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April 29, 2005

Diagnosis and Symptoms

Question from Madison, Wisconsin, USA:

I am a 38 year old female. Nine months ago, I had a common childhood virus called Fifth's disease. Since then, I have never really felt right. I have felt very fatigued, frequent headaches, increased thirst and hunger (gaining almost 20 pounds in nine months) and what felt like hypoglycemic episodes. I had a glucose tolerance test. My fasting level was 94 mg/dl [5.2 mmol/L]; 30 minute reading was 281 mg/dlm[281 mmol/L]; one hour reading was 240 mg/dl [13.3 mmol/L]; and two hour reading was 61 mg/dl [3.4 mmol/L]. At the clinic where I am seen, the only values that count in this test are the fasting value and the two hour value, which were both considered normal. I have had several other tests, including a C-peptide of 1.3, an insulin level of 3.5, and several A1c tests that have risen month after month but still are considered normal since they started at 5.4, four months ago,and are at 6.0 now. I have seen an endocrinologist who feels I am a smoldering type 1. He did run GAD autoantibody tests which are not back yet, in addition to four 24 hour urine tests (average volume of 3550 ml). My endocrinologist is very difficult to get in to see. I am really curious to know if this sounds like type 1 even though most of my laboratory values continue to be normal. I feel lousy most of the time, not because of high or low blood sugar but the rate of the drop in blood sugar. If this is type 1, how long does the preemptory stage last?

Answer:

Your symptoms are the prominent part of your presentation. You have an OGTT that is not diagnostic of diabetes. You also have an A1c that is suspicious, but not diagnostic, of diabetes. The OGTT is the most sensitive test you can have. Antibody results would be helpful, but cannot make the diagnosis of diabetes. Some individuals that go on to develop type 2 diabetes may have disordered insulin secretion prior to being diagnosed with diabetes and these could conceivably be what is going on with the later drop in blood sugars. Unfortunately, you still cannot make the diagnosis. Time will tell. In the meantime, rest, proper diet, and exercise (as tolerated) with follow-up with your physician are the best recommendations.

JTL