Aggressive and devastating neuropathy: the consequence of untreated slow-onset type 1 diabetes by P. Narendran et al; QJM (2011) 104 (6): 523-526 | DOI: Aggressive and devastating neuropathy: the consequence of untreated slow-onset type 1 diabetes | QJM: An International Journal of Medicine | Oxford Academic; Published: 27 July 2010
We describe two cases of T1D where a period of undiagnosed and untreated hyperglycaemia resulted in the aggressive onset of microvascular complications. These cases support our previous understanding that T1D can present with preceding prolonged hyperglycaemia but go on to illustrate for the first time that this hyperglycaemia can result in diabetic complications. The phenomenon of undiagnosed diabetes resulting in complications is well recognized in type 2 diabetes (T2D), where a significant proportion of patients have a complication at the time of diagnosis, but as far as we are aware this has not been described in T1D.
There are clear similarities between these cases (young white Caucasian adult males, insidious presentation of T1D, initial aggressive development of neurological and other microvascular complications with a subsequent stabilization), and they may form a distinct variant of T1D.
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“While it is traditionally believed that newly diagnosed patients with type 1 diabetes (T1D) present to medical care acutely, a careful history reveals this is not always the case. Children describe an average of 2 weeks of osmotic symptoms at the time of diagnosis, and adults up to 5 weeks.”
Interesting – if this is truly what the state-of-the-art medical science believes about diabetes, this is another case where our diabetes specialists don’t know much. I have heard much first-hand evidence that this is not the case, and that children can “present osmotic symptoms” (i.e. increased urination) for much more than 2 weeks before diagnosis. My son was diabetic for probably five months, possibly more, before he was diagnosed – that is clear from his behavior in the year preceding his diagnosis.
If your A1C is high at diagnosis, then, clearly, you have been diabetic for a while… For instance, at diagnosis, my son’s A1c was 12.5%.
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Me, too, at least 6 months, and like @drbbennett, following an illness (horrendous flu). So scary to realize how many of us go so long before getting treatment and having to worry about complications afterward.
I also was thinking though that an earlier DX in my case might (erroneously) have been as T2 and I might not have been put on insulin right away, which I did desperately need! Sigh…
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