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Recognizing the Signs of Metabolic Syndrome and Polycystic Ovary Syndrome in a Caucasian Adolescent Girl: Differentiating Type 2 From Type 1 Diabetes

The first 300 words of the full text of this article appear below.

	Case Presentation

 
C.K., a 12-year-old Caucasian girl, came to our office for a school entry physical. Her medical history included being diagnosed with type 1 diabetes 18 months earlier when she presented to an emergency room with flu-like symptoms of lethargy and dehydration and was found to have a blood glucose level of 994 mg/dl. After a short hospitalization, she had been discharged on split doses of rapid- and long-acting insulin. Because of her poor glycemic control, her insulin dosages had been increased at each of two subsequent visits with her previous diabetes care provider.

At the time of her first visit to our office, her insulin regimen was 60 units of lente with 40 units of lispro (Humalog) in the morning, 45 units of lispro at lunch, and 70 units of lente with 30 units of lispro at dinner. Her blood glucose ranged from low to 437 mg/dl (mostly in the high 200s) before breakfast, 63–174 mg/dl before lunch, 97–370 mg/dl before dinner, and 151–441 mg/dl before bed. A hemoglobin A1c (A1C) measured 7 weeks before this visit was 9.0%. She had been instructed after the A1C test to increase both her lente and lispro dosages but had not done so; she refused to take two injections (more than 100 units) at breakfast and dinner. Instead, she had continued with the same insulin dosages, which allowed her to fill a single 1-cc syringe.

Her family history was positive for diabetes, hypertension, cardiovascular disease, hypothyroidism, and depression. Menarche had occurred about 1 year ago, and her menstrual frequency was sporadic. Menstruation had occurred less than nine times during the past year, and the date of her last menstrual period was unknown.

A review of her dietary habits revealed usual breakfasts of cereal, milk, juice, bagels, muffins, and waffles or pancakes with low-calorie . . . [Full Text of this Article]

	Discussion

 
Case Study Follow-Up
Conclusions

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