Misdiagnosis of Diabetes
The most likely diagnostic problem with diabetes is failure to diagnose it early because patients do not recognize its early mild symptoms. Once a doctor is seen, diabetes is not often completely misdiagnosed because it is well-known to physicians and has fairly definitive diagnostic tests (blood glucose test; urine glucose test). However, more difficulty is found in determining the correct type of diabetes, diagnosing any complications of diabetes, or associated diseases.
Undiagnosed Diabetes. The most likely misdiagnosis related to diabetes is that it remains undiagnosed in many people. This mostly refers to Type 2 Diabetes, where the disease can take years to progress to major symptoms, but undiagnosed Type 1 Diabetes can occur (though usually becomes visible within weeks or months). Read more about: Symptoms of Diabetes.
Acute Complications of Undiagnosed Diabetes: If diabetes is undiagnosed, some of the symptoms and complications can become very dangerous. These can often remain undiagnosed until too late, or can be misdiagnosed as something else. Fatality is possible. The complications include:
- Diabetic Ketoacidosis (DKA). This is a dangerous, potentially-fatal complications of diabetes, due to the production of acidic ketones in the blood. Suspected DKA is a medical emergency.
- HHNS. HHNS is similar to DKA, but has a slightly different profile due to the body still processing some sugars. It is mainly a complication of Type 2 Diabetes, whereas Type 1 Diabetes would usually lead to DKA. However, Type 2 Diabetes can also lead to DKA. HHNS should be treated as a medical emergency.
- Dehydration. The chronic urination symptoms of diabetes can often lead to dehydration, despite the patient having massive thirst and taking in lots of fluids.
- Electrolyte imbalance. The imbalance results from the onset of DKA or HHNS. Serious imbalance can have dangerous consequences, even a potential heart attack (e.g. from low magnesium) .
- Diabetic Coma
Most Dangerous Misdiagnosis: One of the most dangerous errors in diagnosis is to incorrectly diagnose a person with Type 2 Diabetes, sending them home with instructions about diet and how to monitor their blood sugar levels. If they actually have Type 1 Diabetes, insulin is required, and trying to treat it with diet changes alone is likely to result in DKA and even death. There are real-world examples of this diagnostic mistake. A six-year-old girl died after being sent home in this way, with a Type 2 Diabetes diagnosis, and a diet treatment plan (insulin was required; DKA was the result). But Type 2 Diabetes is extremely rare in children under 10; it’s almost certainly Type 1 Diabetes in that age group. And an older child or a teenager is actually the most likely age to get Type 1 Diabetes requiring insulin (although the reverse misdiagnosis is possible since some teens are being diagnosed correctly with Type 2 Diabetes). Another example case is a 29-year-old man sent home with instructions about dieting and monitoring, with a diagnosis of Type 2 Diabetes. Although it’s more likely for a 29-year-old than a 6-year-old to have Type 2 Diabetes, the age is still an unusual age for Type 2 Diabetes. And at 29, the possibility of Type 1 Diabetes is still there, and this was the actual correct diagnosis (insulin was required). MODY Diabetes is another possibility for a younger adult in their 20’s or 30’s with Type 2 Diabetes, rather than the classic ages of onset for Type 2 Diabetes (40’s or 50’s or later).
Misdiagnosed: The list of conditions that mimic diabetes is not really that long. A total misdiagnosis is highly unlikely.
- Fructosuria. A rare condition that causes the appearance of fructose in the urine that may trigger a false positive on a urine glucose test. But a blood glucose test should not be high in this case.
- Xylulosuria. Another rare disease that causes some forms of sugar in the urine, but which also shouldn’t cause glucose in the blood.
- Glucagonoma. A rare endocrine tumor of the endocrine pancreas, that over-produces glucagon, which can stimulate the liver to create too much sugar in the blood. (Note that the better known type of Pancreatic Cancer is not similar to this disorder; however, a pancreas disorder can sometimes lead to reduced insulin production and diabetes.)
- Diabetes Insipidus: Despite its similar name, this rare disease has almost no relationship to common diabetes, except that its hallmark symptom is excessive urination. This disease is a kidney disease (due to a pituitary disorder) and is extremely unlikely to be misdiagnosed as diabetes.
Hidden Causes (Secondary Diabetes): There are a number of medical conditions that can cause diabetes symptoms, or diabetes-like conditions, mainly due to their impact on the pancreas. These conditions usually cause “insulin deficiency” rather than “insulin resistance”.
- Pancreatitis. An inflammation of the pancreas can sometimes cause the insulin-related part of the pancreas (endocrine pancreas) to fail. However, pancreatitis more commonly causes digestive symptoms than diabetes-like symptoms.
- Hemochromatosis (“bronze diabetes”). A genetic disease that is often overlooked, occurring in about 1 in 200 to 300 people, which damages the pancreas, liver, heart, and joints, among other symptoms. If you are diagnosed with diabetes, then a second diagnosis of hidden hemochromatosis is one of those rare cases where it’s good to get a second disease! Hemochromatosis is often readily treatable, and doing so can often improve diabetes symptoms, or at least stall any further diabetes progression. (Read more about: Hemochromatosis.)
- Pancreas disorders. Other disorders of the pancreas can affect it in a way to cause diabetes-like symptoms. Pancreas injury of any type, or any pancreas surgery, may also cause this.
- Acromegaly. A rare and insidious disorder of the growth hormone that can cause a form of secondary diabetes.
- Cushing’s syndrome. Another endocrine disorder that can cause secondary diabetes. Cushing’s syndrome involves the adrenal glands producing too much corticosteroid hormones, so the effect is similar to “steroid diabetes”. There are various other symptoms.
- Pheochromocytoma. A form of cancer that may have secondary diabetes as one of its symptoms; other symptoms are likely.
- Somatostatinoma. An extremely rare form of cancer that may cause over-production of statins, and show the effects of secondary diabetes. Other gastrointestinal symptoms are typical.
Drug-Related Diabetes: There are a number of drug medications that can sometimes cause diabetes or diabetes-like conditions.
Genetic Syndromes with Increased Diabetic Risk: There are a number of genetic diseases or disorders where the person is at higher risk of diabetes.
- Down Syndrome
- Turner Syndrome
- Friedeich’s Ataxia
- Klinefelter Syndrome
- Glycogen Storage Disorder (Type 1)
- Laurence-Moon-Biedl Syndrome
- Refsum Syndrome
Wrong Type of Diabetes: Sometimes people are correctly diagnosed with diabetes, but the wrong subtype is diagnosed. There are two main types of diabetes and a few rare types.
- Type 1 Diabetes (Juvenile Diabetes). The insulin-requiring juvenile type of diabetes is less common, affecting about 0.5% of the population (about 1 in 200). A teenager diagnosed with diabetes would usually be considered for Type 1 Diabetes, but recent increases in teenage obesity rates have increased the rate at which teens are found to have Type 2 Diabetes. Read more about Misdiagnosis of Type 1 Diabetes.
- Type 2 Diabetes. The most common form of diabetes, which typically affects older adults in their 40’s or 50’s. However, some teens can get Type 2 Diabetes. A younger adult in their 20’s or 30’s could have Type 2 Diabetes, but Type 1 Diabetes may also be likely. It is rare for someone in their 40’s or 50’s or older to have Type 1 Diabetes, so misdiagnosis between the types in that age group is unlikely.
- MODY Diabetes. A rarer form of diabetes that is less well-known.
- Gestational Diabetes. A form of diabetes in pregnant women, that usually disappears after the baby is born. It is usually thought to be a form of Type 2 diabetes (or pre-diabetes) that is exacerbated by pregnancy’s hormone changes and weight gain, but becomes dormant again once these changes reverse after birth.
- Diabetes Insipidus. Not likely to be misdiagnosed! This is not actually a form of Diabetes Mellitus, they just have similar names for historical reasons. Diabetes Insipidus is a rare disease of the pituitary gland and the kidneys. It has nothing to do with sugars or the pancreas. The main similar symptom is excessive urine, which contains sugar in diabetes mellitus but is without sugar (insipid) in diabetes insipidus. A positive diabetic test for urine glucose or high blood glucose very quickly rules this one out.
- Pre-Diabetes. This is an early type of diabetes, also called Impaired Glucose Tolerance (IGT). It is often undiagnosed due to its mild or absent symptoms, but it is usually correctly diagnosed once diabetes testing is performed.
- Stress diabetes. This is a rare diagnosis. Acute stress can sometimes trigger a form of diabetes which, like gestational diabetes, is believed to be due to stress exacerbating an underlying condition of pre-diabetes or Type 2 diabetes. If stress is removed, this type of diabetes may reverse. Recurrence of pre-diabetes or Type 2 diabetes is common in later life.
Subtypes of Type 2 Diabetes: There are actually subtypes of the main Type 2 Diabetes, which can affect how to treat it. The main issue is whether your body is producing too much insulin but resisting it (called “insulin-resistant”), or the less common case where your body is producing too little insulin (called “insulin-deficient” type). Detection of insulin resistance (and hyperinsulinemia) makes it very likely that the diabetes is classic Type 2 Diabetes, but the detection of an insulin-deficient type may increase the suspicion of another rarer type of diabetes or secondary diabetes.
- Type 2 Diabetes Insulin-Resistant Type. This is the main form of Type 2 Diabetes, where the body cells fail to be able to properly process insulin. Most people with Type 2 Diabetes are “insulin resistant”, which means their body cells are resistance to insulin, and paradoxically, they often actually have levels of insulin in the blood that are too high.
- Type 2 Diabetes Insulin-Deficient Type. This refers to a form of Type 2 Diabetes where the pancreas produces less insulin than normal. Although Type 2 Diabetes is common, this subtype is not. Most people have the other type, the insulin-resistant type. However, a less common “insulin deficient” subtype of Type 2 Diabetes should not be overlooked. This subtype can often result from some form of hidden pancreas disorder (e.g. hemochromatosis, pancreatitis, pancreas injury, etc.)
- MODY Diabetes. A quite rare form of diabetes occurring in adults.
Undiagnosed Chronic Complications of Diabetes. The onset of Type 2 Diabetes can be so slow that the complications of diabetes can have time to develop prior to the diabetes being discovered. And once diagnosed, the careful watching for any signs of diabetes complications becomes an ongoing management concern. Read more about diabetes complications, but some of the complications more likely to be undiagnosed include:
- Diabetic heart disease. This is a serious concern, as diabetes-related heart disease is one of the main long-term killers of people with diabetes, although it usually only does so after years of struggling with diabetes control.
- Cerebrovascular disease (stroke). This refers to damage to the blood vessels in the brain. The risk is brain hemorrhage and stroke.
- Peripheral vascular disease
- Diabetic kidney disease. Like all forms of kidney disease, the early stages of this disorder can be without any major symptoms.
- Diabetic neuropathy. Damage to the nerves, which can cause a variety of different problems depending on which nerves are damaged.
- Diabetic peripheral neuropathy. Damage to the peripheral nerves (hands, feet, fingers, toes), which can cause issues like tingling fingers, tingling or numb toes, and various other concerns. Management of the feet in diabetics is of particular importance. Tingling toes is an extremely common symptom in diabetes.
- Mononeuropathies. Sometimes a single nerve may be affected by neuropathy.
- Diabetic gastroparesis. A paralysis of the stomach nerves causing digestive issues. This is a type of neuropathy.
- Diabetes diarrhea. A disorder of the intestines caused by diabetes. This is also a type of neuropathy.
- Diabetic retinopathy. Damage to the retina at the back of the eye, that can lead to vision loss.
- Autonomic neuropathy
- Diabetic foot ulcers.
- Erectile dysfunction (impotence). Diabetes is a major cause of erectile dysfunction.
- Stroke. People with diabetes have a high risk of stroke. This is a medical emergency.
- Chronic or recurring infections.
Associated (Comorbid) Conditions: Not only is there diabetes, and the various complications of diabetes, but people with diabetes can often have additional diseases. People with Type 1 Diabetes are more likely to have other types of Autoimmune Diseases (e.g. Addison’s Disease). A list of comorbid disorders for Type 1 diabetes includes:
People with Type 2 Diabetes often have three other disorders: hypertension, obesity, and high cholesterol, which is a cluster of four diseases (including diabetes) which is called Metabolic Syndrome (Syndrome X). There are various other associated diseases for diabetes. A list of these comorbid disorders for Type 2 diabetes includes:
- Metabolic syndrome (obesity; high cholesterol; hypertension; diabetes). Also known as “Syndrome X”.
- Insulin resistance
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Note: This site is for informational purposes only and is not medical advice. See your doctor or other qualified medical professional for all your medical needs.