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Question:

From California, USA:

My husband is 48. Just took a physical and fasting blood glucose was 261. His 3 month level was 13. He was immediately put on Amaryl. Also on a diet and exercise program which immediately worked. Within 1 week his glucose levels were in diabetic normal range. The doctor told him about a honeymoon stage. I went with him on his next appointment and asked about this. He then said because he is of normal weight (142 pounds and 5 foot 10 inches) and is Caucasian with no family history he is most likely a type 1. So I asked the doctor what my husband's last blood glucose was when he had his physical a little over 2 years ago; he said he didn't have it, but four years ago, his level was 142. When he went out and the nurse came in I asked her to see what it was two years ago; she had no trouble finding it. It was 167.

Should he have been watched two years ago or longer? Would type 1 have still came to be? My husband complained 2 years ago at that physical that he was always tired. The doctor said it was stress. Can type 2 diabetics be of normal weight with no family history? Also the doctor that he has been seeing all these years is a endocrinologist.

Answer:

I am surprised and saddened that an endocrinologist apparently ignored what are clearly abnormal blood glucose levels for the past several years. The value of 142 was slightly abnormal if fasting (normal fasting is 70-110 mg/dl and diagnostic level for diabetes was 140 mg/dl). It should have been followed up with a repeat test.

Two years ago, it was clearly abnormal, especially in the light of the complaint of being tired. The new diagnostic level (as of 1999) is a fasting of 126 mg/dl. Your husband may in fact be a person with type 2 diabetes. If he were a type 1 diabetic the Amaryl wouldn't work. Type 1 diabetes is a condition of insulin deficiency; therefore if he had type 1 the Amaryl wouldn't be expected to be effective. As a type 2, the Amaryl makes his pancreas squirt out a little extra insulin -- if he weren't still making insulin the Amaryl wouldn't work. Lots of Caucasian folks have type 2 diabetes. Yes, it is possible to have type 2 and be of normal weight.

If he had type 1, I would expect him to progress to high blood glucose quicker than over the time period you describe: but this is a typical progression into type 2 diabetes.

There are many good books on the market to teach you about type 2 diabetes. The most important thing to learn is for him to become his own diabetes manager.

VV

Additional comments from Dr. Bill Quick:

One point to make is to find out if the earlier lab tests were fasting, or done after meals (in which case the numbers could be in the ranges you describe). In any case, this is a very disturbing story if it occurred as described, and I'd suggest it's worth a discussion with the doctor to learn his rationale for the diagnosis and subsequent treatment recommendation, and why his nurse found the information so fast when he stated he couldn't locate it. If you don't receive clear and persuasive answers, I'd suggest you and your husband plan on switching physicians.

WWQ

DTQ-20000221135531
Original posting 21 May 2000
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:09:10
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