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August 19, 2008

Diagnosis and Symptoms, Other

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Question from South Carolina, USA:

Diagnosed with type 1 in 2003, not overweight, I had positive antibodies and a C-Peptide of 0.5. Now, five years later on an insulin pump for four years, my antibodies are now negative and my C-Peptide is 5.3. My doctor took me off my insulin pump and put me on pills (metformin XR) due to my C-Peptide level, thinking I might have type 2. Well, that lasted five days. To make a long story short, on days one and two, my blood sugars were not too bad, 100 mg/dl [5.6 mmol/L] to 200 mg/dl [11.1 mmol/L]. On day three, my blood sugars were 85 mg/dl [4.7 mmol/L] to 250 mg/dl [13.9 mmol/L]. On day four, my blood sugars were 200 mg/dl [11.1 mmol/L) to 375 mg/dl [20.8 mmol/L]. I was 480 mg/dl [26.7 mmol/L] with ketones on day five. I was so sick my body ached all over and I could not eat or drink, I felt like I was going to throw up, I just stayed in bed. The doctor put me back on the pump that day. He is not sure what type of diabetes I have. I use approximately 30 units of insulin a day. My basal is around 18 units. I do not have any blood sugars below 60 mg/dl [3.3 mmol/L]. I do have hypothyroidism and my father also has type 1 diabetes and on a pump. I have a strong family history of diabetes. My question is with C-Peptide: why did the pills not work? What type of diabetes might I have? Have you seen anything like this before?

Answer:

From: DTeam Staff

With type 1 diabetes, it is not unusual for the antibodies to revert to negative months to years after the diagnosis. Only one of the antibodies, the anti-GAD antibody, stays positive for a long period after the diagnosis of type 1 diabetes. I am not sure why the C-Peptide level was so high after you had been treated with insulin for a number of years. It appears to me that the trial of oral agents proves you have type 1 diabetes. It makes me wonder whether the original C-Peptide of 5.3 was really true. Your history of primary hypothyroidism is also seen more frequently with type 1 diabetes.

JTL