Diabetes Diagnosis of Hoya Basketball Player Unclear, But Why?
The Washington, DC, area and diabetes community has been abuzz with the recent diagnosis of diabetes in a 20-year-old star Georgetown University Hoya basketball player. As always, when a prominent figure (especially sports) receives a significant medical diagnosis, the world pays close attention.
Interestingly enough, although our Hoya presented with the typical symptoms of new onset diabetes, it took a bit of time to finalize the diagnosis. He is currently under treatment with a respected adult endocrine colleague of mine who practices at Georgetown University School of Medicine.
The biggest controversy in regard to his diagnosis was determining what form of diabetes he has. Apparently, the sports media (including our local Washington Post) has interviewed authorities and the "verdict" will not be out for at least a month. Why is that?
By now, I hope many of you have had a chance to review a previous post, Diabetes: Which One (or Two) is It? During that discussion, I described the different presentations of type 1 and type 2 diabetes and associated variations. Thus, one might expect that it would be relatively easy to diagnose which type our Hoya has. At this stage, I believe his medical team is adopting the "wait and see" attitude. My assumption is that our young man most likely has type 1 diabetes that will require exogenous insulin administration. I am basing my assumptions on the following information (I have not discussed this with his treating physician due to all the media requests for his attention):
1. He is a young man in excellent physical condition with a BMI that is not in the obesity range.
2. He presented with symptoms fairly quickly, prompting treatment at Georgetown University Medical Center.
3. He was started on insulin (I am not privy to the type of insulin regime, but I would certainly imagine that he would be started on some form of basal/bolus therapy to maximize flexibility of his management).
4. He has indicated during interviews that he will need to balance his diet and exercise with insulin.
5. His treating physician has been present at all of his basketball games to be available should anything happen (like lows).
By now, I assume that much of his laboratory work has been analyzed including a hb A1c, c-peptide (looking for the presence of endogenous insulin produced by the remaining pancreatic islet cells), GAD-65 antibodies (checking for the presence of autoimmunity), and insulin levels prior to starting insulin therapy. It is possible that his pancreatic islet cells have resumed some insulin production after the initiation of exogenous insulin (honeymoon period). Should this be the case, it would be appear that our player is producing insulin and will therefore require less insulin administered by injection.
The diagnosis of type 1 vs. type 2 is not always clear cut due to possibility of features of both types present in one individual. Perhaps this may be the case with our Hoya (type 1.5 diabetes), or he may be in the honeymoon period with associated insulin production that may cloud the distinction between type 1 or type 2. Thus, it is not unreasonable for the authorities to announce that the diagnosis (type 1 vs. type 2) may not be known definitively for a month as the clinical course usually determines the type of diabetes based on response to medical therapy (insulin/diet etc) along with final results of associated lab work.
Should our Hoya respond rapidly to insulin with normalized blood sugars, eliminating the glucose toxicity surrounding his pancreatic islet cells, reveal the absence of GAD-65 antibodies with low risk HLA typing for the type 1 diabetes alleles, have a family history of diabetes, and have some features of insulin resistance (even without obesity), one might than consider the possibility of type 1.5 or type 2 diabetes. However, if he continues to have a significant insulin requirement (after the honeymoon period) with associated positive antibodies and moderate/high risk HLA-typing, than the most likely diagnosis would be type 1.
The question that will next come into play is what form of insulin therapy will best suit his needs. This topic is a very hot issue in view of the multitude of comments on the FDA blog by Ann Bartlett. I will address this topic in next week's blog.
If you're in the DC area, be sure to purchase a ticket to the April 25 game between the Washington Nationals and Los Angeles Dodgers and support children with diabetes!