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January 9, 2002

Diagnosis and Symptoms

Question from Denmark:

I am 24 years old, I am 5 feet four inches tall, I weigh 87 kilograms [191 pounds], and I was diagnosed with type 1 diabetes about 18 months ago when I had DKA. Since then, I've been moving back and forth between the US and Denmark. I am finally settled in Denmark, and next month I will be going to the hospital for my work up so they can have a file on me. Because I have dry dark brown patches on the sides of my waist, underarms, and neck as well as some dark spots at my elbows and knees, and the fact that I had DKA, the only endocrinologist I went was undecided as to whether I have type 1 or type 2 diabetes. He suggested doing C-peptide and GAD tests. I mentioned this to my Danish doctor, and he said regardless of what the tests showed, the Danish system would still keep me on my current insulin injections (with slight modifications), because it's their belief that is the best way to treat all diabetes. My husband and I have also wondered if I might have PCOS, due to my having several symptoms which oddly seem to mix in with type 2 diabetes. What should I do?


You have raised several good questions which are frequently asked. First, I presume that the brown patches are questioned to be a skin condition associated with type�2 diabetes, known as Acanthosis Nigricans. I agree that you probably have type�1 diabetes, given your age and the onset with DKA [diabetic ketoacidosis]. However, type 2 diabetes is more common in the population and is associated with Polycystic Ovary Syndrome. You may have type 1 diabetes with inherited insulin resistance and predisposition to type 2 diabetes.

The C-peptide and anti-GAD antibody tests would help answer some of your questions by looking for autoimmune markers and absolute insulin lack, characteristic of type 1 diabetes.

Your Danish physician gives you one side of the argument. I agree insulin is very good treatment for both. However, if you have no evidence for autoimmune type 1 diabetes, and have evidence of PCOS, you may benefit from other medications which would address fertility, lipids, and cardiovascular risk, in addition to the blood sugars.