From Dallas, Texas, USA:
I am 55 years old, a first generation African American from East Africa, and I have no family history of diabetes. I weight 160 pounds, and I am 5 feet 10 inches tall. About nine months ago I was diagnosed with type 1 diabetes after being admitted to the ICU with a blood sugar of 1000 mg/dl [56.7 mmol/L] and DKA.
After three days in the hospital, my blood sugar was less than 180 mg/dl [10 mmol/L], so I was released and was instructed to monitor my blood sugar and inject insulin three times a day. After three weeks, I stopped injecting insulin to see whether I am producing insulin. I administered 70 gram of glucose and monitored my sugar. One hour later my blood sugar was 202 mg/dl [11.2 mmol/L], two hours later it was 150 mg/dl [8.3 mmol/L], and three hours later it was 95 mg/dl [5.3 mmol/L]. I told my doctor about it and I stopped taking insulin.
I still monitor my fasting glucose, which on the average is 90 mg/dl [5 mmol/L]. My fasting C-peptide was 3.0 ng/ml, and after meals, it was 8.0 ng/ml. GAD 65, ICA 512, and insulin antibodies were all negative. My recent hemoglobin A1c was 6.0% (A1c home kit 5.7%). I do not take no medication to control my blood sugar, but I have changed my eating habits. All my blood and urine chemistry are within normal range and I have no complications or any health problem. My random glucose level some time shoots to 150 -180 mg/dl [8.3-10 mmol/L] after meals and drops to 90 mg/dl [5 mmol/L] after two to three hours.
The only concern I have is that my oral glucose tolerance test some times goes a little bit above 200 mg/dl [11.1 mmol/L] and comes to 100 mg/dl [5.7 mmol/L] within three hours, which indicates impaired glucose tolerance. My doctor has reclassified my condition as type 2, and I have several questions:
- Do I have diabetes?
- Is my condition common?
- Could it be IGT or typeá1B instead of type 2?
- Do you think my case is a good research material?
We handle various forms of this question from subscribers, and I continue to think to myself how confusing this must be for people to understand. There continue to be inconsistencies in our definition of these conditions.
First, you have diabetes. No question about that. For whatever reason, your pancreas is making insulin enough to keep your sugars in good control, although glucose levels may not be completely normal following an oral glucose tolerance test. The question remains as to wether or not you have typeá1 diabetes mellitus. We may not be able to evaluate that now. It may take time to declare itself. For instance, you could be in a honeymoon phase of type 1 diabetes. That means that the beta cells in the pancreas that may not have been destroyed by an immune-mediated mechanism have been helped by unloading them from the stress of very high glucose levels. The high glucose levels have been known to inhibit normal insulin secretion.
You may ask why type 1diabetes is still a possibility when the antibody levels were negative: it is because the antibody levels help most when they are positive. They do not rule out type 1 diabetes when they are negative. You may have Late-onset Autoimmune Diabetes of Adulthood (LADA) which is a late-onset form of type 1 diabetes that may not be as stormy as usual onset of type 1 diabetes in children. Finally, you may have a form of diabetes similar to typeá2 diabetes seen in other African-American individuals that can present with DKA [diabetic ketoacidosis] but behaves more like type 2 diabetes after the episode of ketoacidosis.
The most important point is that as long as you are not treated, you need to monitor your sugars closely and work with your physician if they begin to rise. It also may be helpful to repeat the antibody tests at sometime in the future. Whether you are good research material depends a lot on what questions the researcher is trying to answer. Someone who is interested in the classification of diabetes may find your case wonderful, but you have to find out who that is. You may want to review the studies being conducted through TrialNet.
Original posting 10 Nov 2003
Posted to Diagnosis and Symptoms
Last Updated: Tuesday April 06, 2010 15:09:52
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