The 2017 type 1 diabetes resolution...
I have the ultimate New Years resolution to make for 2017: let's not miss any more new cases of type 1 diabetes before they can get too far out of control.
I'm a member of a consortium of specialist physicians and health care organizations aiming to raise awareness of the signs and symptoms of type 1 diabetes and to get more doctors to screen for this.
New cases of type 1 diabetes are on the rise. This has been the case for as long as I can remember. As a pediatric endocrinologist, I've heard the detailed stories of what led up to my patient's formal diagnosis. In my professional experience I have found that the diagnosis is missed early on in at least one third of cases. This includes patients, their families, and many doctors.
In defense of my fellow physicians, making diagnostic errors is a burden we all must live with. I've certainly made my share of wrong diagnoses in all areas of my work. Any doctor who says they've never made a treatment error or missed a diagnosis is simply not telling the truth. Learning from diagnostic errors and changing one's approach and thinking is what defines a good doctor from a great one.
Sometimes the family or patient actually suspected they or their child had diabetes symptoms and signs, but the doctor chose not to investigate further. This led to a delay in diagnosis which resulted in the patient returning later in a poorer metabolic state, maybe even in diabetic ketoacidosis or coma.
Often, the early signs and symptoms of diabetes are not very specific. Doctors are trained to look for common conditions first. As common as diabetes is overall, new onset type 1 diabetes affects about 3-4 per persons out of 1,000. Most doctors' personal experience with diabetes comes from their contact with large numbers of patients with type 2 diabetes, which is far more common.
These patients tend to have a more gradual onset and there is often less of a sense of urgency to making a diagnosis. Still, even type 2 cases are frequently missed due to lack of consideration by the physician. And many type 1 patients are mistakenly diagnosed as type 2. At least they were discovered, but the way they get managed after that creates it's own set of problems.
There are several common presentations for type 1 diabetes in youngsters. A suspected case of stomach flu or a viral syndrome may be how a child or teen presents with type 1 diabetes. Ironically, this could also be the real problem and it simply precipitates a precarious metabolic balance which has been reached after 85-90% of the child's insulin producing cells (beta cells) have been lost or compromised by the type 1 diabetes process. The slightest stress or a minor infection is enough to push them 'over the edge'. The process causing the loss of the insulin producing cells is usually present for months to years before symptoms occur.
Similarly, a strep throat-like picture or suspected urinary tract infection can be a presenting history.