October 27, 2004
Diagnosis and Symptoms
Question from Quality, Kentucky, USA:
I am grateful to Dr.Brink and Dr. Schwartz for answering my previous question Dr. Schwartz asked for more information.
I take my 16 year old son to Vanderbilt Children’s hospital diabetic center. They told me that he is a mystery. We still do not know if he is type 1 or 2. We took him to the doctor because he was sleepy most of the time, drinking massive amounts of water, and losing weight. He is about 5 feet 11 inches and weighed about 170 pounds at diagnosis. This was down from a normal of 175 pounds. His blood sugars are still normal after two months. He has not needed insulin since the first day of diagnosis. He is on a 240 carbohydrate a day diet, and is still losing weight. He now weighs 158 pounds and has moderate ketones in his urine. We have not seen his doctor since August 4, 2004.
At our last appointment on September 30th, his doctor had an emergency case to deal with, therefore we received little new information. I did find out that his insulin production was in the lower end of the normal range when his sugar level was 355 mg/dl [19.7 mmol/L]. A new A1c test read 5.5, down from 7.9 on August 4th. I would be grateful if you can help solve this mystery of type 1 or 2.
Answer:
I don’t know if I can solve it. I wonder, if now, the ketosis and weight loss reflect such a seemingly keen restriction of carbohydrates. I am assuming “240 carbohydrates a day” really means 240 GRAMS of carbohydrates a day. If it really is 240 CARBS a day (3600 grams) that would not be restrictive at all; 15 grams = 1 CARBOHYDRATE.
Dietary restriction was how diabetes used to be treated prior to the availability of insulin: no carbohydrates, no elevated glucose; no weight gain. Starvation, but less DKA.
For me, I might consider having the young man go through an I.V. glucose tolerance test (not an oral GTT) in order to really quantitate what is called the “first phase insulin response.” Doing HLA-typing for the common risk pattern of type 1 might also be helpful, if the distinguishing of type 1 versus type 2 remains clinically important. It is academically of importance.
Your son’s situation is very interesting.
DS
