View each diagnosis of diabetes on its own

At last count, there were close to a dozen genes connected with the development of Type 2 diabetes.

The number grows each year. As more is learned about the genetic reasons why our bodies lose the ability to control sugar levels in the blood, we have a lot of catching up to do in regard to translating this knowledge into better individualized treatment plans in the doctor??s office.

The rate of medical treatment failure for Type 2 diabetes is simply too high. While the diabetic ultimately is responsible for following the treatment plan, the choice of prescribed drug therapy often can be one size fits all. Failure may not always be the patient??s fault, because many of the underlying causes which triggered the diabetes also might affect the response to treatment.

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Because diabetes is so common, seeing diabetics in the clinic may become very repetitive. Many of the patients?? stories may seem similar and tend to blend together. The office visit with the doctor may be brief, and other complex health problems also may require the doctor??s attention. Not surprisingly, short cuts and assumptions may creep in.

Diagnosing diabetes is easy. Our ability to properly classify it is not so straightforward, and sometimes incorrect. For example, about 1 in 10 diabetics labeled as Type 2 have blood markers that typically are found in people with Type 1. So regardless of your age, if you are not obese and have been told you have Type 2 diabetes, you should discuss the possibility of other diabetes types with your doctor. It takes a special blood study called an anti-islet cell autoimmunity panel to answer the question.

Another form of diabetes that can masquerade as Type 2 diabetes is called monogenic diabetes. There are several known forms of this diabetes, also known as MODY. Between 5 percent and 10 percent of diabetics have this type, but it is very underdiagnosed. The medicines used for these forms may be very different. These diabetics usually have related family members, such as a parent or a grandparent, with diabetes and have a 50 percent risk of passing the MODY gene on to children.

As we learn more about the different genes that cause diabetes, it is going to provide opportunities to develop targeted treatments before high blood sugars occur and ultimately prevent the disease altogether.

Money also plays a role in this problem. New diabetes medications are much more expensive than older generics, making generics the drugs of choice by insurance companies and cost-conscious doctors. This is not a bad thing. Many old diabetes medicines are still very valuable.

The special tests required to comb through these other forms of diabetes are very expensive and are performed only at special laboratories. Many insurance companies may not pay for these special tests without lots of justification by the doctor in the form of letters and phone calls.

So while we may be making progress against diabetes, getting this knowledge to the bedside or diabetes clinic is a slow process. Just understand that you remain your best advocate.

Dr. Stephen Ponder has Type 1 diabetes. He has been a pediatric endocrinologist for 23 years. He directs the Healthy Families program at Driscoll Children??s Hospital. Join by texting HEALTHY to 25827. He can be contacted at 361-694-4864 or , or follow at twitter.com/dr_steve_ponder

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By Dr. Stephen Ponder

Jun 24, 10 • Diabetes Support Blog