The 12 yr old girl with Diabetes about whom I posted few days ago came with her lab reports. The C peptide level was in the upper range of normal.It means considerable amount of Insulin is being secreted from her Pancreas.
Does it mean she is having Type 2 Diabetes? We cannot be sure yet. There is something called 'honey moon' period in Type 1 Diabetes where the patient's requirement of Insulin injections will be less or even nil. That does not mean the patient is not suffering Type 1 Diabetes. After such honey moon period which lasts for few months the Insulin requirement will increase and the patient will show all features of Type 1 Diabetes.
Let us hope it is not Type 1 Diabetes but only time will tell.Meanwhile I have started her on Oral tablets in addition to Insulin.Let us see the response.
Showing posts with label type 1 Diabetes. Show all posts
Showing posts with label type 1 Diabetes. Show all posts
Friday, August 22, 2008
Thursday, August 14, 2008
Diabetes Type 1 or Type 2?
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.
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.
Friday, August 1, 2008
Doctor,please give me your cellphone number
Doctor, please give me your cellphone number.Then in case of an emergency we can contact you directly.
I receive such request very frequently. How should I respond?
You will think that this is a reasonable request. Each and every patient should be able to contact the treating doctor directly in an emergency. You wont have any second thoughts about how I should respond. But.............
I am sure if each and every patient I treat get my cellphone number, I wont have a single minute of peaceful living. I will be deluged with calls while sleeping, eating, bathing, driving, when seeing patients in my Consultation room, while taking rounds etc etc. Sense of propriety and ethics are forgotten. The facility will be misused [as some already do who have somehow got my cell number.]
I am available in the daytime at my land phone numbers. At night in case of an emergency, the patient have to approach the hospital were I work. The staff at the hospital can contact me 24 hours a day.
For some of my patients, I give my cellphone number without hesitation. They are
1. HIV positive persons
2. Type 1 diabetes patients
I don't hesitate for HIV positive persons, because I feel with all the stigma and discrimination they face, they should at least be positively discriminated by me. They should be able to talk to me anytime they want.
Type 1 diabetes patients need constant communication with the treating doctor as they have to self manage a lot and may need physician guidance in management.
Another reason for lack of hesitation is that 'positive' persons and type 1 diabetics under my care constitute less than 1 percentage of total number of patients. So, I need not loose sleep giving away cellphone numbers to them.
Do you think of me as a selfish and uncaring doc?
I receive such request very frequently. How should I respond?
You will think that this is a reasonable request. Each and every patient should be able to contact the treating doctor directly in an emergency. You wont have any second thoughts about how I should respond. But.............
I am sure if each and every patient I treat get my cellphone number, I wont have a single minute of peaceful living. I will be deluged with calls while sleeping, eating, bathing, driving, when seeing patients in my Consultation room, while taking rounds etc etc. Sense of propriety and ethics are forgotten. The facility will be misused [as some already do who have somehow got my cell number.]
I am available in the daytime at my land phone numbers. At night in case of an emergency, the patient have to approach the hospital were I work. The staff at the hospital can contact me 24 hours a day.
For some of my patients, I give my cellphone number without hesitation. They are
1. HIV positive persons
2. Type 1 diabetes patients
I don't hesitate for HIV positive persons, because I feel with all the stigma and discrimination they face, they should at least be positively discriminated by me. They should be able to talk to me anytime they want.
Type 1 diabetes patients need constant communication with the treating doctor as they have to self manage a lot and may need physician guidance in management.
Another reason for lack of hesitation is that 'positive' persons and type 1 diabetics under my care constitute less than 1 percentage of total number of patients. So, I need not loose sleep giving away cellphone numbers to them.
Do you think of me as a selfish and uncaring doc?
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