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Question:

From New York, New York, USA:

I was diagnosed with Type 2 at 51. I spent six months on oral agents, then switched to insulin. Two years later I developed hypothyroid, and am now on thyroid replacement hormone. My diabetes diagnosis was changed to type 1. I also have pancreatitis; but not the kind associated with diabetes. I'm now 56. My insulin needs vary, 16 to 27 units in a 24 hour period. I weigh 165 lbs. I probably should need 40 or more units. Daily monitoring is good and A1C shows good.

In your answers to some other questions I noticed a reference to slowly developing type 1. I would like to know more about this from you and perhaps you can provide some reading suggestions also. I also noticed you have reference to insulin antibodies as a cause of type 1. I would like to know more about this and whether or not it may be a factor.

knockatee@AOL.com">Type 1?

Answer:

I am not surprised that your doctor changed the original diagnosis of Type 2 Diabetes to Type 1 after you developed hypothyroidism. Nowadays this combination might be referred to as one of the autoimmune polyglandular syndromes (Type II). To prove this it would be necessary to do a spectrum of antibody tests; but the results would not really affect treatment even though you seem to be on a very low dose of insulin. The pancreatitis is not reported as an associated autoimmune condition although of course, there are a number of situations in which diabetes may in fact be secondary to a chronic pancreatitis. Fitting the pancreatitis with the hypothyroidism and the diabetes all into one syndrome does not seem to be possible. And there are some other very rare possibilities; but the difficulties and expense of a specific diagnosis are so far not cost-effective in leading to better treatment.

Autoimmune diabetes has been reported as late as the sixth decade. Anti-insulin antibodies do not seem to have a role in promoting Type 1 diabetes; but the B9-23 peptide of insulin may have a role in helping to trigger lymphocyte activation by an antigen presenting cell with a specific genetic pattern.

Without knowing a little bit more of your capacity for technical jargon, I hesitate to suggest a reading list; but you might venture into PubMed using 'autoimmune polyglandular syndrome' as the research phrase. Another way if you live near a medical library would be to have one of the librarians steer you through a program like OVID which also accesses the national Library of Medicine.

DO'B

Original posting 7 Sep 1998
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:09:00
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