I am so surprised that patients many times do not know the type of diabetes they have. Are we, as healthcare professionals, not making the distinction clear to patients? If this isn't disturbing enough, I think that some healthcare professionals are also confused about type 1 and 2. I still encounter healthcare professionals who are under the impression that if a person with diabetes uses insulin, the patient is considered insulin dependent.
We must address some of the misconceptions regarding diabetes diagnosis and make sure that everyone who delivers care to the patient understands the types of diabetes and the differences in the care they receive.
One of my colleagues was seeing a patient recently who came in for a post hospital follow up after being hospitalized with pancreatitis. The patient stated she was told she had type 1 diabetes and admitted she had not been checking her glucose levels and was self-titrating her insulin. My colleague had a valid question regarding if the patient had been correctly diagnosed. The patient was Hispanic, had a family history of diabetes, and had a BMI >25. A detailed history is crucial in correctly diagnosing individuals with diabetes.
In patients in which I suspect type 1 diabetes, I check a plasma c-peptide and insulin level, and insulin antibodies. An ADA Diabetes Care Supplement has a more detailed description of laboratory tests conducted to diagnose type 1 diabetes. In someone with type 1 diabetes, the c-peptide and insulin levels will be very low or undetectable. Patients with type 1 diabetes are usually diagnosed in the emergent care setting as a result of DKA.
Patients with type 2 diabetes are easier to diagnose because we have time to trend their A1C levels. I don’t usually measure c-peptide levels in these patients but I measure insulin levels in those who present with signs of hyperinsulinemia.
Do you clearly reinforce the type of diabetes a patient has when he/she is diagnosed? Do you explain the difference? How do you make sure that all staff and colleagues know the difference between the types and know how to deliver care accordingly?