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Question:

From Saugus, California, USA:

My brother was diagnosed about a month ago with Type 2 diabetes. He is 38 years old, not overweight, and in excellent physical shape. He went to the doctor originally complaining of extreme thirst, urination, weight loss and blurred vision. I am questioning his diagnosis of Type 2, because we have 3 members in our family with Type 1 and nobody in our family with Type 2. He is being treated by his family doctor, not an endocrinologist. I asked my brother if he was given the "autoimmune" test and he said "no". He said that the doctor was certain that he was Type 2, because when his blood was tested he had a high blood sugar (345), but no ketones. He said that Type 1's have ketones at diagnosis and that Type 2's do not. He put my brother on Glucophage [metformin, a pill for Type 2 diabetes] and he is having great control with his blood sugars, but I think he is just honeymooning. What do you think or recommend?

Answer:

The presence or absence of ketonuria at the time of diagnosis is not an inviolate way of distinguishing between Type 1 Type 2 diabetes. But with three other first degree relatives with Type 1, I would have thought an antibody test would be justified. This assumes that you know that the other affected members of the family do indeed have what is now known as Type 1A or autoimmune diabetes and not one of the rarer insulin dependant forms of diabetes in the young.

Another reason for getting an antibody test is that it would be an opportunity nowadays also to test for two other autoimmune conditions: namely, celiac disease which affects 10% of Type 1 diabetics and the much less common adrenocortical insufficiency. The former can be a source of poor control and is readily treated by diet and in the latter case foreknowledge may prevent unexpected complications of any acute illness.

Having said all this it is also possible that the family doctor is right and that your brother does indeed have Type 2 Diabetes; the occurrence of Type 1 and Type 2 in the same family is not uncommon. The crucial thing to remember, however, is that what is most important irrespective of the precise diagnosis is to keep blood sugars as close as possible to normal. On the long term this can best be assessed as an A1c test that stays normal or close to the upper range of normal for the laboratory.

DOB

Original posting 13 May 1999
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:09:04
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