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Podcast
Podcast: Does Your Patient Have Type I or Type II Diabetes?
By Irl B. Hirsch, MD |
June 17, 2011
Dr Irl Hirsch addresses that question in this podcast. Dr Hirsh is Medical Director of the Diabetes Care Center at the University of Washington Medical Center in Seattle, where he is also Diabetes Treatment and Teaching Professor of Medicine. Does Your Patient Have Type I or Type II Diabetes? by Irl Hirsch | July 01, 2011 3:00 AM EDT There is very little reason to draw a c-peptide level when initially evaluating a newly diagnosed patient due to the fact they are extremely insensitive. Many patients with type 1 diabetes will be making some insulin for months or even years while those with type 2 may have extremely low or suppressed c-peptide at diagnosis if recent glucose levels were high (glucotoxicity and lipotoxicity to the beta-cell). C-peptide does not note pathogenesis of the diabetes which is what is critical in type 1 or type 2 diabetes. After years of diabetes it may be helpful to help clarify type of diabetes since most type 1's have little or no C-peptide by then (and autoantibodies are usually negative over time). Different forms of monogenic diabetes have to be considered as we appreciate how common MODY, neonatal, and mitochondrial diabetes really are. These three forms of diabetes require high index of suspicion due to family history and all will be c-peptide positive. For the more common type 1 vs. type 2, measuring c-peptide or insulin at the time of diagnosis will rarely if ever be helpful. by claire katz | June 29, 2011 4:22 PM EDT what about cpeptide levels? |
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How can you determine whether your patient with newly diagnosed diabetes has type I or type II disease?