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From Gainesville, Florida, USA:

I'm a 22 year old female and I was diagnosed with diabetes about a year ago. However, no one is quite sure whether I have Type 1 or Type 2. I'm thin and I have a large history of Type 2 Diabetes in my family (my mother, aunt, and grandfather). Also, my case wasn't extreme--I was tested mainly because of recurrent yeast infections, but I didn't have any other symptoms. I am now on insulin therapy (NPH and R, two shots a day, 20 units total), and my A1C's have been good ("excellent" to "good" control) for the whole time.

I'm very interested in finding out whether I am Type 1 or Type 2. I would like to know whether I will be able to take oral agents successfully later on. My doctor was going to experiment with Rezulin with me, but I refused because of it's effect on my oral contraceptives. I may, however, want to try them in the future, but I want to know now if they will be possible for me! How can I find out? I have heard of the autoimmunities test, but I'm not very clear on how it works and what it could tell me. Will it work for me now, even though I've used insulin for the past year? And could the results be different ten years from now when I might want to try the oral agents?


In the last few years the distinction between Type 1 and Type 2 Diabetes has become increasingly blurred. For example it is now recognised that about half the children of Spanish-American or African-American descent who get diabetes do not have the autoimmune or Type 1 form. At the other end of the spectrum a significant number of people who become diabetic in later life, and perhaps you are one, are really Type 1. Certainly this is true up to the middle forties and perhaps even into the sixties. The most certain way to diagnose Type 1 is to have an antibody test and in your case you should ask your doctor to call the nearest of these three numbers 1-800-552-0219 (Gainesville), 1-305-243-3781 (Miami) or 1-813-974-5805 (Tampa) to arrange this. If you are antibody positive you are really at this time committed to insulin injections on a permanent basis until a good deal more progress has been made in transplant technology, that is unless you have the bad luck to progress to kidney failure. Troglitazone (Rezulin) is expensive and has been rather disappointing in Type 1 and even with this present small dose of insulin it is unlikely that you would be able to dispense with injections completely.

Type 2 Diabetes is increasingly being subdivided into genetically distinct groups. There has however, been little impetus to make the specific diagnosis because the treatment of all of these subgroups is very much the same and again the process is tedious and expensive. However if you turn out to be antibody negative it would certainly be worth trying to see if you can maintain blood sugar control with one of the oral preparations; but you should not make any changes without discussing it with your doctor.


Original posting 28 Nov 97


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