She was 12 years old, studying in 7th standard. She was admitted in a nearby hospital with fever, vomiting, and recent lose of weight of 10 kgs. Her urine sugar test showed brick red color (meaning more than 2 percent glucose). Her blood sugar was then checked. It was 468mg percent. She was diagnosed as type 1 diabetes with Diabetic ketoacidosis[DKA]. She was managed with Insulin and intravenous fluids. She recovered well. She was then referred to me to confirm the diagnosis of type 1 Diabetes.
As they walked in, the child looked relaxed. The parents were tensed and stressed. What they were hoping was, I will tell them that this is not real diabetes. They repeatedly told me that no one in their family were diabetic.They did not had any clue why their daughter had so high blood sugar. Neither had I.
She was an obese child. According to parents, she had lost about 15 kilograms in 4 months. All started after she was ill with chicken pox.
Is she having an Insulin dependent type 1 Diabetes seen commonly in children or is she having a type 2 diabetes commonly seen in adults, but now also seen in obese teenagers?
If it is type 1 diabetes, she will need Insulin life long. If it is type 2 diabetes, she may be able to manage with diet, exercise, and tablets for a long time.
Diagnosis is little tricky in her case. History of obesity is in favour of type 2 diabetes, but sudden weight loss, DKA, and history of chicken pox suggests type 1 diabetes (type 1 often follows a viral infection).
Two tests may help me. One is a test for antibodies against pancreatic cells. Such antibodies are seen in most type 1 patients. Other is estimation of C peptide, which is an indirect measurement of body's insulin production. C peptide will be low in type 1 diabetes.
Antibody tests are costly. C peptide estimation is less costly.The family is poor with both parents not having any regular employment. So, I opted for C peptide estimation.
Type 1 or type 2? The answer may become clear next week when the lab results come.