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Question:

From Scranton, Pennsylvania, USA:

I was recently diagnosed with diabetes, but my doctor isn't actually sure if I am Type 1 or 2. For one thing, I do not take insulin; I control my sugars with diet, exercise, herbs, and a sulfonylurea diabetes pill. I'm 26 and in excellent health (active, not overweight in the least) so isn't it more likely that I am Type 1? Anyway, I just read Type 1 diabetics are not supposed to take oral meds, but it didn't say why. Could you please answer this for me?

Answer:

It's very important, whenever possible and as early as it can be done, to be sure on the differential diagnosis of diabetes in a young adult. This can be assessed by antibody testing, and basal and post-glucagon residual insulin secretion. It may be really useful and certainly more rational to give you a small amount of insulin to avoid exhausting your residual endogenous insulin secretion and to modify the lymphocyte response that damage the beta-cells of the pancreas that produce insulin (if your type of diabetes were confirmed by autoantibody tests to be of autoimmune pathogenesis).

In your case, oral agents, which are often prescribed by doctors as first-line agents to control high blood sugar in Type 2 diabetic patients, can shorten the life of your still functioning beta-cells. Therefore, on the basis of my professional experience, in young adults I start insulin much earlier, rather than to wait for blood sugar deterioration.

MS

[Editor's comment: The concept of slowly-evolving Type 1 diabetes occurring in young adults seems to apply to your case. Unlike the usual dramatic presentation of Type 1 diabetes in children (with severe symptoms and frequently with DKA), there are young adults with mild symptoms, who are diagnosed as Type 2 and treated with oral agents for several years, who later become totally insulin-deficient and require insulin therapy. Dr. Songini discusses one rationale that's been proposed to explain the contribution of the use of oral agents on "exhausting" the capabilities of the beta cells; whether that's right or not, it seems likely that many slender young adults who are initially successfully treated with diabetes pills will become insulin-dependent later in life. WWQ]

Original posting 12 Dec 97

  
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Last Updated: Tuesday April 06, 2010 15:08:56
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