Some advice please

[RossMcM]

I was diagnosed type 1 diabetic at the age of 40. I was taking insulin for a couple of years. I gradually reduced insuln usage through exercising, a lot, and diet to reduce sugar levels. I got to the point were no insulin was required but was eating very little and exercising loads to do this. I was then diagnosed type 2 as opposed to type 1. I then moved onto and still am on a strict ketogenic diet. Throughout I was having some whisky each night which was having an impact on blood sugars, i.e. bringing them down.

I have recently stopped drinking on a night. I am still on the strict ketogenic diet. I however find that I cannot bring down my blood sugars below 7. Even when fasting. I am taking two 500mg of metformin each day.

Questions are. Is hovering around 7 when fasting acceptable. Are my symptoms akin to type1 or type2. If I have a sniff of carbs I will be above 20 very quickly.

Thanks in advance...

 

[ert]

What tests were you diagnosed with? You will need a current c-peptide to see how much insulin your body is producing. If your result is abnormally low, well below the normal range, it would support type 1. If the result is higher than the normal range, it would support type 2. If it's in the normal range, it could support you are still in a honeymoon period for type 1 (as you appeared to need insulin for some time) or have MODY. It's something to discuss with your GP.

 

[RossMcM]

Thanks for the advice...

 

[Wayward Blood]

Hi Ross,

I can't say for sure whether you'd be Type 1 or Type 2. If you do turn out to be Type 1 though, the following may be of interest:

There's a small amount of evidence (although no clinical research as far as I'm aware) that the autoimmune response from Type 1 diabetes does not completely destroy the ability of the pancreas to produce insulin. What kills off the rest of the cells is high blood sugar levels; insulin-producing cells are pretty fragile, unfortunately. That means that if you have been keeping your blood glucose levels low then you might (important: *might*) still have some insulin producing capability left. Dr Richard Bernstein believes this to be the case. He can't test the theory on himself: he was diagnosed in childhood, and didn't start following a low carbohydrate diet until he was in his thirties (he's in his eighties now). However, he has claimed to be able to maintain some insulin function in newly-diagnosed patients.

Another example of this is Dr Troy Stapleton. He was diagnosed as an adult around 2012, and quickly adopted a low carbohydrate diet. He's given various talks (many of which are available on YouTube); in some of them, he has mentioned that he only takes long-acting insulin, and does not need to cover his low carbohydrate meals with short-acting. I don't know if that's changed for him now, and he himself said that he wasn't sure if he'd need to start taking short-acting at some point.

So it could be that you need to take some long-acting insulin to help your pancreas to maintain your blood glucose levels. However, as I say, take all of the above information with a pinch of salt. The establishment has been very against low carbohydrate diets up to this point, so there's not enough evidence to conclusively support the claims made above. The important thing is to monitor your blood glucose levels, and to dose accordingly, ideally with support from your diabetes specialist care team. Or it could be that you are Type 2, in which case different medication will likely be required.

 

[RossMcM]

Thanks for the further advice. Much appreciated. I'll have a look at the videos on YouTube you recommended and also talk to GP. I didnt mention above but interesting you mentioned auto immune. About 2 years after the diagnosis of diabetes i was diagnosed with iga nephropathy and ended up on steroids and auto immune suppressant drugs. I was told not related to the diabetes. I've always thought there may be a connection. Thanks again for the advice.

 

[DCUKMod]

Thanks for the further advice. Much appreciated. I'll have a look at the videos on YouTube you recommended and also talk to GP. I didnt mention above but interesting you mentioned auto immune. About 2 years after the diagnosis of diabetes i was diagnosed with iga nephropathy and ended up on steroids and auto immune suppressant drugs. I was told not related to the diabetes. I've always thought there may be a connection. Thanks again for the advice.

Hi Ross, nobody here can tell you if you are T1 or anything else. You need a diagnosis from your doctor.

It could well be you have always been T1, but have been enjoying a bit of a honeymoon period, where your pancreas sparks back into activity and can cope with your blood sugars (to a greater or lesser extent) for a while. Those in honeymoon period usually find that ends, eventually, meaning they need more pharmaceutical support, with insulin.

If you didn't have it at the time of your initial diagnosis, a C-Peptide test would be informative, to help you, and your team, know how much insulin you are still able to produce.

I know one other person who had IgA Nephropathy. Her story was a bit complicated, and the fact her kidney failure was due to IgA antibodies, as opposed to T1 diabetes was missed, leading up to and beyond her first kidney transplant. Once better understood, her second transplant was better manged and she lives a great life. She too has been told her IgA Nephropathy wasn't related to her pre-existing T1, however, having one autoimmune condition tends to predispose the person to developing others.

Good luck with it all.

(Just to add, of course not everyone the IgA Nephropathy goes on to require a kidney transplant.)

 

[RossMcM]

Thanks for the advice. Glad to hear your friend is now ok.