August 24, 2007
Diagnosis and Symptoms, Exercise and Sports
Question from Delhi, India:
I am 32 years and I was diagnosed with hyperglycemia six months ago with a fasting blood sugar of 283 mg/dl [15.7 mmol/L] and a postprandial blood sugar of 390 mg/dl [21.7 mmol/L]. I started off with insulin therapy, 22 units. After three months, my blood sugar values dipped to 60 mg/dl [3.3 mmol/L] even when I took only 15 units of insulin. Since then, I’m on metformin and have normal sugars, 90 mg/dl [5.0 mmol/L] to 105 mg/dl [5.8 mmol/L] fasting and 130 mg/dl [7.2 mmol/L] postprandially, even after a rich, sugary meal.
So, I’m pretty confused as to what kind of diabetes I have. Is it type 1/LADA or type 2/MODY? I have a family history of diabetes, but all had it in their 40s. My doctor does not agree that I should be on insulin, which I feel is necessary for prolonging the honeymoon if it be so. The following are my laboratory results: A1c – 8.3%; C-Peptide – 1.9 ng/ml and 381.4 pmol at diagnosis; GAD-65 antibody – negative; urine microalbuminuria – 38 mg/g creatinine and 28 mg/g creatine on separate occasions; total cholesterol – 185; LDL – 106; HDL – 43; VLDL – 35.5; and triglycerides – 179.6. My BMI, before weight loss, was 27.
I do aerobics and weight training occasionally, but feel discouraged because of restricted diet and weight loss. I had a bulky and muscular physique which I lost after dietary restrictions and weight loss. Can I consume protein shakes to build up my physique when I do weight training? Do I come under the high normal albuminuria/microalbuminuria category?
Answer:
You most likely have type 2 diabetes. Patients with either type 1 or type 2 diabetes may require insulin at the time of diagnosis. The numbers are high. As a result, the high glucose environment prevents the production of insulin. This hyperglycemia has to be removed first before the insulin can be effectively produced again in the insulin-producing cells of the pancreas, the beta cells. In your case, the insulin was able to bring your blood sugars down and allow your own body to reestablish insulin production such that you will now respond to an oral agent in the form of metformin. The fact that you are only on metformin, have measurable C-Peptide levels, and have negative immune markers in the form of anti-GAD 65 antibodies, points towards type 2 diabetes. Family history is a risk for type 1 diabetes, however, you should not be surprised by the onset of disease in the 30s instead of the 40s. This appears to be the new presentation for type 2 diabetes and is fairly common.
The microalbuminuria levels are relatively high. One is frankly high and the other is on the high end of normal. This will often get better with treatment of the high blood sugars. However, if they do not, you may benefit from medication that decreases albumin excretion into the urine. These drugs protect the kidneys. Please talk to your physician about these medications.
JTL
[Editor’s comment: Please see a previous question about the use of protein shakes.
BH]
