Very overweight with very different stories

Marcy is a 22-year-old woman has had type 1 diabetes since age 6 years. During the past year or so, she has been chasing hypoglycemia and has ballooned to a BMI of 44.6. As she has gained the weight, she has clearly developed some insulin resistance. To her credit, she is seeing a dietitian regularly and has an appointment set up to consider bariatric surgery.

Jody, on the other hand, is also 22 years old, but her story is quite different. Almost 12 months before she was referred to my clinic, she was diagnosed as having type 2 diabetes. Her clinician could not have been more incorrect! She has ballooned to a BMI of 60.8 — not a typographical error — as she struggled to avoid the symptoms of hypoglycemia. Because her blood glucose values were more often low than high, she was not placed on any therapy to control “diabetes.” Be thankful for small mercies.

Her fasting blood glucose when the initial diagnosis was given was 105 mg/dL with an HbA1c of 5.6%. Fasting insulin level was 70! An octreotide scan has confirmed the diagnosis of an insulinoma and laparoscopic surgery will be completed well before this blog is posted.

What remains uncertain is how this young woman will lose the weight she has gained since the incorrect diagnosis was made. I am also concerned that she might have insulin resistance, albeit at an insulin secretion rate below her current levels.

Readers, have you encountered this type of case before?