Diagnosis of Type I vs. Type II

My 15 year old son's doctor confirmed my son had diabetes yesterday.  I'm waiting for a consult with an endocrinologist however the pediatrician was confused about my son's diabetes and I am too.

Here's the issue.  HUGE family history of Type II diabetes.  My son is a tall (5'10"), slender (128lbs), athletic boy.  He has recently been having symptoms of dizziness and fatigue (which we chalked up to all-night video game playing), eats and drinks like a horse (he's grown 6" this year), no excessive urination, and is gaining weight (8lbs in 2 months).  He doesn't really fit the text-book profile of Type II (his age and he's so young and slender) or Type I (gaining 8lbs in 2 months).

How do doctors determine if a teenager has Type I or Type II diabetes?

As a side note, his blood sugar (checked on two different meters to ensure the readings weren't off) has bounced between 68 and 266 over the past few days.  Even though he's really limited carbs today he bounced up to 185 after water, salisbury steak, and an orange at school.  The doctor suggested this could be rapid onset of diabetes that we caught very early and his A1C today of 4.9 confirms that may be the case.

Thank you, I appreciate the advice. I can manage my diabetes fine and my son is taking all of this in stride along with the diet change and hourly glucose readings (the pediatrician asked him to log them for the endocrinologist) but we're confused if he's headed towards insulin or metformin.

[JDRF-Team-CDB]

Hi Utahmomma,
I'm a momma, too, not a doc, so let the docs call it-- you definitely need to see a good endocrinologist. That said, I have a type-1 daughter and a type-2 husband, and type-2 is rampant in his family, so I'm pretty familiar with both.

You're right that it makes no sense for him to have Type 2. I have heard of a couple of non-overweight people getting type 2 when there's a strong genetic history, but they don't usually get it until well into middle age. In general, you don't see it in skinny people like your son.

It does sound like type 1 that was caught very early, and he could have gained weight because he could be in the middle of a big growth spurt-- maybe he would have gained 15 pounds if it weren't for the blood-sugar issues. If it is type 1, he's headed for insulin.

If it is type-1, it's good news if it was caught very early. My daughter was caught fairly early, though her BG was 450 on diagnosis. She has been excellent about controlling it, and the result was that her honeymoon period went on for what seemed to be a record time. Catching it earlier means a better chance to keep the pancreas producing at least some insulin for a long time, which helps them feel good and stay in control without too much effort. It makes the transition to living with this disease much less stressful.

Good luck, and let us know what happens.

[utahmomma]

Thank you for your reply.  My family does have a very big history of Type II and I was probably only about 15lbs overweight when they diagnosed mine (5'3" and 145lbs then - down to 130 now).  I had my daughter call someone on their father's side and there is Type I there too (not as strong though).

How does a doctor determine whether it's Type I or not?  Is there a pancreas function test or enzyme levels to be watched?  Do we just try different meds until we hit the correct one??

My son is like me, he wants to be very informed before going to a doctor so he can ask meaningful questions.

thanks!

[limpsy]

I was diagnosed with Type 1 when I was on the corner of my 23rd birthday.  Unfortunately it was very late and I was posing all the symptoms so that may be why they didn't do any tests that they told me about, just put me on the insulin and sent me on my way after I recovered in the hospital.

[JDRF Team SGG]

Ask your son's doctor to do a blood test to check for antibodies that show whether his immune system is attacking his pancreas or not. This is the real test to determine whether he is developing type 1 -- the antibodies WILL be there if his immune system is currently attacking his pancreas. There are different antibodies that can be tested for to see if the thyroid or adrenal glands are under attack by the immune system. When diabetes is caught this early, those antibodies would be the sure-fire test. If caught after the immune system has already done its destruction, later on in the development of type 1 diabetes, the antibodies may not be present, for the immune system may have settled back to normal.

[utahmomma]

Thank you, thank you, thank you!!!  I have an appointment with a pediatric endocronologist in two weeks and will make sure that he runs the antibody tests.  My family also has a HUGE history of thyroid problems (mostly cancer) and a ton of autoimmune problems, I want to get on top of this situation with him ASAP.  You've been a lifesaver!!

[type1steve]

TYPE 1 will land your behind in a hospital bed for a week with acute diabetic ketoacidosis.  You must have insulin to survive.
Everything else (diet, exercise, etc, etc, etc) can help, but without insulin you will not get any nourishment and you will die.   this renders diet useless.  and have you ever tried to exercise with no energy?

i have no idea about type 2 except that it is the more forgiving form of diabetes (i didn't say easy, just not as scary).

[utahmomma]

That is exactly why I'm trying to get my son's diagnosed, and treated, ASAP.  Apparently we caught it very early and I'm hoping we can get things under control (diet, exercise and insulin or metformin depending on Type I or II) before there is serious damage.  I know if it is Type I (which is my bet based on his age and very skinny body) he will be put on insulin someday soon - I just want to get this diagnosed so we are treating it correctly.