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Question:

From White Plains, New York, USA:

I'm trying to figure out what type of diabetes I have and my doctor is no help. I am a 38 year old male. In 1994, my fasting blood sugar was 121 mg/dl [6.7 mmol/L], as measured by my doctor's office. I took a glucose tolerance test and the results were in the normal range. My doctor at the time just told me to be careful with carbohydrates and avoid sugar as I was "pre-diabetic."

By way of family history, my mother was diagnosed as diabetic when in college in the 1960s, but has never taken medication. She completely avoided sugars for decades, is now very underweight. She was slightly overweight in college. Now, in her late 50s, the doctors are telling her she is technically not diabetic. Her original diagnosis was while she was in the infirmary for pneumonia and her fasting blood sugar and two hour tests now don't fall in the diabetic range.

I was diagnosed as insulin-resistant in 2003. Fasting blood sugar results at the time were routinely in the 120s mg/dl [6.7 to 7.0 mmol/L] right around 126 mg/dl [7.0 mmol/L]. As of November 2003, my A1C was 5.8 and my cholesterol was 229. My two hour tests never have been much higher than the 140s mg/dl [7.8 8.0 mmol/L]. I am, and have always been, thin. At 5 feet, 11 inches, I weighed 152 pounds when diagnosed in 2003. At that time, my doctor put me on Avandia, which did nothing for my fasting blood sugar. However, while watching my diet and exercise (my weight dropped to 145 pounds), my A1c went up to 6.0 within three months and my cholesterol jumped to 306. My fasting blood sugar levels started to go up as well (all while taking the medication).

By August of 2004, my A1c was 6.4, my cholesterol was down some to 253, but still high, and my fasting blood sugar levels were routinely in the 130s mg/dl [7.2 to 7.7 mmol/L] and climbing into the 140s mg/dl [7.8 to 8.2 mmol/L]. In other words, insulin-resistance drugs seemed to make me worse rather than better.

My doctor has tried prescribing Avandia, Actos and Avandamet (with metformin) which all have no effect on my fasting blood sugars. I took Avandamet for a week and it lowered my fasting blood sugar to 115 mg/dl [6.4 mmol/L] the first day but, it was right back in the 130s mg/dl [7.2 to 7.7 mmol/L] the next day. The Avandamet simply killed my appetite so that I lost another five pounds. I'm now down to 135 pounds. It also caused me to sweat profusely at night. I tested for type 1 antibodies, islet antibodies and GAD antibodies, and have none. My insulin levels are elevated, 27.7 on a scale where below 17 is normal. My C-peptides, the one time they were tested, were also elevated.

My doctor now wants me to try taking a drug that actually prods my pancreas to produce more insulin. I am afraid to take this drug since drugs have been seemingly hurting me and this one is contra-indicated for type 1.5 according to my web search. I am going to go to a new doctor in two weeks.

I can't figure out what's going on with me. I am thin and I don't respond to insulin resistance drugs, which would suggest I am type 1 or type 1.5 My doctor now says he thinks I am type 1.5, but seems uneasy with that diagnosis. However, I have elevated insulin levels, elevated C-peptide levels, not completely outrageous sugar levels, a long history of sugar problems and no antibodies, which would all suggest that I am type 2. Do you have any suggestions for me? I'm stumped and I can tell my current doctor doesn't really have a clue.

At this point I have taken myself off all medication. Any guidance would be helpful.

Answer:

I agree with your assessment. What I am not clear about is how you define failure of the agents you were treated with. Thiazolidinediones, such as Actos and Avandia, may demonstrate a lag time of weeks before lowering blood sugars. Metformin tends to work more rapidly. This drug tends to work better on the fasting blood sugar. Your elevated C-peptide and insulin levels with a positive family history and negative antibody levels point to type 2 diabetes. If you do not have any response to the current oral medications and the A1c and glucose levels continue to rise, you are probably going to have to be on some combination that includes either an insulin secretagogue (such as glipizide, glyburide) or insulin. Sometimes acute glucose lowering allows the beta cells of the pancreas to make insulin more efficiently. However, this usually occurs at elevated blood sugars above 200 mg/dl [11.1 mmol/L]. It will be interesting to see what happens to your sugars and what combination works. The most important thing is to stay with it until sugars are treated.

JTL

DTQ-20050110105428
Original posting 19 Jan 2005
Posted to Diagnosis and Symptoms and Type 2

  
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Last Updated: Tuesday April 06, 2010 15:10:00
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