Q: I am a 31 years old male. I have been diagnosed with high blood sugar, which has come out as 280 (fasting) and 383 (pp). In the past 3 months I have lost 5 kg weight. I had started with Humulin 30/70 and 21 units of insulin. Of late, my blood sugar level has started dropping to 60-65, with even 16 units of insulin. Now I'm completely off insulin. My blood sugar hovers around 90-100 fasting and 130 pp, even after a rich carbohydrate meal. I tried avoiding Metformin one day and noticed just a 10 point increase in PP level (fasting was 95). I'm very confused about these figures. Following are the other test results: HbA1c - 8.3% at time of diagnosis C- peptide - 1.9 ng/ml and 381.4 pmol at diagnosis GAD 65 antibody - negative Urine Microalbuminuria - 38.1 mg/g creatinine and 28.4 mg/g creatine on seperate occasions Total Cholesterol - 185 LDL - 106 HDL - 43 VLDL - 35.5 Triglycerides - 179.6 BMI - 27 (before weight loss) Please answer the following questions: 1. What kind of diabetes is this? Is it type 1 or type 2? My father also had diabetes. 2. Could it be MODY - 1 /2, as it occurred at a very young age? I don't have enough money to get myself tested for MODY. 3. Should I request for a low dose insulin therapy? 4. Can I consume some protein shakes? 5. Do I come under high normoalbuminuria / microalbuminuria category? 6. If this is a type 1 diabetes, then should I go off insulin?

A:Hyperglycaemia promotes hyperglycaemia. When you control it with insulin, there is an apparent remission. Your goal should be to prevent yourself from becoming a diabetic as long as possible. Metformin and Pioglitazone are both good drugs that have been studied successfully in pre-diabetics. You can exercise and try to loose a couple of kilos in a healthy way to maintain a BMI around 23. Protein should not be a problem and you evidently do not have microalbuminuria. Occasional dietary indiscretions are OK but try to limit this to one meal. You say you have a family history of diabetes and you are evidently in a honeymoon period which can be prolonged significantly by avoiding foods with high glycaemic index (like potatoes, white bread and rice). A regular exercise will also benefit you.