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From Columbus, Ohio, USA:

My daughter is 20 years old and has been a Type 1 diabetic since age 7. Recently she has been told she is really a Type 2 and needs a different course of treatment. Is this possible? She did go through a honeymoon period shortly after being diagnosed but has needed consistent insulin ever since. The new treatment includes NPH in the morning and evening with pills during the day.


Is it possible? Yes. Is it likely? Probably no.

If your daughter had been thin at the time of diagnosis, or has had any episodes of diabetic ketoacidosis, it's very likely she had been previously correctly diagnosed as Type 1 diabetes. Antibody studies, if they had been done (very unlikely several years ago!) and if they were positive, would help make the diagnosis of autoimmune Type 1 diabetes. (The antibody studies could be done now, but might have gradually faded out over the past decade, and thus would be less likely to be positive now than earlier. If someone had deep-frozen a sample of her blood years ago, it could be thawed and checked now; but that's improbable.)

If your daughter had been overweight at the time of diagnosis, and has never had DKA, then there's a reasonable chance she has the relatively rare condition of MODY diabetes. If that's the case, a trial of using diabetes pills, either alone or together with insulin, would be worth a very careful try under very close observation (blood sugar testing at least four times daily, and abandonment of the trial if any problems develop).

If your daughter is seeing an endocrinologist who's up-to-date on diabetes, I'd be more comfortable with the proposed rediagnosis and a trial using pills. If she's not, she should look for a second opinion.


Original posting 16 Nov 97


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