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Dietician's advice at odds with everything I've read

catapillar said:
It's very unusual for a type 2 diabetic to be diagnosed with ketones. The presence of ketones on diagnosis points towards type 1.



I'm not sure why you are thankful a cpeptide test came back negative? No cpeptide means you aren't producing any insulin, at all. Which would be unusual for a newly diagnosed adult type 1 diabetic because they would be expected to be honeymooning. It would be very unusual for a type 2 diabetic who would be expected to have higher than normal cpeptide because type 2 is hyperinsulimia. So no cpeptide points to type 1. What exactly do you mean by a negative result on your cpeptide test?

25% of type 1 diabetics are GAD negative. A negative GAD test doesn't mean you aren't type 1.



So that's a total daily dose of 46 units? And you're staying over 4? That's a fairly standard dose, it doesn't suggest insulin resistance. Nor does it suggest you'll be fine without insulin and without testing and injecting. You are obviously needing those injections to keep blood sugars in check.
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Once again catapillar, I'm in awe of your knowledge on the subject. To be honest, I wasn't expecting the dietician to have my blood test results (I assumed I would have been sent them in the first instance?) So I was caught a little off guard and probably didn't question her enough (in retrospect, I should have asked for a printout). All I recall her saying is that the antibody tests showed "negative". I had mentioned both GAD and c-peptide, so perhaps incorrectly assumed she meant both.

Re: the ketones, the initial diagnosing GP and then the DSN said the same as you (along with the fact the symptoms were sudden onset). However, the dietician seems to have a hunch that it's something else. I'm hanging onto that hope, of course and I said I was happy to experiment if it clarified things.
 
dbr10 said:
Does that make sense to you?
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I've always subscribed to the "everything in moderation" mantra, but I'll admit my personal adherence was probably not the best, which probably goes towards explaining the situation I find myself in.
 
Resurgam said:
As you are on insulin and planning to stay on it, if you drive a car you should have notified your insurer and the driving license people.
There are rules about driving and testing your blood glucose levels you need to comply with.
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Indeed that was all explained to me. I have informed my insurer and DVLA and got a 3 year licence back.
I presume if the insulin or medication does happen to become unnecessary at some point, I would get the full licence back?
 
catapillar said:
It's very unusual for a type 2 diabetic to be diagnosed with ketones. The presence of ketones on diagnosis points towards type 1.
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I was. Sorry, I don't know the level of ketones as it is on the hospital computer, not my GPs computer. But it was high enough that they wanted me to come back 3 days later to repeat the blood gas test. But my BG was clearly dropping without treatment along with everything else pointing towards Type2 (liver function, very high trigs, etc.)

I had started to drink orange juice due to my wife telling me the sugar-free can drinks were not natural and I had started to exercise more at a hot time of year. The increased thrust that I assumed (wrongly) was due to the heat and exercise led me to drink more orange juice, including about one litre about 20 minutes before having some blood tests. Hence a reading of 33 comes back from the lab!
 
OK, early days, but I wanted to share some results and see what people think. I *think* it suggests I'm not Type 1.
Yesterday, fasting, 20:33 : 5.7 mmol/L
Shortly folliwed by chicken curry, no rice/bread followed by 2 scoops Oppo ice cream and some pistachios to snack on. I did not bolus for this.
22:49 : 7.1 mmol/L
23:57 : 7.2
I did not take my usual Levemir shot in the evening
Today, 06:38 : 7.1
No breakfast, no basal again this morning
12:40 : 6.9
Shortly followed by lunch which was smoked salmon, cottage cheese, cucumber in a whole seed wrap (30.5g carbohydrates). Again, I did not bolus.
14:47 : 7.5

I'm now super confused. I don't think I need the exogenous insulin at all! Did giving my pancreas a rest from sugar fix it? Or am I jumping the gun here?
So what was with the ketone levels being so high?
 
It is not possible to tell, as when someone first gets Type1 they can have some days when with the pancreases makes a lot of insulin and other days when it makes very little. Therefore test, test and test more, being ready to respond to any increase in BG. A FreeStyle Libre may be a good investment while you are trying to work out what is going on.

There are even a few research papers that report a few cases of people having DKA and once BG is brought back to normal levels by the hospital not needing insulin again. This just does not make sense according to medical text books………..

Sorry just to leave you with more questions then answers.
 
Apart from the whole seed wrap I think that you are eating low enough carb foods for a lucky type two to cope with.
I could look at 30 gm of wrap, possibly touch it with a fingertip, but for a year I have not eaten 'ordinary; bread - except once in an absent minded moment I ate a wholemeal roll instead of the Lidl protein rolls I can just manage.
I can live quite happily without medication on an absolute maximum of 60 gm of carbs a day - but more like 50 and some days 40 and I stay under 7 mmol/l - which is why I put forward the idea of a similar diet being an option for you.
If you follow the advice to increase carbs from rice and pasta etc then those numbers will not last even for a lucky type two - it means there will probably be a lot of salad in your future, but there is the possibility of being medication free and diet controlled.
Of course, if your numbers can't be controlled just by low carb, then you need to inject insulin, you need to check.
I think that if you are not using insulin for a while then the restriction is removed, but that is just something I might have read - as it doesn't apply to me it wasn't something I made a note of.
 
ringi said:
There are even a few research papers that report a few cases of people having DKA and once BG is brought back to normal levels by the hospital not needing insulin again. This just does not make sense according to medical text books………..
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Fascinating. Do you have any links to the research on this phenomenon?
 
There are a few drugs that works very well for Type2, but it first has to be proven them someone is dependably creating insulin of their own before they can be considered. Therefore the more carefully recorded data that can be presented to the consultant the better. Not just BG reading but also details and photos of all meals, along with timings etc.

A fasting insulin level test may be worthwhile (private if need as the NHS tends not to do them) it can only be done if no insulin has been injected for at least a few days. This would allow the level of inslin resitance to be worked out, provided a BG test is done on the same bloood sample. Worth asking your consultant about it.
 
Jaylee said:
Fascinating. Do you have any links to the research on this phenomenon?
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Sorry I did not record details of the papers, but I found them from Google and Google Scholar, these are some that have come up on a quick search. You can find other by looking for papers that cite these, and are cited by these papers etc. I was left with more questions than answers having reading some of the papers, but clearly the high keytones on presentation always equals Type1 has now been disproven, but is still often the case.

http://www.bmj.com/content/346/bmj.f3501
http://clinical.diabetesjournals.org/content/22/4/198
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842543/
https://emedicine.medscape.com/arti...69+xJ/mqJZ1Sq721tRR+VIEM903oaTexhZrGEfizZ20Q=
http://onlinelibrary.wiley.com/doi/10.1002/pdi.1852/abstract
 
Interesting. So high ketone levels can be just a combination of a lull of insulin production and resistance. I'm going to continue my experimentation (unless levels go wide of the normal range of course). If it stays like this, bonus (though it would probably confuse the GP who said it was definitely type 1! :D )
 
I got a copy of the textbook your GP most likely used in his/her first two years at university, according to it, you are type1. However be very thankful that your GP unlike most did not assume that all adults must be type2, as some of the type2 drugs are very high risk for someone who is type1.

Remember that most GPs will only see a few new cases of type1 in their life, most years they will not see one.
 
OK, pre-dinner reading was 7.6
Just gone for another mid-carb meal, large tub of chicken and mushroom soup - another 26g carbs. Let's see if that does anything. Note that the Levemir should have completely worn off by now, yet only a gentle creep up. I have to admit, though, I feel very slightly wooly. Only slightly.

Ringi, I think you are right about the GP. He's actually private in the financial business part of the city - I noticed most other people there were sporting injuries. I suspect he doesn't even get many people presenting with diabetes symptoms.
That said, the diabetes nurse concurred with him.
 
OK, in addition to the soup 2 hours ago, I've had some nuts. I've also had a large glass of red wine, which may have been a bad idea.
Anyway, new reading is.....7.8!
I think I've been sold a duffer! I feel like celebrating with some Kendal mint cake (joke...joke!)
 
My policy was to stay under 8 mmol/l at 2 hours after meals - I only tested after my two meals, BUT - over time I saw that my readings for the same meals were reducing - so I reasoned that my metabolism was rebalancing itself - and I told myself how lucky I was. I do not push my luck and I eat, as a rule, fewer carbs than I could cope with.
I am 13 months from diagnosis, perhaps in another 11 months I might start to relax the control just a very little, as long as I have continued to lose weight and change shape, increasing activity is also on the cards.
I have felt the brush of the angels wings - so I am going to be hanging on here with fingers, toes and teeth. I think that those who can keep control with diet (and it is a great way to eat) are the lucky ones, and I appreciate the opportunity to show that it can be done with fairly minimal effort.
 
Bertyboy said:
OK, in addition to the soup 2 hours ago, I've had some nuts. I've also had a large glass of red wine, which may have been a bad idea.
Anyway, new reading is.....7.8!
I think I've been sold a duffer! I feel like celebrating with some Kendal mint cake (joke...joke!)
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The wine will stop gluconeogenisis so you won’t rise much. Spirits lower me. Wine keeps me the same.
 
7.8 this morning :)
I was given a book as a Christmas present by a friend who is a GP receptionist. It's called "Foods that Harm. Foods that Heal".
This is the sort of food that is recommended for people with diabetes...
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It isn't very clear on my screen, but "jacket potatoes with coleslaw but no mayonnaise" jumped out at me. That is something that I, as a diet controlled T2, could not cope with on a regular basis.
 
Bluetit1802 said:
It isn't very clear on my screen, but "jacket potatoes with coleslaw but no mayonnaise" jumped out at me. That is something that I, as a diet controlled T2, could not cope with on a regular basis.
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What about the nice big bowl of risotto "with a little chicken"?
Or the bowl of tagliatelle with some olives and chopped tomatoes?
 
Bertyboy said:
What about the nice big bowl of risotto "with a little chicken"?
Or the bowl of tagliatelle with some olives and chopped tomatoes?
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Pasta and rice are off my menu, but that doesn't worry me because they have always been off my menu! They are very starchy carbohydrates. The chicken would be nice though!
 
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