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Type 1.5/LADA Diabetes
Confused about my doctors/consultants advice, am I type 1.5?
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<blockquote data-quote="christi99" data-source="post: 902377" data-attributes="member: 179601"><p>I think the clinical importance with regard to establishing what type (2 or 1.5) is perhaps simply an academic one. Either type usually presents with insulin insufficiency and/or insulin resistance, and tends to worsen with age and or lifestyle factors. Type 1.5 is usually associated with autoimmunity whereas Type 2 commonly r/t obesity- but not always so!! A type 2 or 1.5 does not necessarily need oral or injectable medication- it all depends on how your body responds to behavioral modifications such as low carb diet and exercise regimen. (Even 10 minutes of sustained cardiovascular exercise decreases insulin resistance for a while). Exercise helps move insulin into the cell, therefore the body requires less circulating insulin to get the job done. The same is true for ingested carbs - requires significantly more insulin to metabolize than protein and so sends a message to pump out lots of insulin (if you have any type of diabetes, carb counting is essential for blood glucose control.) If you are type 1, a VLCD is more difficult as hypoglycemic events can be a problem - because one injected insulin- it needs to be fed, so to speak. However, every body is different.</p><p></p><p>As for VLC diets- my son has been on one for 1 month (he needs to lose about 35 lbs but he is 6'5''- type 2 for 2 yrs) and he is also on medication. He has been able to reduce is oral meds in half, BS has improved dramatically AND he feels great. Also lost 15 lbs. There is clearly a metabolic principle at work here. This dietary concept works even as it presents a dilemma for clinicians- ketones in the urine! Your doctor wants you to go back to having more carbs so HE/SHE knows how to manage your disease (or merely to see if the ketones disappear, which is likely if you add more carbs to metabolize- shifting out of the true benefit of a VLCD!) I really doubt he /she is trying to see if your ketones skyrocket with a dietary change that adds carbs as that just has no medical basis unless you happen to simultaneously morph into a type 1 at the same time (and produce no insulin). They are taught a pretty narrow treatment /monitoring protocol making it difficult for MDs or other clinicians to interpret data when someone is on a VLCD. I understand their dilemma and he/she's does have a responsibility to monitor and respond to your findings- which is difficult when they find ketones, even if it can be explained by diet. The medical profession really doesn't provide much in the way of creative or out of the box thinking for them to safely practice! Too much liability and they need to cover themselves by establishing that they really did look into the ketone issue in case there is a problem in the future. With that said, I don't think YOU should have to challenge your body so he can see how you respond (unless you want to and you consider it temporary)! If they monitored you based on BG, you would be a success. Ketoacidosis (DKA) is extremely rare in Type 2's. While ketosis is a state that happens when we burn high amounts of fats resulting in ketone production, DKA is a very, very different metabolic dysregulation that rarely is triggered by dietary intake but a serious lack of indogenous insulin. Our bodies normally have a great ability to maintain blood Ph due to the many buffers that respond to changing acid/base metabolic byproducts and within respiration- the acidosis in DKA is a catastrophic failure of our buffer system due to hyperglycemia and subsequent complications of this in the body. That is just medical fact. There are negative side effects to every treatment- including meds, and ketone production (or ketosis) is not ketoacidosis! If there are any negatives to ketosis, is it worse than the negatives of the other oral agents? Depends who you ask I guess. Important to keep well hydrated though. To me it seems the benefits of a VLCD outweigh the risks, when you look at the negative impact of poorly controlled blood glucose.</p></blockquote><p></p>
[QUOTE="christi99, post: 902377, member: 179601"] I think the clinical importance with regard to establishing what type (2 or 1.5) is perhaps simply an academic one. Either type usually presents with insulin insufficiency and/or insulin resistance, and tends to worsen with age and or lifestyle factors. Type 1.5 is usually associated with autoimmunity whereas Type 2 commonly r/t obesity- but not always so!! A type 2 or 1.5 does not necessarily need oral or injectable medication- it all depends on how your body responds to behavioral modifications such as low carb diet and exercise regimen. (Even 10 minutes of sustained cardiovascular exercise decreases insulin resistance for a while). Exercise helps move insulin into the cell, therefore the body requires less circulating insulin to get the job done. The same is true for ingested carbs - requires significantly more insulin to metabolize than protein and so sends a message to pump out lots of insulin (if you have any type of diabetes, carb counting is essential for blood glucose control.) If you are type 1, a VLCD is more difficult as hypoglycemic events can be a problem - because one injected insulin- it needs to be fed, so to speak. However, every body is different. As for VLC diets- my son has been on one for 1 month (he needs to lose about 35 lbs but he is 6'5''- type 2 for 2 yrs) and he is also on medication. He has been able to reduce is oral meds in half, BS has improved dramatically AND he feels great. Also lost 15 lbs. There is clearly a metabolic principle at work here. This dietary concept works even as it presents a dilemma for clinicians- ketones in the urine! Your doctor wants you to go back to having more carbs so HE/SHE knows how to manage your disease (or merely to see if the ketones disappear, which is likely if you add more carbs to metabolize- shifting out of the true benefit of a VLCD!) I really doubt he /she is trying to see if your ketones skyrocket with a dietary change that adds carbs as that just has no medical basis unless you happen to simultaneously morph into a type 1 at the same time (and produce no insulin). They are taught a pretty narrow treatment /monitoring protocol making it difficult for MDs or other clinicians to interpret data when someone is on a VLCD. I understand their dilemma and he/she's does have a responsibility to monitor and respond to your findings- which is difficult when they find ketones, even if it can be explained by diet. The medical profession really doesn't provide much in the way of creative or out of the box thinking for them to safely practice! Too much liability and they need to cover themselves by establishing that they really did look into the ketone issue in case there is a problem in the future. With that said, I don't think YOU should have to challenge your body so he can see how you respond (unless you want to and you consider it temporary)! If they monitored you based on BG, you would be a success. Ketoacidosis (DKA) is extremely rare in Type 2's. While ketosis is a state that happens when we burn high amounts of fats resulting in ketone production, DKA is a very, very different metabolic dysregulation that rarely is triggered by dietary intake but a serious lack of indogenous insulin. Our bodies normally have a great ability to maintain blood Ph due to the many buffers that respond to changing acid/base metabolic byproducts and within respiration- the acidosis in DKA is a catastrophic failure of our buffer system due to hyperglycemia and subsequent complications of this in the body. That is just medical fact. There are negative side effects to every treatment- including meds, and ketone production (or ketosis) is not ketoacidosis! If there are any negatives to ketosis, is it worse than the negatives of the other oral agents? Depends who you ask I guess. Important to keep well hydrated though. To me it seems the benefits of a VLCD outweigh the risks, when you look at the negative impact of poorly controlled blood glucose. [/QUOTE]
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