New to this

Timetells said:

Hi All,

I am newly diagnosed Type 2 diabetes, was admitted to hospital with my Glucose sugars over 46 and Ketone blood reading of 7.2, following a week long stay in hospital, I was discharged with insulin, administering 24ml Lantus twice a day and 18ml Novorapid 3 times a day, the first week following discharge, it was really difficult to get my blood sugars under control, am on my second week now, and readings, usually fasting levels read on average about 5.2.

During the day; it doesn't usually go higher than 9.5 but when I go walking, it will drop as low as 3, at those times, I get very light headed, and will need to stop and eat something to bring levels back up.

I am trying to get the hang of this, I lost 60lbs in the space of 2 months, and was advised this was due to the ketosis (am not sure if its the right term) since discharge have put on 9lbs, but am over weight, and still need to lose weight, I have always been heavy, and what I have read on here, it appears that possibly the weight is a symptom of the diabetes, I am watching what I eat, and waiting for my first formal appointment at the diabetic clinic.

Anyway, the concern for me is that my eyesight has been appalling since the admission to hospital, I have bought a pair of cheap reading glasses so at least I can see the screen and my phone, but am worried that this is going to be permanent, my eyes get tired very quickly, from what I have read it will correct itself but its so frustrating right now.

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Type 2 with ketones? Okay... Does that mean you're following a ketogenic diet?

Okay, let me start at the beginning. If you have a lot of ketones floating around, your body is burning body fat. That is a good thing, if you're eating a very low carbohydrate diet. (Meaning 20 grams of carbs a day or less). But from the sound of it you didn't know the term ketosis before all this happened, and people who go that low carb, usually know the lingo. So I'm a little concerned here. If you've got ketones and high bloodsugars, I wonder what you're eating. Because you could be a T1, Mody or LADA instead, and if you are, you really, really want to know, as treatment is different. If you're still eating a carb-heavy diet (bread, spuds, pasta, rice, corn, cereal etc), go back to your doctor and ask for a C-peptide and a GAD test. Otherwise, if you're 100% certain you're truly a T2, have a read here: https://www.diabetes.co.uk/forum/blog-entry/the-nutritional-thingy.2330/ Don't follow the advice in there blindly if you're on insulin, just learn a little about the condition and go from there. Don't do or change anything without your doc's help. And get yourself Dr. Jason Fung's the Diabetes Code, it's an excellent read and a lifesaver.

As for your eyesight: The sugar in your eyes was distorting your vision. Now the insulin is reducing the sugar in your body, your brain, which has been correcting for your distorted vision all this time, has to get used to not doing that anymore. So getting cheap specs was a good move, because your eyesight'll return to normal in a week or two.

And careful with the 3's. Those are hypo's, and as you're on insulin they can knock you out, and worse. Make sure you always have dextro or jellybabies with you.

Good luck!
Jo

Timetells said:

Thank you Jo, whilst I was in hospital they had difficulty in diagnosing whether I was Type 1 or Type 2 because my ketones would not drop, staying around 3.2 since discharge and my blood sugars have dropped below 10 the ketone reading is about 0.2-0.4.

The consultant said I had a sub type of type 2, where it looks like I am type 1 but am actually type 2, its all very confusing, I will get the book you have recommended, and just trying to absorb all the information thrown at me at the moment.

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They have to figure it out. You get into ketosis on a very low carb diet, called the keto diet. I follow it myself, and my ketones are high while my bloodsugars are low. If you still eat a lot of carbs but there's a lot of ketones present, well, that's weird and not healthy, and usually only happens for T1's... High bloodsugars (which you currently don't have) and high ketones (which seem to be okay now too), can be very problematic. So... If you go high, with both of them, get help immediately. If both are high you can get something called Diabetic Ketoacidosis, and it can turn deadly. Not to scare you, just saying... Keep an eye on things and call for help if you feel off, 111 should be able to help if you're uncertain about what action to take. I've never heard of a T2 "subtype" that presents as a T1, it's either T1, T2, Mody, LADA or one of the T3's, far as I know. All in all... Keep testing. And if you ever feel bad, nausious, dizzy, always test and check where you're at. Never play a "wait and see" if the numbers tell you not to.

Jo

Timetells said:

The consultant said I had a sub type of type 2, where it looks like I am type 1 but am actually type 2

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Did they do any other tests like C-peptide or GAD antibody tests?
Your significant weight loss and presence of unexpected ketones sounds remarkably like a deficiency in endogenous insulin rather than classic T2.

Timetells said:

The consultant said I had a sub type of type 2, where it looks like I am type 1 but am actually type 2, its all very confusing, I will get the book you have recommended, and just trying to absorb all the information thrown at me at the moment.

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Hi and welcome to the "Don't fit in the square hole" club........like you I am a "sub t2", I'm what is classed as a "Non Producer" in that I don't produce any of my own insulin and am clear on the c-peptide and GAD antibodies tests....... I am not insulin resistant and I am insulin sensitive so I only need small doses.
It could be you are in a similar position, I cannot give you any advice on dosages as my regime will be different to yours but it will get easier once you and your consultant get to grips with the amounts of insulin you need........ it may take a few months till you and he are happy you can manage on your own but don't loose heart
There is one thing I can advise you on though test , test , test and test again let your meter become your best friend and the best tool you have in you arsenal.......it will guide you through your meal dosages if you test just before first bite and 2hrs after, it will tell you if you've taken enough insulin or whether you need to cut out a potato from that meal
Your eyesight should improve as your numbers steady it may even be better than before........I know how frustrating it can be but hang on in there.

I thought about 20% of T1s don't show antibodies on those blood tests?

OP sounds like T1 from where I'm sitting because those readings were similar to mine when diagnosed. I did have antibodies on 2 tests but even if I hadn't the consultant said definitely T1

It does rather read as though you are getting too much insulin now - no sense in having to eat carbs to give normal readings - perhaps as your stress reduces you should be checking up with a dr or nurse onhow to adjust your insulin to cope with alterations.
Do try to ensure adequate hydration - particularly if you are experiencing the same hot weather as we are here - I have a mug by the sinks, have a routine of having a mug of water first and last thing during the day and when I go to prepare meals - I only eat twice a day but my husband has lunch, and I have at least one mug of coffee with cream, cinnamon and a small pinch of salt - plus I add salt to my salad as I get cramps at night if I forget that.

Too many of us type 1's/LADA have been misdiagnosed as a type 2 originally. It stills happens all the time. Weight loss and immediate insulin use is more along the lines of a type 1. An antibody test and a C peptide test would help you know.

And a problem with type 1/LADA is at the beginning you still make some insulin until you don't, so it makes dosing trickier. It is called the honeymoon phase. Going too low is a sign of too much insulin, but you mentioned it was after exercise. Exercise on insulin is a learning experience, you learn to compensate with less insulin. There is no set rules, you have to learn how you react.

They always start you out at an easy dosing regimen, but if you call them with the fact that you dropped, I believe they will tell you an adjusted amount. What you will need to do is learn how to carb count and give dosing to what you eat.

Here in the states if you don't make insulin it is considered a type 1. Antibodies don't always show up and there are some other categories. My diabetic nutritionist, doesn't have the antibodies but she makes no insulin and calls herself a type 1
Making no insulin is a type 1 thing, a type 2 is insulin resistant, and that just isn't hardly ever a type 1's issue. You had said you were overweight and sometimes that leads to a misdiagnosis even more, they just automatically class you as a type 2.

You need the test done/results to know.

It’s very unusual for type 2 to have DKA as they still produce insulinI have read so many type 2 get misdiagnosed, and are actually type 1. I’m not saying this has happened in your case

Marie 2 said:

Too many of us type 1's/LADA have been misdiagnosed as a type 2 originally. It stills happens all the time. Weight loss and immediate insulin use is more along the lines of a type 1. An antibody test and a C peptide test would help you know.

And a problem with type 1/LADA is at the beginning you still make some insulin until you don't, so it makes dosing trickier. It is called the honeymoon phase. Going too low is a sign of too much insulin, but you mentioned it was after exercise. Exercise on insulin is a learning experience, you learn to compensate with less insulin. There is no set rules, you have to learn how you react.

They always start you out at an easy dosing regimen, but if you call them with the fact that you dropped, I believe they will tell you an adjusted amount. What you will need to do is learn how to carb count and give dosing to what you eat.

Here in the states if you don't make insulin it is considered a type 1. Antibodies don't always show up and there are some other categories. My diabetic nutritionist, doesn't have the antibodies but she makes no insulin and calls herself a type 1
Making no insulin is a type 1 thing, a type 2 is insulin resistant, and that just isn't hardly ever a type 1's issue. You had said you were overweight and sometimes that leads to a misdiagnosis even more, they just automatically class you as a type 2.

You need the test done/results to know.

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I agree. This is very unusual. Nearly 40% of type 2 are actually type 1

Here is an article about 'ketosis-prone type 2 diabetes' where there is an acute reduction in insulin secretion accompanied by insulin resistance:- https://www.bmj.com/content/346/bmj.f3501

Edited to add: More information here:- https://gpnotebook.co.uk/simplepage.cfm?ID=x20160928141517439169

Dave Wilde said:

I agree. This is very unusual. Nearly 40% of type 2 are actually type 1

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40%? Where did you get this statistic from?

It's clear we need a broader classification system rather than type 1 or type 2.
Here are the cluster subgroupings based on 9,000 people with diabetes in Sweden and Finland. They classify 5 types of diabetes.
https://www.nhs.uk/news/diabetes/are-there-actually-5-types-diabetes/

That's a weird study.........and grouping. I feel like they left out LADA's? The only group that has the GADA positive is group one, but then they say usually it starts at a younger age. But 50% of LADA/type 1's get it after the age of 30 and BMI has nothing to do with it sooooo.???

I think what David meant earlier is that 38% (40%) of type 1's/LADA's are diagnosed as type 2's first. ????

EllieM said:

Surely this makes you a T1 not a T2? (If you're not producing insulin then the c-peptide is going to come up as such?) Plenty of T1s don't show up on the antibody tests.

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I agree. You aren’t type 2 if you are not producing insulin