As a diabetes educator and Children's National Medical Center physician, I often meet with individuals outside my usual role as healthcare provider. It was in this unique situation that I found myself meeting with a lovely gentleman who had literally "purchased" my consultative time during the silent auction at The Oktoberfest fundraiser held at the Old Angler's Inn in Potomac, Maryland. He wanted to meet me for dinner to discuss his diagnosis of diabetes. During dinner, while discussing his medical history, it became apparent that he was unsure of just what kind of diabetes from which he was suffering. I was determined to investigate. I have written several blogs about how to diagnose diabetes and the different kinds of diabetes. In this situation, however, I truly realized the frustration, suffering, and confusion endured when someone is unaware of his or her true diagnosis. Sometimes, we are unable to diagnose precisely the type of diabetes; but in many instances, we can at least limit the number of possibilities by both laboratory testing and clinical observation.
After the diagnosis of diabetes is confirmed, I then decide if the diabetes is insulin or non-insulin dependant. Sometimes, I may start insulin immediately (to eliminate glucose toxicity), even if I decide that the newly diagnosed type of diabetes may ultimately turn out to not be insulin dependant. If I determine that the child or young adult has insulin dependant diabetes it usually is either type 1 autoimmune diabetes, type 1 idiopathic in nature (i.e., cause unknown), steroid or medication induced diabetes, or cystic fibrosis related diabetes (CFRD).
If I determine that insulin is not required for survival, I am generally thinking of either type 1.5 diabetes, type 2 diabetes, or a genetic form of diabetes identified as Maturity Diabetes Onset of the Young (MODY). In neonates with hyperglycemia, a genetic form of Diabetes: Permanent Neonatal Diabetes must be ruled out as well, which may be treated with oral medication.
What are the physical and laboratory characteristics typically associated with insulin dependant or type 1 diabetes?
- Generally a patient with new onset type 1 diabetes is thin and has symptoms of increased drinking, increased urination, increased appetite, and has lost weight.
- Individuals with type 1 diabetes may present with diabetic ketoacidosis secondary to lack of insulin production.
- Type 1 patients need insulin to survive. (Oral medications may increase insulin sensitivity; but will not be sufficient to sustain survival).
- C-peptide (a marker of insulin) is not detected in the blood. (The exception is the honeymoon period when the body pulses out insulin from the remaining live pancreatic beta cells.)
- GAD-65 antibodies (and others) may be present in autoimmune type 1 diabetes (though not always).
- After the honeymoon period, blood sugars fluctuate a bit more than in type 2 diabetes.
- In some cases, there is a family history of autoimmune diseases (Celiac, Hashimoto's Thyroiditis, Graves Disease, or Addison's Disease <adrenal insufficiency>).
- In many cases, there is no family history of type 1 diabetes.
What are the physical and laboratory characteristics associated with Non-insulin dependant diabetes? (Type 2, MODY)