New type 2 and confused

[ME_Valentijn]

I am at a complete loss as to what the panic is about on the part of your treatment team.

Well, I can say from experience that being that hyperglycemic and badly symptomatic from it was a completely miserable experience at diagnosis. Combined with a complete lack of guidance and a med that will take weeks to do anything, I'd rather see a bit of panic, or at least something other than apparent indifference.

 

[BarbaraG]

That's really good news, Tracey, well done!! Great that they gave you ketone strips too.

If you do go very low carb (well under 50g) you will probably go into nutritional ketosis - this is a benign metabolic state in which your body is very good at burning fat for fuel. It's completely different from diabetic ketoacidosis (DKA)

It's the concern about potential DKA which prompted them to give you the ketone strips. What have they told you about the numbers you get from that and what to do with them? Ketones up to 5 are nothing to be concerned about, but some HCP's don't realise this and panic at the slightest hint of ketones. DKA = high ketones plus high BG. Nutritional ketosis = moderate ketones plus low to moderate BG.

 

[steveyp]

Well, I can say from experience that being that hyperglycemic and badly symptomatic from it was a completely miserable experience at diagnosis. Combined with a complete lack of guidance and a med that will take weeks to do anything, I'd rather see a bit of panic, or at least something other than apparent indifference.

I have a sneaky feeling the Dr hadn't made the DB team appointments as after a week I'd heard nothing but then yesterday I had both in one day...

 

[steveyp]

That's really good news, Tracey, well done!! Great that they gave you ketone strips too.

If you do go very low carb (well under 50g) you will probably go into nutritional ketosis - this is a benign metabolic state in which your body is very good at burning fat for fuel. It's completely different from diabetic ketoacidosis (DKA)

It's the concern about potential DKA which prompted them to give you the ketone strips. What have they told you about the numbers you get from that and what to do with them? Ketones up to 5 are nothing to be concerned about, but some HCP's don't realise this and panic at the slightest hint of ketones. DKA = high ketones plus high BG. Nutritional ketosis = moderate ketones plus low to moderate BG.

Hi Barbara the urine sample was negative and the nurse said 0 to 1 ketones was ok. it was 0.5 yesterday and 0.2 today. I'm having up to 100 g carbs but usually I have around 80 ish.

 

[Winnie53]

Well, I can say from experience that being that hyperglycemic and badly symptomatic from it was a completely miserable experience at diagnosis. Combined with a complete lack of guidance and a med that will take weeks to do anything, I'd rather see a bit of panic, or at least something other than apparent indifference.

ME_Valentijn Here's the problem. Diabetes is a carbohydrate intolerance. The medications help a lot initially, but the diabetes continues to progress, so slowly that you don't feel alarmed.

Diet and exercise is the only way I know to stop its progression and put it into remission, and it takes regular glucose monitoring to stay motivated. That said, if the pancreas is being attacked by the body, which is an autoimmune problem, then injecting insulin becomes necessary.

I wish I could turn back the clock. When I crossed over into pre-diabetes in 2002, then type 2 diabetes in 2005, I received the best standard of care in the USA from an endocrinologist and was monitored quarterly for three years. I was given a glucose meter and test strips but no one told me how to get my glucose levels down with diet, so, discouraged, I gave up, and ignored it, eating foods that are healthy for non-diabetics, but not for diabetics.

No amount of money or medications turns this around. It takes grit. A commitment to doing the hard work of changing the diet and increasing physical activity.

If I was able to stop the progression of my diabetes - (I have severe insulin resistance and can achieve a blood glucose level in the mid 200's with one inappropriate meal) - anyone can do it. And that's why I'm here, to help those who are where I was 15 years ago.

 

[ME_Valentijn]

The medications help a lot initially, but the diabetes continues to progress, so slowly that you don't feel alarmed.

Yes, and that's why insulin is often used in the short-term at diagnosis, so someone doesn't have to figure out how to drastically alter their life while also sick as a dog. Then it can be stopped when blood sugar is down to a sane level.

Diet and exercise is the only way I know to stop its progression and put it into remission ....

But diet is going to take a week or two to get someone out of the danger zone, and they definitely shouldn't be exercising while they are so hyperglycemic.

 

[Winnie53]

@ME_Valentijn why do you think we shouldn't walk when glucose levels are in the 13.9 mmol/l (250.2 mg/dl) to 17.7 mmol/l (318.6 mg/dl range? I ask only because this is the first time I've been told this.

I went out to breakfast the other day and had a plate filled with an omelet and potatoes. I checked my glucose level when I got home and it was 264 mg/dl (14.7 mmol/l). That hadn't happened in two years. I was horrified.

Went for a two and a half mile walk and my glucose dropped to 116 mg/dl (6.4 mmol/l). That wouldn't have happened two years ago when I was running glucose levels in the high 200's when re-diagnosed with type 2 diabetes of course, but it was so empowering to know that if that ever happens again, I can knock it back down immediately.

 

[ME_Valentijn]

@ME_Valentijn why do you think we shouldn't walk when glucose levels are in the 13.9 mmol/l (250.2 mg/dl) to 17.7 mmol/l (318.6 mg/dl range? I ask only because this is the first time I've been told this.

I said "exercising", not "walking". It can be a problem because people might be producing ketones if they've been that hyperglycemic for a while, as people with a new diagnosis generally are. Exercise would then produce additional ketones, and could put someone at risk of DKA.

 

[Winnie53]

@ME_Valentijn I'm at work right now. Not sure diabetic ketoacidosis (DKA) is a problem for type 2 diabetics at the levels we're discussing unless they're on a medication that can cause that complication. Will research it tonight when I'm home.

 

[Winnie53]

@ME_Valentijn Much of what I read tonight about diabetic ketoacidosis and type 2 diabetes is confusing. Can it happen? Yes, but typically not in an otherwise healthy type 2 diabetic who hasn't previously taken diabetes medications.

To learn more, do a search on "diabetes ketoacidosis type 2".

The American Diabetes Association provided a reasonably good overview and more importantly, a list of symptoms to pay attention to and when to call your doctor... http://www.diabetes.org/living-with-diabetes/complications/ketoacidosis-dka.html

Many, many type 2 diabetics have high glucose levels at the time of diagnosis. My diabetes was caught early because my doctor periodically checked my glucose levels due to my history of hypoglycemia then gestational diabetes in my 20's.

Thankfully, the low carbohydrate diet and walking works well for all types of diabetes.

 

[ME_Valentijn]

Much of what I read tonight about diabetic ketoacidosis and type 2 diabetes is confusing. Can it happen? Yes, but typically not in an otherwise healthy type 2 diabetic who hasn't previously taken diabetes medications.

Unfortunately there isn't a lot known about what type someone is at diagnosis. Despite what nationalized health care likes to think, being older and overweight isn't the vaccine against Type 1, LADA, flatbush, or MODY Finding out requires testing, and that often take a while, assuming that it's done at all. And even with confirmed Type 2, there's indications that ketoacidosis can sometimes be a risk during unusual circumstances, such as with an infection, at diagnosis, and when insulin-producing drugs (gliclazide) needed for that patient have not been taken.

My doctor assumed Type 2 at diagnosis. But after another week at around 15.0 on average I started testing and had detectable levels of ketones in my urine constantly. That was frequently elevated to levels where ketoacidosis is a risk. The only way to know if it's a problem is to check, but most newly diagnosed with Diabetes have no way to check, and might not even have a blood sugar monitor. To quote the American Diabetes Association (Emphasis in bold italics is theirs, conversion to mmol/L is added by me.):

You can often lower your blood glucose level by exercising. However, if your blood glucose is above 240 mg/dl (13.3), check your urine for ketones. If you have ketones, do not exercise.

Exercising when ketones are present may make your blood glucose level go even higher. You'll need to work with your doctor to find the safest way for you to lower your blood glucose level.

This is another reason I think it's incredibly stupid that new patients presumed to have Type 2 aren't given a meter and a prescription for testing strips. Not only can they not figure out what foods work for them, they can't even determine if it's safe to exercise, especially at the beginning when they're very likely to be hyperglycemic.

 

[Winnie53]

You're right, initial diagnosis is made based on information at hand. As more information becomes available, the diagnosis may change.

The good news is that for most of us, lowering carb intake to the 30 - 40 g range per day brings glucose levels back down, for some in 1 week, for people like myself, 2 to 4 weeks with gradual improvement over the next year. As for your concerns about diabetic ketoacidosis or DKA, this can be monitored for with daily glucose testing, upon waking, prior to bed, prior to and 1 and 2 hours after each meal, prior to and after each walk.

That little glucose meter is so empowering. It gives us the feedback we need to figure out what's helping and what's not in real time. No waiting for a doctor to order a lab test.

The first month following diagnosis is loaded with conflicting emotions and angst. I was lucky. A few weeks earlier, I'd left my job for the second time so I was able to wall myself off from the world, and within days find my way here for the support, information, and guidance I needed based on member's experiences and results. Members also responded to my questions with links to online presentations and articles by leading experts in the field.

steveyp is among friends here, you are too. I welcome you to contact me privately if you'd like to talk about this more.

 

[steveyp]

I seem to have been very lucky so far. I'm a teacher and I've had half term to get used to this, I don't know what will happen next week if the metformin trots sets in!. I was seen quickly and I have a free monitor that measures ketones too. This forum is an absolute goldmine of information and I wasted so much time just reading other people's experiences and soaking in information. My levels are also down 12 this morning and 8 this afternoon so I hope I've cracked the low carb diet (80 - 100). It's not all good though my ketones are registering 0.1 so I can't get away with just walking the dog!

 

[Winnie53]

That's very good news. Congrats steveyp on those dropping glucose levels!

I think 0.1 is a normal ketone level.

Read more here... http://www.diabetes.co.uk/diabetes_care/testing-for-ketones.html

What should the ketone test results be?

• Under 0.6 mmol/L - a normal blood ketone value
• 0.6 to 1.5 mmol/L - indicates that more ketones are being produced than normal, test again later to see if the value has lowered
• 1.6 to 3.0 mmol/L - a high level of ketones and could present a risk of ketoacidosis. It is advisable to contact your healthcare team for advice.
• Above 3.0 mmol/L - a dangerous level of ketones which will require immediate medical care.