Monday, August 31, 2009

Neonatal diabetes - a shocking case of correct diagnosis, but 32 years of wrong treatment

Gareth Roberts
You know how it is – when you tackle a subject which leads to exams. You learn all the different categories, which you store in your head in separate little compartments. Thus doctors and nutritionists are taught that there are two main forms of diabetes. There’s Type 1 diabetes, also called early-onset diabetes.  One day a child is fit and well, and next day it’s gravely ill, because its pancreas has stopped producing insulin, and blood sugar can no longer get into cells where it’s needed. There’s only one known treatment – daily insulin injections.
Then there’s the other form – Type 2 diabetes, also called middle-age onset diabetes, associated with obesity. The pancreas is still producing insulin, but not enough, or the tissues are  not responding to insulin.  For milder Type 2 diabetes, insulin injections are rarely necessary. Treatment is to correct overweight and faulty diet, supplemented if necessary by tablets of drugs like the sulphonylureas which stimulate insulin secretion from a flagging pancreas. Type 1 and Type 2 – and ne’er the twain shall meet, right?   Imagine the response of a James Robertson Justice type consultant if the young medic suggests treating a Type 1 (real or apparent) with sulphonylureas! "You NINCAMPOOP!!"
Yet that is what has apparently happened in the case of Gareth Roberts from Blackpool, reported in today’s BBC Health page  ("They have given me my life back") .

Gareth was born with diabetes, which was treated immediately with insulin injections.  For most of his life, he has been treated as if he had Type 1 diabetes. But he doesn’t. Type 1 diabetes usually develops in childhood, usually following an infection. It’s thought to be an auto-immune disease, in which the body starts attacking itself.

The good news for Gareth Roberts is that doctors at a West Country medical school decided to try him on sulphonylureas, for the “wrong” kind of diabetes, with near-miraculous results. The drugs control his diabetes. He no longer has to inject himself with insulin.
The bad news is that he’s spent most of his 32 years receiving 4 injections a day, because it was assumed that his form of diabetes was closer to Type 1 than Type 2, being apparently insulin-dependent, and that sulphonylureas are the wrong kind of treatment.
There is a moral here, methinks.  Medics – and their support scientists –  must always question the soundness or otherwise of their basic assumptions.  People who think out of the box should be given a fair hearing, and not immediately dismissed as nitpickers, awkward squad etc etc. 
Having said that, what a superb outcome it is for Gareth Roberts, to be freed from his daily regime. But spare a thought for the typical “Type 1” sufferers, for whom those daily injections are still needed.

Click here to return to Home Page/Latest Post

No comments: