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Forum Name: Diabetes

Question: Is this type 1.5?


 sngrce - Wed May 20, 2009 3:07 pm

I have had Grave's Disease for 5 years, and had a radioactive iodine treatment done shortly after diagnosis. My thyroid went from high to low for several years, and was aggravated by my first 2 pregnancies (my first child had neonatal thyrotoxicosis). During my 3rd pregnancy I became officially hypothyroid.

Lately I have been having migraines, extreme mood swings, thirst, and dizziness. I started checking my blood sugar levels, as my dad is a Type 1 and was diagnosed at my age. Some days it stays low and in the normal range, but I can feel when it goes above 180 as I start to get a headache. Last week I was feeling fatigued so I picked up an oreo McFlurry on my way home. I finished about 1/3 of it before starting to feel nausiated, so I stopped eating. At 20 minutes I started getting a splitting headache and my BS was 191, then at 45 minutes it was 276, at 1 hr 15 it was 161, and at 2 hr it was 80, at 2 hr 20 min it was 55. My fasting glucose is anywhere from 70 to 131 - and it doesn't seem to be predictable, and it's never been clinically recorded high.

Yesterday I had an appointment with my general physician, who said I clinically am not diabetic. 6 weeks ago, my fasting was 99 and yesterday my 2 hr post-meal was 164.

The med student who saw me before the doctor said something to the extent of, "we don't look at how high it goes, but how long it stays high. If your fasting is above 126 twice or a random is recorded above 200 THEN you're diagnosed as diabetic. In your self registered hyperglycemic event it went back to normal within 2 hours, so you wouldn't even fail a glucose tolerance test. You're likely not diabetic." - is that true? I feel fine some days, but like I'm going through a blood sugar rollarcoaster on other days, but that I had to push them to draw an A1C. Could I have a lazy pancreas that still pumps insulin out but in lower amounts or normal amounts at unpredictable times?
 John Kenyon, CNA - Fri Jun 05, 2009 11:36 pm

User avatar Hello --

Your question is an excellent one, and involves a relatively new class of diabetes which is somewhat controversial, as are a number of aspects of current diagnostic criteria for diabetes.

To get straight to the point, it seems likely you are going through a period of pre-diabetic hypoglycemia with glucose spikes too brief to currently qualify you as diabetic of any of the types. However, two things argue in favor of the likelihood of eventual type 1.5; first Graves' disease, which is an autoimmune issue, as are diabetes type I and I.5 (but not type II); and second, a family history of type I. Your medical student is correct, however, in quoting you the flat, statistical diagnostic criteria currently in use, which would not qualify you for any type of diabetes, even though something is clearly going on and is probably an autoimmune process, something that can attack various body systems.

For now, I would ride the ups and downs and just have yourself tested routinely as normal, but with HB A1C check at least twice yearly. You may never develop a clear-cut type, but most likely something will eventually surface. You are at precisely the average age of onset of type 1.5, so you may be going through a "herald" phase now. The good news is if you wind up as 1.5 your problem will be relatively easy to manage and for the most part this type doesn't carry with it the serious complications of the other types, such as kidney, nerve and heart damage. If you have to have a form of diabetes this isn't a bad one to have, and since you've pretty much missed the takeoff point for type I, this would likely be what you'd develop, if you develop anything. You haven't yet, at least according to what I personally feel are very arbitrary parameters for diagnosis, so again, regular checking clinically is your best bet. It can't hurt to check when things seem to be acting up, as you've been doing, and it may even be worthwhile to keep a journal of your findings, but it won't earn you a diagnosis. It's just as well for now, too. Still, will be worth keeping a record for future reference.

I hope this is helpful. Please follow up with us as needed. Good luck to you.

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