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newly diagnosed ketosis prone type 2 diabetic at 25 years old

2

25yokpt2

Member
Messages
14
Background
I had mostly been a very fit and muscular individual, even having had great generic blood test results that included 26 on the Hba1c. Starting 2 years ago, I went into a decline of my mental and physical health involving depression and rapid weight gain. This peaked recently at an estimated 140kg+ weight (6ft tall) and I went into sudden DKA. I phoned an ambulance and stayed in hospital for a week and left with a diagnosis of ketosis prone type 2 diabetes. I'm on 26 units levermir (morning/evening respectively), 6 units novorapid before each meal, 1000mg metformin (morning and evening respectively) and 20mg citalopram as a precaution for the depression.

I won't begin to describe my thoughts and emotions as it's expansive and abundant as i'm sure people can imagine. Right now, I'm intent on managing this condition well, aiming for remission by losing weight and revising my diet. I just have a few questions on my specific type of diabetes and i'd appreciate any help.

1. Are there any must-have resources that people always recommend (eg, recipe books, literally anything).

2. Some variation of the keto diet/ LCHF seems the clear way to go for me (<50g carbs). Is there any risks associated with keto/lchf diets? is 50g carbs too much?

3. Assuming I achieve remission through exercise, weight loss and diet, is it possible to stay in remission for the rest of my life with ketosis prone diabetes? If not, how long can i expect?

4. Being diagnosed so young at 25, I'm concerned about my life expectancy and quality of life. Is anyone able to give me an idea of what I can expect if i manage my condition well?

5. I'd appreciate any stories or people to talk to who have ketosis prone diabetes.

6. I'm london based and keen to engage in the diabetic community. Are there any obvious steps to start doing so?


Thanks everybody.
 
I'm fairly sure the NHS doctors will be horrified by the idea of a keto diet. If you really are ketosis prone, which they shouldn't be able to tell after only one dka admission, then that diet makes it harder for them. If you're in ketosis and producing ketones, that's fine. If you're in ketoacidosis and producing ketones, that's potentially deadly.

If you're ill and go to a GP, a standard test will be for ketones, which they will find if you're on a keto diet, and you get sent straight to hospital. I've lost count of the number of times I've been hospitalised, waited for the FULL bloods to come back (usually 8hrs), seen the results and left AMA.

Low carb is sensible, and there's plenty of help out there. Going all the way to keto might want to wait until you are absolutely sure what you are doing and can argue it with the doctor.

Life expectancy? My step-grandfather was diagnosed just after insulin became available in the UK, and died at the age of 85. His last five years weren't good, but up to age 80 he was still trying to drive us 'kids' around. Your expectancy and quality of life should be much improved over his.
 

Hello, thank you so much for the helpful reply.

I was actually diagnosed ketosis prone 2 weeks after being discharged from the hospital (yesterday). Although, they did suspect it early on. My wording was just to condense the story/writing. Apologies.

I'm happy doing low carb for now (<50g), thanks. What would you say i need to figure out to be confident enough to "know what i'm doing"? I've got good control of my BG levels so far and understand the basic science you outlined. Thanks for your help on this.

I'm happy for you that your step-grandfather lived a full life. I hope you don't mind me prying? How old was he when he was diagnosed? Was he type 1 or type 2? How well did he manage his diabetes (details please)?

Thanks so much.
 
Can I ask on what basis they ruled you type 2 rather than type 1 or LADA? GAD alone ? Other antibodies? C peptide?

Your age and fitness tend to go against type 2 - or is muscular code for overweight? Did you have an extreme carb heavy diet previously? Any family history?
 

I'm sorry. I actually don't know what exact test they did to determine i was type 2 ketosis prone other than it was an "antibody" test. I should (and will) do better.

I don't think I made this super clear. I was fit until I got depressed and gained alot of weight and become obese (this started approx 2 years ago). Over this time I had a horrific diet. This is why I suspect the type 2 diagnosis is correct. Im not sure on my family history. Although I do have grandparents who are diabetic (not sure the type).

Thanks for your help
 
Mmm. Maybe ask a few more questions. Check if they did cpeptide or insulin tests and if it was a full range of antibodies or just GAD. Antibodies are not always present in type 1 despite this being a common belief. Longer term it matters which you are. Some variant of type1 will need insulin once any honeymoon is over and dka is definitely more likely. Type 2 can often be addressed successfully with lifestyle and diet changes.
 
I agree @HSSS Keep in mind type 1 is possible. I realize you had weight gain and depression, but a couple of things send up red flags.Your age, ketosis and the need for insulin so quickly. Ketosis happens usually in a type 1, not a type 2. But it can happen in a type 2, it's just rare, I've included a link for that below.

Ketoacidosis happens when you have high blood sugar and you don't have enough insulin. A type 2 rarely gets it because they make insulin, they just don't utilize it well. But because they make some, it usually prevents DKA. A type 1 doesn't make insulin but when you are first developing type 1 your production slows and is erratic until it stops all together.

An antibody tests shows if you have the antibodies that are attacking your beta cells which produce insulin. If that is positive it's a sign of being a type 1. A few type 1's test negative but still don't make insulin and they don't know why. A C-peptide test is the next important test as it measures your production of insulin. It's a product that shows up when you make insulin not take it. A high or high normal is a sign of type 2, because they make insulin, they just don't utilize it well. A low or low normal is a sign of a type 1 because you are losing or have loss the ability to make insulin.

38% of type 1's are misdiagnosed as a type 2 at first. Once you are a little overweight they love to put you in the category of type 2 and not do the testing. I'm not saying you are a type 1, but I am saying that when things don't make sense, maybe you need the tests to make sure of what is going on. There are different treatment plans for a type 1 and a type 2, so it makes a difference knowing what you are.

Life expectancy seems to be really geared towards your control of your blood sugars. High blood sugars do damage over time, so the thought is, control your BG level and you control the complications that go with it.

http://archives.diabetesforecast.org/2015/sep-oct/diagnosing-type-1-in-adults.html?loc=ymal

http://archives.diabetesforecast.org/2015/sep-oct/tests-to-determine-diabetes.html

https://www.ncbi.nlm.nih.gov/books/NBK482142/
 
Thank you so much. This is so helpful. I well definitely chase further tests/results and clarify my condition as much as possible.
 
Hi @25yokpt2 and welcome to the forums.

When I googled ketosis prone T2 I found this interesting article.

Ketosis-Prone Type 2 Diabetes: Background, Pathophysiology, Etiology (medscape.com)


So I am assuming that you are antibody negative and beta cell function positive, though I agree with @Marie 2 that a cpeptide test would be useful. (Hopefully they have already done one otherwise I would not expect them to have made the T2 diagnosis.) In any case, in your position I'd want to know the result for future reference. (If it turns out that you are in fact LADA this result would decrease in the future.)

But it seems that some people don't fit into a neat type of diabetes tickbox, so you have to wait and see what happens to your body as your treatment progresses and you get control of your sugar levels. I can cope with my diabetes, albeit T1, but would hate to have long term depression, and I suspect that dealing with your depression may have more impact on your life than anything else at the moment. Weight gain can be a symptom as well as a cause of T2 diabetes, and stress can raise blood sugars on its own, so you've got a fair number of factors to juggle when contemplating your health issues. Many T2 diabetics find that their weight goes down automatically in conjunction with controlling their blood sugars via a lower carb diet. But I agree with @Seacrow that your doctors are unlikely to be enthused by the prospect of a keto diet if you are ketosis prone. (Though some T1s do adopt a keto diet, and T1 diabetics are the ultimate in terms of ketosis prone diabetics.)

But please don't indulge in the blame game. No doubt your diet hasn't been great for the last couple of years, but that is unlikely to have caused your diabetes. T2s are typically overweight as a result of their illness. Your diabetes is caused by genetics and/or bad luck (the jury is still out on the cause of T1 if that is what you end up having).

Good luck. You're still very young and your whole life is ahead of you. You may or may not have to deal with diabetes as a permanent part of that life (not clear whether you'll need insulin permanently) but even if you do there are very few things which it will prevent you from doing. (This is where I typically bring up the maybe you don't want to be an astronaut comment). As regards life expectancy and complications, the treatment for diabetes is still improving drastically. If you take control of your blood sugar levels then there's no reason why you can't leave a long and healthy life.
 
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Hello @EllieM, thanks for the helpful reply.

I can't help but take full blame and responsibility for getting this disease. If i somehow managed to maintain the healthy lifestyle that i always aspired to, I wouldn't be type 2 diabetic. However, I am trying to accept I have the condition and leavet the past in the past now. I have diabetes and nothing can change that now. All I can do is manage the condition as best as possible.

I hope I can live a long and healthy life. The odds of staying in remission for most of my life seem highly unlikely. Worse still, the odds of me avoiding complications aren't encouraging either with ketosis type 2. All I can do is try my best and be optimistic about my future.
 
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Ahhh, having read the references that people have so helpfully dug up, it appears this is part of yet another classification scheme. A(beta) giving autoimmune and insulin production +/- respectively. I'd be interested to see if this is fixed at presentation, or can change over time. (I, for example, would have gone from A+(beta)- to A-(beta)+ )

If you can read the external references given and understand them, I'd say you've got all the knowledge you need. The next stage is can you calmly and logically explain to a doctor in an A&E department why his diagnosis is wrong, possibly while throwing up on him

My step-grandfather was one of the first adopters of insulin in his city. Mid-teens when diagnosed, just old enough to learn how to boil his glass syringes and perform the once a week chemical experiment testing for spill of glucose into urine. Unsurprisingly, for the first years his control was pretty much non-existent. Blood glucose test kits came when he was beginning to lose feeling in his hands and feet, and this made him a very frequent tester. The feeling came back after about three months. He ended up with a wife who was very strict about what he could eat, nothing was absolutely forbidden, but some portions were really small. He believed keeping his blood glucose down was the right way to treat his diabetes, and it appeared to work. (It's amazing to think that even ten years earlier the diagnosis would have been its diabetes, that's terminal, so sorry.)
 
The thing about diabetes is, today is a new day and you can absolutely change the course of your health from this day forward.
 
Hi. I agree with some of the other posts that a C-Peptide test is as important if not more important than an antibody test. This test will measure whether you have high or low natural insulin. Antibody tests can miss other T1 causes such as viruses. I wonder, but just guessing, whether you are possibly T1/LADA but the period of overeating may be hiding that as excess weight naturally leads to a T2 diagnosis. In your position I would keep the carbs down but not go full keto until you fully understand your diagnosis and metabolism
 
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