less than 160 mg/dl [8.9 mmol/L] However, on the two hour oral glucose tolerance test (OGTT), my blood sugar was 311 mg/dl [17.3 mmol/L]. My A1c has gone from a 10.1 to a 7.1 since diagnosis. My insulin levels during this test were 18 at the beginning and 21 at the two hour mark. Additionally, tests for the antibodies have come back negative.
On my father’s side, I have many relatives with type 2 diabetes, although they all fit the classic profile. Finally, I do not seem to be sensitive to foods high in carbohydrates, such as rice, pasta, etc., however, I seem very sensitive to foods with “sugar” listed in the ingredients, such as ice cream, soda, etc. Any thoughts on what I have? Some have suggested possibly MODY 2?
Answer:
I’m sure there are several different takes on this scenario. However, you are not insulin deficient. You have negative autoantibodies. You have a marked history of type 2 diabetes in your family. This scenario sounds most likely to be type 2 diabetes. However, you still may be LADA. We cannot see into the future to see if your insulin secretion will fall with time. The tests are definitive for diabetes. I would make sure therapy is added until the glucose levels are normal and you have a normal A1c.
JTL
