What would you do?

A 21 year old Caucasian female comes into your office in early February. She is 5’3″ and according to your scale is barely over 100 pounds. You diagnosed her about 9 months earlier with Type 2 diabetes and advised her to control it with diet and exercise. You told her to come back and see you if she ever felt “really sick” or when she got pregnant. She thinks the reason she is not feeling well is because of her diabetes and brings you this paper.

 

diabetes dx
 
So here’s the question: what do you do?

0 Comments

  • Well, first and foremost, I’d sit down with her for a very basic yet very informative “diabetes class” and help her truly understand the physiology behind what’s happening in her body, what her responsibilities are as a diabetic, and what to do when she feels confused or lost.

    Then I’d give her a hug.

    (This is a very interesting post, Sara!!!!)

  • Probably admit to the hospital for intensive education and initiation of insulin therapy. Look for precipitant of poor diabetes control.

    This doesn’t sound like type 2 diabetes.

    Might be interesting to check for pancreatic autoantibodies.

    -Steve

  • Wooah, There are many things happening. I think everyone has a point.

    2 things that interest me is;

    1) Are all her numbers like that, perhaps she has been feeling unwell because she is actually unwell???

    2) Something managed to bring her BG down overnight on 2 occasions.

    Mike

  • I’d admit her to the hospital and try a no carb diet to see what her blood sugar does while keeping her very hydrated and then check for the pancreatic autoantibodies. Could be type 1 or could be type 2…I’ve heard it go both ways from similar numbers.

  • Interesting question, especially since I was the gal you describe here…only happened to me at age 27. My GP initially tried to treat me as a T2, when clearly I was a LADA -T1. I think I would have most appreciated an apology, and an immediate referral to an endocrinologist…making the call for her to hopefully get her in quickly. If the patient could not get in to see an endocrinologist within a day or two, I would let her know that I suspected she was a T1, and explain what that means. I’d test her for ketones, and depending on those results, might chose to admit her to the hospital to make sure she avoided DKA. I would also go ahead and do an A1C, start her on a basal insulin like Lantus, tell her to keep her carb intake at 45 grams or less per meal (show her a website like calorieking), and e-mail her blood sugar readings to me daily until the endoc could take over. I would also tell her that diabetes is not her fault, and that no amount of diet, exercise or oral medication will chase it away if she is indeed a T1. I would tell her that her life is not over, and that she can live well with diabetes, though it will mean some changes. I would encourage her to call me with any additional questions she had. Oh, and I’d give her the link to the DOC so she would know immediately that she’s not alone.

  • Hopefully, stop “treating” diabetes and refer ALL my diabetic patients to a doctor who knows more about diabetes. She never should have been diagnosed type 2 (unless she’s lost a lot of weight and BG were controlled with diet/exercise alone to begin with). And a 9 month f/u???!!!! That’s just crazy! A new diagnosis should f/u AT LEAST monthly for a few months (in my opinion anyway). Definitely not longer than 2-3 months. Wow!

  • Admit her to the hospital! Being I’m not a doctor I don’t know what else would happen but I’d sure as hedoubles get some insulin in her!!

    I am so glad she got the necessary help and a proper diagnosis ….. and she is awesome and fine now 🙂

  • Well, since you misdiagnosed her in the first place, you’d probably say, “Damn, girl. You really need some better control.” And then you’d send her to somebody who (unbeknownst to you) probably would do a better job of seeing that she’s most likely T1.

    Of course, that’s just a guess.

  • I don’t agree with the folks saying that she’s DEFINITELY not T2. The only clue the case AS PRESENTED gives about her food choices during the period covered by the number is that she’s not overweight. I certainly agree that T1 seems more likely, but I don’t see why it couldn’t have been poorly controlled T2, which doesn’t require obesity.

  • If it were me-I would write a list of test and questions she should ask the doctor and go from there. I agree with Bob we can not assume that she has Type 1 or LADA with out her having the proper test done.

  • I was really tired when I was diagnoed with T2 diabetes. And if my reading were this hight, i suspect that my doctor would have put me in the hospital rather quickly, to determine what was going on with my BG level. I am still working and have lost over 40 LBs(why I don’t know) but I have. Whoever this is needs to see a doctor really quickly , because they are not well.


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