From Cambridge, UK:
I am a third year medical student at Cambridge University (UK). I am a 20 year old male and was diagnosed as having diabetes mellitus about 10 months ago. I presented with blood sugar levels of 19 mmol/L and high levels of ketones, with an Hb glycosylation value of 9.3%. I have never been overweight and am of medium build and height.
I was admitted to hospital and put on a sliding scale infusion pump. Once my levels stabilised I left the hospital and have been having twice daily and then three times daily injections ever since.
My diabetic control has been excellent and I have had Hb glycosylation values of 4.9 and 5.3 percent at three month intervals. This is without any significant or frequent hypos.
Suddenly last week, I found that I was hypo'ing badly after any meal (and injection) I had. I contacted my diabetes clinic and accordingly reduced the dose. This was of no effect and I still was hypo'ing. On Thursday last week I stopped taking my insulin and ever since have been okay. My blood sugar levels do still go rather high, about 11mmol/L two hours after eating. By about 3 hours after eating they have returned to 6-8 mmol/L and by 4 hours after eating are at around 4 mmol/L. I have hypo'ed once or twice (since stopping the insulin) several hours after meals when I have been exercising.
Needless to say it is extremely bizarre to have been considered insulin dependent, and indeed be so, for ten months or so and then start producing sufficient amounts of insulin for diet control alone. I was wondering if you had any ideas as to what could have gone on, as everyone I have spoken to so far has seemed rather confused by the whole thing.
There can be no argument about the diagnosis of diabetes with the results you report. Your age, build and lack of family history (I assume) together with heavy ketonuria at presentation all suggest Type 1 diabetes. You are less than a year into diabetes and it is entirely conceivable that you are still in a honeymoon phase. However, it is important to consider other possibilities such as the onset of Addison's disease [adrenal gland insufficiency], hypothyroidism or coeliac disease. You could ask if you had autoantibodies checked at diagnosis which would rule out the possibility that you have Type 2 diabetes (which seems unlikely). I don't feel comfortable with you stopping your insulin completely but assume that you are keeping a very close eye upon your blood sugars and urinary ketones. I strongly recommend that you involve your diabetes team in what you are doing.
Last Updated: Tuesday April 06, 2010 15:09:07
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