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Question:

From Illinois, USA:

I was diagnosed about nine months ago (age 29, 500 blood glucose). I took insulin for a couple of weeks and have not needed any medication since then. At the time of diagnosis I was under extreme emotional stress as well as coming off of a night of extremely heavy alcohol consumption.

My first question is: could what happened to me possibly be a case of "transient hyperglycemia"? If not, what are the other possibilities?

Also, I am eating better and exercising more regularly (I am not nor have I ever been overweight), but are there any other treatments to help me keep the diabetes away for a prolonged period of time?

Answer:

On the basis of what you report in your letter (gross hyperglycemia and not overweight), I'd think you probably have a form of slowly evolving Type 1 diabetes occurring in young adults, actually now on its honeymoon phase.

I'm not aware of any fasting/casual transient hyperglycemia as high as 500mg/dl requiring insulin for a couple of weeks simply due to any emotional stress or food/alcohol intake. You have to remember that the immunopathology that leads to Type 1 diabetes is likely to have begun many months or years before the related stress. In your case that's diabetes for sure and it's very important, whenever possible and as early as it can be done, to be sure on the differential diagnosis of the different types of diabetes in a young adult as you are. This can be assessed by antibody testing and basal and post-glucagon residual insulin secretion. If your type of diabetes were confirmed by antibody testing to be of autoimmune pathogenesis, it might be really useful and more rational not to stop insulin, but to stay on insulin administration, even a small amount, to avoid exhausting your residual endogenous insulin production and to possibly modify the lymphocyte response that damage beta cells of the pancreas. Oral agents, which are often prescribed by doctors as first-line agents to control high blood sugar, can shorten the life of still-functioning beta cells.

MS

Original posting 21 Oct 1998
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:09:02
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