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November 26, 2005

Other

Question from Georgia, USA:

I am 19 and have type 1 diabetes. Recently, I had many low blood sugars requiring hospitalization. At first, the doctors had no idea what was causing them. First, they told me the diagnosis was factious hypoglycemia and sent me home under the care of a psychologist, saying I was just stressed from nursing college and my soccer team. Basically, they said I was under too much pressure. Later, I passed out again in class with a blood sugar of 5 mg/dl [0.3 mmol/L] and went into a coma for two days. I was transferred to a hospital with better resources for my care and the doctor there did an MRI and some other tests, including insulin levels, cortisol, and C-Peptides. He said I have an insulinoma. Now, they want to remove it. If I have an insulin producing tumor and I have diabetes, shouldn't they just cancel each other out? Wouldn't this mean that I am no longer diabetic? I asked my doctor the same questions, but he did not answer me. He just said the tumor has to go. I just want to understand this.

Answer:

It would be extremely rare to have both type 1 diabetes and an insulin producing tumor, but not impossible. Before you have any procedures, this or any other kind, however, you should schedule a consultation visit, perhaps also with your parents present, and ask all these questions so that you can understand what tests have been done, how conclusive the tests were, etc. You may also want to get a second opinion, if you are still concerned. A key test would be a C-Peptide level since anyone with long-standing type 1 diabetes should have no or negligible C-Peptide levels; if positive and especially if very positive at the same time there is documented hypoglycemia, then this would demand a search for an insulinoma or insulin-producing tumor. If this is what has already been done, then your doctors have done a good job. Either way you have to be comfortable with what they have done and how they have arrived at this diagnosis.

Lastly, other conditions should be ruled out as well: celiac disease, Addison’s disease, thyroid problems, liver disease. I would assume that if this has been going on for some time, these have all been checked, but you should ask and be sure as well.

SB