My 39 year old son has been diagnosed with diabetes but the type has yet to be determined. His initial symptoms were thirst, tiredness, heavy urination, weight loss & vision problems. He took a blood glucose test and it was 400 prior to eating. It has never come down to below 230 since he was started on Metformin just 4 days ago. He is being sent to an endocrinologist tomorrow, but as of yesterday his breath has that odd fruity - acetone smell to it, and his face is flushed. Ketoacidosis?

Dr. David Erani


The important thing is that your son is seeing an endocrinologist who can provide him with the treatment he needs. In the short term, it is more important to get blood glucose levels under control than to determine the type of diabetes. Any type of diabetes can be dangerous if it is not well-controlled. In practical terms, the main difference between type 1 and type 2 diabetes is that people with type 1 diabetes always have to take insulin to control their blood glucose and prevent diabetic ketoacidosis. There are many medications other than insulin for people with type 2 diabetes. So, which type does your son have? We can’t know for sure from the information that is currently available. We do know that 90-95% of people with diabetes have type 2 diabetes. Also, there are several factors which are associated with increased risk of developing type 2 diabetes. These include obesity, family history of diabetes, and belonging to certain racial and ethnic groups. There are certain blood tests which can help identify people with type 1 diabetes. You mention that metformin does not seem to be controlling your son’s blood glucose. Metformin would not be effective for type 1 diabetes, but even with type 2 diabetes, its effect is not immediate. Also, your son was very hyperglycemic. Severe hyperglycemia itself makes blood glucose levels more difficult to control by affecting insulin secretion as well as insulin action. These effects are referred to as “glucose toxicity.” Your son’s endocrinologist will focus on getting his blood glucose levels under control. This will most likely require insulin at least in the short term, regardless of the type of diabetes he has.

June 3, 2014 at 8:30 pm

3 replies

Anonymous 2016-04-02 11:17:58 -0500 Report

I was a type 2 than after a peptide test so was rediagnosised with type one brittle. My diabetes is so out of control no matter how hard I try too many highs and lows. The lows are the worse I am completely drained. I get tired easily and after working a 40 plus work week I just want to sleep on Saturday. I hate it is this normal?