Author Question: Why do you think Matias was originally diagnosed with T2DM? Why does the MD now suspect he may ... (Read 8 times)

cnetterville · **on:** Aug 21, 2018

Why do you think Matias was originally diagnosed with T2DM? Why does the MD now suspect he may actually have T1DM or LADA?

What will be an ideal response?

Question 2

What are the standard diagnostic criteria for each of these diagnoses?

What will be an ideal response?

trampas · **Reply #1 on:** Aug 21, 2018

Answer to Question 1

He was diagnosed with type 2 diabetes one year ago due to hyperglycemia; there were probably no antibodies present at that time, meaning he met only the type 2 criteria.
Now, the presence of antibodies GADA, IAA, and ICA indicates an autoimmune attack on the beta cells of the pancreas. The presence of antibodies makes a diagnosis of type 1 diabetes or LADA more appropriate.
His c-peptide is 0.6, which is very low, indicating that very little insulin is being produced due to the auto-destruction of the beta cells, further confirming a type 1 diagnosis.

Answer to Question 2

Type 1 diabetes:
Casual blood glucose above 200 mg/dL
Fasting blood glucose above 126 mg/dL
Oral glucose tolerance test >200 mg/dL (2-hr postprandial)
Presence of antibodies ICA, GADA, IA-2A, and IAA
Weight loss
Polydipsia, polyuria, polyphagia
C-peptide also used to help distinguish type 1 diabetes; low c-peptide indicates low or no insulin production
HbA1c >6.5
Type 2 diabetes:
Polydipsia, polyuria, polyphagia
Casual blood glucose above 200 mg/dL
Fasting blood glucose above 126 mg/dL
Oral glucose tolerance test >200 mg/dL (2-hr postprandial)
HbA1c >6.5
LADA: Generally, the most accepted diagnostic criteria for LADA includes the following: the presence of autoantibodies (e.g. ICA, GADA, and IA-2A), onset after age 30, and non-insulin dependent for at least six months past diagnosis