RE: hope for type 2's

[Guest guest]

Yes, I am. How are you?

Re: hope for type 2's

you mentioned you are on the pump. are you totally blind. thanks, karen

RE: hope for type 2's

Hi Bill,

This is true that treating a low with random amounts of sugar might cause a

high, but by the time someone's blood sugar is low enough that they are only

semi-conscious or unconscious, their life may be in danger. This is

particularly true if they are type 1 (type 1s often cannot effectively bring

up their own blood sugar), and they may also still have insulin in their

systems continuing to drive their blood sugar even lower. It is possible for

a type 1 to reach a blood sugar of 20, 10 or even 0, and frequently by the

time someone is semi-conscious or unconscious their sugar has dropped into

the 20s or 30s.

Although I haven't had a severe low in many years, I have been in this

situation, and I would rather someone give me sugar immediately, with

whatever is available close by, rather than spend time trying to find

something suitable or remember detailed instructions for measuring out the

proper amount. It is different when the person is able to treat a low

themselves, but when they are unable to ask for assistance, it has become an

emergency and must be treated quickly. When trying to get sugar into someone

who is non-responsive or uncooperative because of a severe low, it's also

difficult to get an exact amount of anything into them. When I had severe

lows as a teenager I used to frequently refuse to eat or try to spit out

things people put in my mouth.

In the short-term a low blood sugar is immediately dangerous. A high blood

sugar, unless it lasts for very prolonged periods of time, is really not

that dangerous by comparison. Most people having a low are likely type 1 and

have insulin on hand to correct any rebound high that results from

overtreating. In addition, even if the " right " amount of food is given,

someone who experiences a severe low may go high hours later regardless

because of their body's response of releasing counter-regulatory hormones

and stored-up glucose. Glucagon, which is a hormone that triggers the

release of glucose from the liver and is often not produced quickly or in

appropriate amounts by people with type 1, can be injected if someone is

unconscious. Glucagon injections often causes prolonged high blood sugars

several hours after an injection (similar to how a person's own body can

cause such a rebound), but this is considered preferable to the person dying

or experiencing brain damage due to time spent unconscious from

hypoglycemia. The reason you never give an unconscious person anything by

mouth is that there is a danger that they will aspirate (breath into their

lungs) whatever is put into their mouth since they cannot consciously

swallow, which would result in another life-threatening situation.

Once the person has recovered from the low and their life is no longer in

danger, then they can take steps to bring down whatever high has resulted

from the treatment they received. Anyway, sorry I've rambled on so much, but

I wanted to put an explanation about why I believe the advice about treating

severe lows is not " outdated " or bad advice.

Jen

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[Guest guest]

patricia, i am totally blind and was recently told i could not be allowed to go

on the pump because of my lack of sight. why would that be. karen

RE: hope for type 2's

Hi Bill,

This is true that treating a low with random amounts of sugar might cause a

high, but by the time someone's blood sugar is low enough that they are only

semi-conscious or unconscious, their life may be in danger. This is

particularly true if they are type 1 (type 1s often cannot effectively bring

up their own blood sugar), and they may also still have insulin in their

systems continuing to drive their blood sugar even lower. It is possible for

a type 1 to reach a blood sugar of 20, 10 or even 0, and frequently by the

time someone is semi-conscious or unconscious their sugar has dropped into

the 20s or 30s.

Although I haven't had a severe low in many years, I have been in this

situation, and I would rather someone give me sugar immediately, with

whatever is available close by, rather than spend time trying to find

something suitable or remember detailed instructions for measuring out the

proper amount. It is different when the person is able to treat a low

themselves, but when they are unable to ask for assistance, it has become an

emergency and must be treated quickly. When trying to get sugar into someone

who is non-responsive or uncooperative because of a severe low, it's also

difficult to get an exact amount of anything into them. When I had severe

lows as a teenager I used to frequently refuse to eat or try to spit out

things people put in my mouth.

In the short-term a low blood sugar is immediately dangerous. A high blood

sugar, unless it lasts for very prolonged periods of time, is really not

that dangerous by comparison. Most people having a low are likely type 1 and

have insulin on hand to correct any rebound high that results from

overtreating. In addition, even if the " right " amount of food is given,

someone who experiences a severe low may go high hours later regardless

because of their body's response of releasing counter-regulatory hormones

and stored-up glucose. Glucagon, which is a hormone that triggers the

release of glucose from the liver and is often not produced quickly or in

appropriate amounts by people with type 1, can be injected if someone is

unconscious. Glucagon injections often causes prolonged high blood sugars

several hours after an injection (similar to how a person's own body can

cause such a rebound), but this is considered preferable to the person dying

or experiencing brain damage due to time spent unconscious from

hypoglycemia. The reason you never give an unconscious person anything by

mouth is that there is a danger that they will aspirate (breath into their

lungs) whatever is put into their mouth since they cannot consciously

swallow, which would result in another life-threatening situation.

Once the person has recovered from the low and their life is no longer in

danger, then they can take steps to bring down whatever high has resulted

from the treatment they received. Anyway, sorry I've rambled on so much, but

I wanted to put an explanation about why I believe the advice about treating

severe lows is not " outdated " or bad advice.

Jen

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[Guest guest]

Using a pump with little or no vision does take some extra work (memorizing

menus and screens), but there are several of us on this list who are legally

blind or totally blind and use pumps. My endocrinologist's response when I

told him I was interested in going on the pump was, " I would have put you on

the pump years ago but I thought you couldn't use one since you can't see

the screen. " He was a bit concerned that there would be safety issues with

me using one, but I assured him I had looked at pumps before and knew I

could operate one without reading the screen.

In the end the choice of whether to use a pump is up to you and not your

doctors, but if you are able to count carbohydrates and give your own

injections independently now, and are willing to learn how a pump works and

memorize the on-screen messages and menus, there's really no reason a

totally blind person can't use a pump. Inserting infusion sets and filling

cartridges are both easy to do without vision, too. It might be worth

looking at some pumps in person if you have never seen one, so that you can

assure people you've tried one out and are able to use it.

Jen

Re: hope for type 2's

patricia, i am totally blind and was recently told i could not be allowed to

go on the pump because of my lack of sight. why would that be. karen

[Guest guest]

I know people on the pump that are totaly blind

Kell

MSN: Kell@...

Skype: KlarssonNY

" I have never been able to find out precisely what feminism is: I only know that

people call me a feminist whenever I express sentiments that differentiate me

from a doormat or a prostitute. " -- West

RE: hope for type 2's

Hi Bill,

This is true that treating a low with random amounts of sugar might cause a

high, but by the time someone's blood sugar is low enough that they are only

semi-conscious or unconscious, their life may be in danger. This is

particularly true if they are type 1 (type 1s often cannot effectively bring

up their own blood sugar), and they may also still have insulin in their

systems continuing to drive their blood sugar even lower. It is possible for

a type 1 to reach a blood sugar of 20, 10 or even 0, and frequently by the

time someone is semi-conscious or unconscious their sugar has dropped into

the 20s or 30s.

Although I haven't had a severe low in many years, I have been in this

situation, and I would rather someone give me sugar immediately, with

whatever is available close by, rather than spend time trying to find

something suitable or remember detailed instructions for measuring out the

proper amount. It is different when the person is able to treat a low

themselves, but when they are unable to ask for assistance, it has become an

emergency and must be treated quickly. When trying to get sugar into someone

who is non-responsive or uncooperative because of a severe low, it's also

difficult to get an exact amount of anything into them. When I had severe

lows as a teenager I used to frequently refuse to eat or try to spit out

things people put in my mouth.

In the short-term a low blood sugar is immediately dangerous. A high blood

sugar, unless it lasts for very prolonged periods of time, is really not

that dangerous by comparison. Most people having a low are likely type 1 and

have insulin on hand to correct any rebound high that results from

overtreating. In addition, even if the " right " amount of food is given,

someone who experiences a severe low may go high hours later regardless

because of their body's response of releasing counter-regulatory hormones

and stored-up glucose. Glucagon, which is a hormone that triggers the

release of glucose from the liver and is often not produced quickly or in

appropriate amounts by people with type 1, can be injected if someone is

unconscious. Glucagon injections often causes prolonged high blood sugars

several hours after an injection (similar to how a person's own body can

cause such a rebound), but this is considered preferable to the person dying

or experiencing brain damage due to time spent unconscious from

hypoglycemia. The reason you never give an unconscious person anything by

mouth is that there is a danger that they will aspirate (breath into their

lungs) whatever is put into their mouth since they cannot consciously

swallow, which would result in another life-threatening situation.

Once the person has recovered from the low and their life is no longer in

danger, then they can take steps to bring down whatever high has resulted

from the treatment they received. Anyway, sorry I've rambled on so much, but

I wanted to put an explanation about why I believe the advice about treating

severe lows is not " outdated " or bad advice.

Jen

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[Guest guest]

kel, could you talk more about totally blind on the pump and give us some feed

back. thanks, karen

RE: hope for type 2's

Hi Bill,

This is true that treating a low with random amounts of sugar might cause a

high, but by the time someone's blood sugar is low enough that they are only

semi-conscious or unconscious, their life may be in danger. This is

particularly true if they are type 1 (type 1s often cannot effectively bring

up their own blood sugar), and they may also still have insulin in their

systems continuing to drive their blood sugar even lower. It is possible for

a type 1 to reach a blood sugar of 20, 10 or even 0, and frequently by the

time someone is semi-conscious or unconscious their sugar has dropped into

the 20s or 30s.

Although I haven't had a severe low in many years, I have been in this

situation, and I would rather someone give me sugar immediately, with

whatever is available close by, rather than spend time trying to find

something suitable or remember detailed instructions for measuring out the

proper amount. It is different when the person is able to treat a low

themselves, but when they are unable to ask for assistance, it has become an

emergency and must be treated quickly. When trying to get sugar into someone

who is non-responsive or uncooperative because of a severe low, it's also

difficult to get an exact amount of anything into them. When I had severe

lows as a teenager I used to frequently refuse to eat or try to spit out

things people put in my mouth.

In the short-term a low blood sugar is immediately dangerous. A high blood

sugar, unless it lasts for very prolonged periods of time, is really not

that dangerous by comparison. Most people having a low are likely type 1 and

have insulin on hand to correct any rebound high that results from

overtreating. In addition, even if the " right " amount of food is given,

someone who experiences a severe low may go high hours later regardless

because of their body's response of releasing counter-regulatory hormones

and stored-up glucose. Glucagon, which is a hormone that triggers the

release of glucose from the liver and is often not produced quickly or in

appropriate amounts by people with type 1, can be injected if someone is

unconscious. Glucagon injections often causes prolonged high blood sugars

several hours after an injection (similar to how a person's own body can

cause such a rebound), but this is considered preferable to the person dying

or experiencing brain damage due to time spent unconscious from

hypoglycemia. The reason you never give an unconscious person anything by

mouth is that there is a danger that they will aspirate (breath into their

lungs) whatever is put into their mouth since they cannot consciously

swallow, which would result in another life-threatening situation.

Once the person has recovered from the low and their life is no longer in

danger, then they can take steps to bring down whatever high has resulted

from the treatment they received. Anyway, sorry I've rambled on so much, but

I wanted to put an explanation about why I believe the advice about treating

severe lows is not " outdated " or bad advice.

Jen

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[Guest guest]

jen, my husband is very concerned about the pump and having lows. but i have

lows with thee injection and had one yesterday which was two point two and not

nice. times for eating got changed with a easter family dinner. it is really

hard when your schedule gets out of wack. i had a peanut butter sandwich with me

and planned on eating it for lunch at my regular time. i know that would have

worked but did not want to insult the host. lunch was put off till two p m

whnich went on to four thirty so it thru off the supper time also. i think i

should have planned better and not worry about the others and when they were

eating. how would you work around that if you were on the pump. karen

Re: hope for type 2's

patricia, i am totally blind and was recently told i could not be allowed to

go on the pump because of my lack of sight. why would that be. karen

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[Guest guest]

Dave,

WOW! I've never actually heard of anyone with a low of 14 and can't conceive

of how awful that would even feel. Lucky for you that someone intervened,

because at that low a level you could never have helped yourself. I was

scared enough when I had a reading of 41! My mom, on the other hand, has

readings in the 30s a lot but I just cannot get through to either her or to

my dad how to change their regimen a litle to even out her sugars and pull

the reins in on the roller-coaster she's constantly riding. I concede that

type 1's will have to be treated differently than type 2's.

In my original post, I think my goal, which I don't think I accomplished,

was to point out that there is a lot of confusion amongst the public on how

to treat a comatose diabetic. Q Public knows, in very simplistic form,

that diabetes can be caused by overeating sweets for a prolonged period, yet

sweets are what you give a comatose diabetic to wake them up. That concept

is quite confusing. What I'd like to see them learn is it's a controlled

amount of sugar instead of a " sky's the limit " approach that I've heard some

in the public subscribe to. I hate to aggravate one problem with another,

yet the immediate goal is to wake that person from a coma and then deal with

the roller-coaster effect later. I guess in the meantime, until the public

can be better educated, we'll have to settle for comatose diabetics getting

too much of a sugar jolt to wake them and then having to deal with the

sling-shot effect of high sugars later.

I haven't had that many " dangerous " lows, being a type 2, but as terrible as

I can feel when I get int othe 40s, it's frightening to me to think of

someone getting into the 30s or 20s and below. So I take it then that type

1's that go this low don't experience the " dawn " effect of sugars going up

overnight? As a type 2 this can happen to me, and it's frustrating when it

does, though I've been learning to moderate my evening snacks to keep the

morning result within normal limits, always a struggle though. I guess if I

were a type 1, I take it that I wouldn't have this phenomenon?

Bill

[Guest guest]

I'm not Jen, but I would have eaten at least half the sandwich and if the

hostess did not understand, well, too bad! Certainly you could have

explained that to her.

Re: hope for type 2's

jen, my husband is very concerned about the pump and having lows. but i have

lows with thee injection and had one yesterday which was two point two and

not nice. times for eating got changed with a easter family dinner. it is

really hard when your schedule gets out of wack. i had a peanut butter

sandwich with me and planned on eating it for lunch at my regular time. i

know that would have worked but did not want to insult the host. lunch was

put off till two p m whnich went on to four thirty so it thru off the supper

time also. i think i should have planned better and not worry about the

others and when they were eating. how would you work around that if you were

on the pump. karen

Re: hope for type 2's

patricia, i am totally blind and was recently told i could not be allowed to

go on the pump because of my lack of sight. why would that be. karen

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[Guest guest]

Bill, and all, " roller-coaster " is pretty much the word with most type 1s. I

doubt any type 1 on this list, many of whom I believe represent the smaller

segment of diabetics who really take control of their disease, are ever free of

this roller-coaster ride that is inescapable at times.

As far as the dawn phenomenon, yes, type 1s are quite susceptible. In fact,

throw in the roller-coaster just for some extra fun, and it is really a pain!

Most of the time, my bed-time Lantus and checking my bg in the middle of the

night helps me from having too much trouble with the unwanted dawn affect.

Dave

A wise man's heart guides his mouth, and his lips promote instruction. (Proverbs

16:23)

RE: hope for type 2's

Dave,

WOW! I've never actually heard of anyone with a low of 14 and can't conceive

of how awful that would even feel. Lucky for you that someone intervened,

because at that low a level you could never have helped yourself. I was

scared enough when I had a reading of 41! My mom, on the other hand, has

readings in the 30s a lot but I just cannot get through to either her or to

my dad how to change their regimen a litle to even out her sugars and pull

the reins in on the roller-coaster she's constantly riding. I concede that

type 1's will have to be treated differently than type 2's.

In my original post, I think my goal, which I don't think I accomplished,

was to point out that there is a lot of confusion amongst the public on how

to treat a comatose diabetic. Q Public knows, in very simplistic form,

that diabetes can be caused by overeating sweets for a prolonged period, yet

sweets are what you give a comatose diabetic to wake them up. That concept

is quite confusing. What I'd like to see them learn is it's a controlled

amount of sugar instead of a " sky's the limit " approach that I've heard some

in the public subscribe to. I hate to aggravate one problem with another,

yet the immediate goal is to wake that person from a coma and then deal with

the roller-coaster effect later. I guess in the meantime, until the public

can be better educated, we'll have to settle for comatose diabetics getting

too much of a sugar jolt to wake them and then having to deal with the

sling-shot effect of high sugars later.

I haven't had that many " dangerous " lows, being a type 2, but as terrible as

I can feel when I get int othe 40s, it's frightening to me to think of

someone getting into the 30s or 20s and below. So I take it then that type

1's that go this low don't experience the " dawn " effect of sugars going up

overnight? As a type 2 this can happen to me, and it's frustrating when it

does, though I've been learning to moderate my evening snacks to keep the

morning result within normal limits, always a struggle though. I guess if I

were a type 1, I take it that I wouldn't have this phenomenon?

Bill

[Guest guest]

Because your doctor apparently does not think you are capable of memorizing

the various menus and beeps on the pump! If possible change docs!

Re: hope for type 2's

patricia, i am totally blind and was recently told i could not be allowed to

go on the pump because of my lack of sight. why would that be. karen

RE: hope for type 2's

Hi Bill,

This is true that treating a low with random amounts of sugar might cause a

high, but by the time someone's blood sugar is low enough that they are only

semi-conscious or unconscious, their life may be in danger. This is

particularly true if they are type 1 (type 1s often cannot effectively bring

up their own blood sugar), and they may also still have insulin in their

systems continuing to drive their blood sugar even lower. It is possible for

a type 1 to reach a blood sugar of 20, 10 or even 0, and frequently by the

time someone is semi-conscious or unconscious their sugar has dropped into

the 20s or 30s.

Although I haven't had a severe low in many years, I have been in this

situation, and I would rather someone give me sugar immediately, with

whatever is available close by, rather than spend time trying to find

something suitable or remember detailed instructions for measuring out the

proper amount. It is different when the person is able to treat a low

themselves, but when they are unable to ask for assistance, it has become an

emergency and must be treated quickly. When trying to get sugar into someone

who is non-responsive or uncooperative because of a severe low, it's also

difficult to get an exact amount of anything into them. When I had severe

lows as a teenager I used to frequently refuse to eat or try to spit out

things people put in my mouth.

In the short-term a low blood sugar is immediately dangerous. A high blood

sugar, unless it lasts for very prolonged periods of time, is really not

that dangerous by comparison. Most people having a low are likely type 1 and

have insulin on hand to correct any rebound high that results from

overtreating. In addition, even if the " right " amount of food is given,

someone who experiences a severe low may go high hours later regardless

because of their body's response of releasing counter-regulatory hormones

and stored-up glucose. Glucagon, which is a hormone that triggers the

release of glucose from the liver and is often not produced quickly or in

appropriate amounts by people with type 1, can be injected if someone is

unconscious. Glucagon injections often causes prolonged high blood sugars

several hours after an injection (similar to how a person's own body can

cause such a rebound), but this is considered preferable to the person dying

or experiencing brain damage due to time spent unconscious from

hypoglycemia. The reason you never give an unconscious person anything by

mouth is that there is a danger that they will aspirate (breath into their

lungs) whatever is put into their mouth since they cannot consciously

swallow, which would result in another life-threatening situation.

Once the person has recovered from the low and their life is no longer in

danger, then they can take steps to bring down whatever high has resulted

from the treatment they received. Anyway, sorry I've rambled on so much, but

I wanted to put an explanation about why I believe the advice about treating

severe lows is not " outdated " or bad advice.

Jen

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[Guest guest]

Bill,

Type ones still have the dawn effect-we just have to adjust our basal insul,

si covers that. Forinstance between midnight and 3 in the morning, the pump

gives me .4 unit of insulin and between 4AM and 7Am, I get .7 unit of

insulin to cover the dawn effect. I have had sugars a low as 14 amybe lower

as the pareamedicis could not even get a BG. Iwa unconscious, of courser

and convulsing. (My husband calls it " flopping like a tuna " !) Fortunately

someone was around and could call the paramedics. I would much rather deal

with the high BG that happens afterwards, however.

RE: hope for type 2's

Dave,

WOW! I've never actually heard of anyone with a low of 14 and can't conceive

of how awful that would even feel. Lucky for you that someone intervened,

because at that low a level you could never have helped yourself. I was

scared enough when I had a reading of 41! My mom, on the other hand, has

readings in the 30s a lot but I just cannot get through to either her or to

my dad how to change their regimen a litle to even out her sugars and pull

the reins in on the roller-coaster she's constantly riding. I concede that

type 1's will have to be treated differently than type 2's.

In my original post, I think my goal, which I don't think I accomplished,

was to point out that there is a lot of confusion amongst the public on how

to treat a comatose diabetic. Q Public knows, in very simplistic form,

that diabetes can be caused by overeating sweets for a prolonged period, yet

sweets are what you give a comatose diabetic to wake them up. That concept

is quite confusing. What I'd like to see them learn is it's a controlled

amount of sugar instead of a " sky's the limit " approach that I've heard some

in the public subscribe to. I hate to aggravate one problem with another,

yet the immediate goal is to wake that person from a coma and then deal with

the roller-coaster effect later. I guess in the meantime, until the public

can be better educated, we'll have to settle for comatose diabetics getting

too much of a sugar jolt to wake them and then having to deal with the

sling-shot effect of high sugars later.

I haven't had that many " dangerous " lows, being a type 2, but as terrible as

I can feel when I get int othe 40s, it's frightening to me to think of

someone getting into the 30s or 20s and below. So I take it then that type

1's that go this low don't experience the " dawn " effect of sugars going up

overnight? As a type 2 this can happen to me, and it's frustrating when it

does, though I've been learning to moderate my evening snacks to keep the

morning result within normal limits, always a struggle though. I guess if I

were a type 1, I take it that I wouldn't have this phenomenon?

Bill

[Guest guest]

Pat,

Yeah I see your point about preferring to deal with the highs later on

instead of extreme lows. You were very lucky someone was around on your low

BS since you were not even conscious. I sure do remember how much of a

struggle it was for me the time I reached 41 just to have sense of mind

enough to check my BS to confirm what I was feeling and then act to correct

the situation. Folks like my mom can't make that connection so when they

feel bad they simply don't have the presence of mind to know what to do. And

I sure don't want to find out at what level I would not be able to make that

rational decision on my own, not if I can help it.

Also, thanks for letting me know that type ones do have the dawn phenomenon,

too. I figured that only type twos have it because, as I understand it, our

bodies produce enough sugar to make us wake up in the morning, though

sometimes it's simply too much of a jump start. And I figured type ones did

not have that push, but I learn something here every day.

Bill

[Guest guest]

I agree. Most type 1s cannot achieve the kind of stability in blood sugars

that type 2s, especially type 2s not taking insulin, can on a daily basis. I

am in good control (A1c in the 6% range, use a pump, test 8-12 times a day,

exercise and try to eat well, and make frequent insulin adjustments) and

went on a continuous glucose monitor for a week several months ago, which

measured my blood sugar every minute and then plotted the results on a

graph. There was not a single day when my blood sugar did not go above 200

or below 70 at least once or twice, and usually multiple times. This was

frequently between tests when there was really not much I could do to stop

it, though even when I test I find it hard to keep all of my readings in a

good range. The nurse looking at my results said I was one of the

best-controlled patients she had seen.

I do experience the dawn phenomenon. Before I got an insulin pump I used to

go to bed at 110-140 every night and wake up above 200 and sometimes above

300 almost every morning. My blood sugar would be fine until 3:00 in the

morning and then would begin a sharp rise. If I didn't eat breakfast, it

would continue to rise even after I woke up. The only way to stop It was to

wake up at 3:00 in the morning every night to give myself a unit or two of

Humalog. Now I have my pump set so that between 3:00 and 8:00 in the morning

it delivers a higher rate of insulin, which covers the rise nicely. The dawn

phenomenon is something that even nondiabetics get, but their bodies are

able to effectively produce and use the extra insulin needed to stop their

blood sugars from rising.

Jen

Re: hope for type 2's

Bill, and all, " roller-coaster " is pretty much the word with most type 1s.

I doubt any type 1 on this list, many of whom I believe represent the

smaller segment of diabetics who really take control of their disease, are

ever free of this roller-coaster ride that is inescapable at times.

As far as the dawn phenomenon, yes, type 1s are quite susceptible. In fact,

throw in the roller-coaster just for some extra fun, and it is really a

pain! Most of the time, my bed-time Lantus and checking my bg in the middle

of the night helps me from having too much trouble with the unwanted dawn

affect.

Dave

[Guest guest]

Hi ,

I agree that you should have just eaten the sandwich. If the host was

insulted by that it's her problem, not yours! I ramble on about how the pump

works below, it does enable you to delay or even skip altogether meals, but

it doesn't eliminate lows completely, that is just part of being type 1.

Also, like other regimens, the pump only works as well as the energy someone

puts into it. If someone boluses and then delays eating, they will go low

just as easily as if they had done the same on shots.

The pump has a basal rate which is a little drip of insulin it's delivering

around the clock. This does the same thing as a long-acting insulin like

Lantus would normally do. The pump only uses rapid-acting insulin like

Humalog, NovoRapid, or Apidra, no long-acting insulin. The difference is

that unlike Lantus, with a pump you can change the amount of basal insulin

that's delivered at different times of the day. You " test " this basal rate

by skipping meals and seeing if your blood sugar rises or falls. If it does,

you adjust your basal rate up or down. If it's set correctly, the basal rate

keeps your blood sugars steady between meals and overnight, even if you skip

a meal. It's also possible to temporarily raise or lower the basal rate for

a few hours, if you decide to exercise, for example. The pump is perfect for

erratic lifestyles because you don't need to eat on a schedule to keep good

control.

When you do eat, you program a " bolus " of insulin. You do this by figuring

out how many carbohydrates you're supposed to be eating and what your blood

sugar is and whether it needs adjusting. You pre-program into the pump how

much insulin you need to cover a certain number of carbs (your

insulin-to-carb ratio), and also how much a unit of insulin will lower your

blood sugar (your correction ratio), and also where you would like your

blood sugar all the time (your target blood sugar) and then at mealtimes the

pump uses this information to calculate your insulin dose. You would enter,

for example, that you're eating 25 grams of carbs and that your blood sugar

is 8.4, and you have entered that a unit of insulin will cover 15 grams of

carbs and will lower your blood sugar 2 mmol/L and that your target blood

sugar is 6.0, the pump uses this information to suggest a dose. It is

also possible to do fancy things with boluses such as set different carb

ratios for different times of the day (for example, if you need more insulin

to cover the same number of carbs at breakfast than you do at other times of

the day), or use " extended " boluses which spread the delivery of a bolus out

over several hours, which is uses to cover high-fat foods such as pizza.

The pump actually decreases the number of lows most people have, and also

makes those lows less severe and easier to treat. Of course you have to make

sure you're counting carbohydrates properly and making adjustments for

things like exercise, otherwise you'll get lows just as easily. But the pump

in and of itself allows much finer adjustments of insulin than shots do,

making the insulin you get match much more closely what your pancreas would

be producing if it were able to produce insulin.

Jen

Re: hope for type 2's

jen, my husband is very concerned about the pump and having lows. but i have

lows with thee injection and had one yesterday which was two point two and

not nice. times for eating got changed with a easter family dinner. it is

really hard when your schedule gets out of wack. i had a peanut butter

sandwich with me and planned on eating it for lunch at my regular time. i

know that would have worked but did not want to insult the host. lunch was

put off till two p m whnich went on to four thirty so it thru off the supper

time also. i think i should have planned better and not worry about the

others and when they were eating. how would you work around that if you were

on the pump. karen

[Guest guest]

Hi Bill,

Several years ago someone on the list posted that she had a low of 15 and

drove herself to the emergency room.

Long about that time either Harry or posted that the highest reading

was 2,500 and it was a 12 year old boy.

Hope all had a good weekend.

Cy, The Anasazi.

_____

From: blind-diabetics

[mailto:blind-diabetics ] On Behalf Of Bill Powers

Sent: Monday, April 13, 2009 9:58 AM

To: blind-diabetics

Subject: RE: hope for type 2's

Dave,

WOW! I've never actually heard of anyone with a low of 14 and can't conceive

of how awful that would even feel. Lucky for you that someone intervened,

because at that low a level you could never have helped yourself. I was

scared enough when I had a reading of 41! My mom, on the other hand, has

readings in the 30s a lot but I just cannot get through to either her or to

my dad how to change their regimen a litle to even out her sugars and pull

the reins in on the roller-coaster she's constantly riding. I concede that

type 1's will have to be treated differently than type 2's.

In my original post, I think my goal, which I don't think I accomplished,

was to point out that there is a lot of confusion amongst the public on how

to treat a comatose diabetic. Q Public knows, in very simplistic form,

that diabetes can be caused by overeating sweets for a prolonged period, yet

sweets are what you give a comatose diabetic to wake them up. That concept

is quite confusing. What I'd like to see them learn is it's a controlled

amount of sugar instead of a " sky's the limit " approach that I've heard some

in the public subscribe to. I hate to aggravate one problem with another,

yet the immediate goal is to wake that person from a coma and then deal with

the roller-coaster effect later. I guess in the meantime, until the public

can be better educated, we'll have to settle for comatose diabetics getting

too much of a sugar jolt to wake them and then having to deal with the

sling-shot effect of high sugars later.

I haven't had that many " dangerous " lows, being a type 2, but as terrible as

I can feel when I get int othe 40s, it's frightening to me to think of

someone getting into the 30s or 20s and below. So I take it then that type

1's that go this low don't experience the " dawn " effect of sugars going up

overnight? As a type 2 this can happen to me, and it's frustrating when it

does, though I've been learning to moderate my evening snacks to keep the

morning result within normal limits, always a struggle though. I guess if I

were a type 1, I take it that I wouldn't have this phenomenon?

Bill

[Guest guest]

Cy,

The highest BS I've ever heard of, back when I was a medical

transcriptionist doing an Emergency Room account, was 1,250 or so, but to

qualify thisit was a 725 pound man. amazingly, he was conscious and even

more amazing, he brought himself to the ER (or at least that is what the doc

was led to believe.) Wow! I can't imagine that high a reading. Isn't

anything above 600 usually fatal? In fact I knew a man who drank and smoked

constantly and he was definitely diabetic, who supposedly went into a

" diabetic coma " with a reading of 850. (This confused me, I thought you only

went into a coma on low blood sugars, not on high ones, yet I can tell you

that on the few times my sugar has gone really high I've felt very sleepy.)

Bill

[Guest guest]

Hi Bill,

You can definitely go into a coma from high blood sugar! And blood sugars

can get much higher than 600 and not be fatal. Many type 1s are diagnosed

with blood sugar levels of 600-1000 or even higher. I myself hit a blood

sugar in the 500 range about once a year or so, and when I was diagnosed I

was over 600, but I don't know what the exact number was. It's not the blood

sugars themselves that cause problems, it's other conditions that *cause*

the high blood sugars that can be fatal. I've posted below an article about

these two types of conditions, one that occurs with type 1s and one that

occurs with (usually elderly) type 2s.

Jen

When You Need to Go to The Emergency Room with High Blood Sugars

My uncle, like all his family, was a bit of a cheapskate. He hated to spend

money unless it was absolutely necessary. He was thin and active, having

only recently given up a career as a singer and dancer performing weekly on

a nationally televised variety show. So when he felt unwell one weekend

night, he turned down his wife's suggestion that she drive him to the

emergency room and told her he'd wait til Monday when he could see his

family doctor. Why waste all that money on an ER visit that was probably

unnecessary?

As it turned out, he didn't need to see his doctor on Monday. He died that

night. He was a few years younger than I am now and the fatal heart attack

he experienced was the first symptom he had of our family's odd form of

inherited diabetes.

But this is why, even though I've inherited the family " cheap " gene, if

there's any possibility something dangerous is going on, I head for the ER.

Usually it is a waste of money. I was in a small car accident a few weeks

ago that left me with nerve pain running up and down my arms and legs. I sat

for four hours at our local ER, saw the doctor for five minutes, and was

sent home. The diagnosis, whiplash. The treatment, wait and see if it gets

worse. The bill? Over $900.

I went to the ER because I'd called my family doctor's office and they told

me to. Whiplash usually resolves on its own, but occasionally it can cause

swelling in your neck that can kill you. I'm not equipped to judge what kind

I had, and unlike my uncle, I wasn't about to gamble.

So with this in mind, you can understand my reaction when a stranger

contacted me recently, after reading my web page, and told me that his blood

sugar, which had been normal until very recently, was testing in the 500s on

his meter except when his meter wasn't able to give him a number. Cutting

the carbs out of his diet was not lowering his blood sugar, either. He'd

been told to go to the ER, but didn't have insurance. This is an ugly

situation, but being alive without insurance is a whole lot better than

leaving a tidy estate. I told him to go to the ER too.

A blood sugar over 500 mg/dl is an emergency. Especially if you aren't

already diagnosed with diabetes or under a doctor's care. It's an emergency

not because those very high blood sugars will lead to complications. They

will, but it takes more than a few days of exposure to high blood sugars to

cause complications. It's an emergency because the are two different

disorders that can occur when your blood sugar is very high that can kill

you within hours.

One is diabetic ketoacidosis (DKA). This is a condition that usually occurs

in people who are not making any insulin at all. Usually this means someone

with a diagnosis of Type 1 diabetes. But it is also diagnosed in people with

Type 2, probably because many people who develop diabetes late in life are

misdiagnosed with Type 2 when they really have some form of autoimmune

diabetes that is killing off their beta cells.

DKA occurs when people have no insulin in their bodies to counteract their

rising blood sugars. Unable to burn glucose without insulin, their cells

begin to starve even as their blood sugar rises extremely high. The body

survives by burning stored fat which produces ketones. If high levels of

ketones build up in their bloodstream, which is already filled with

unprocessed glucose, the acidity of the blood rises to a point where, if not

treated, it damages tissues irreversibly and causes death.

The symptoms of DKA are high blood sugars (300 mg/dl or higher ) and:

excessive thirst, frequent urination, nausea and vomiting, Abdominal pain,

loss of appetite, Weakness or fatigue, shortness of breath, fruity-scented

breath, and confusion.

The occurrence of DKA is often what triggers a Type 1 diagnosis. Estimates

of its fatality range from 1% to 10% but if you get to a hospital when you

develop DKA you can be rescued with intravenous insulin and fluids.

The other dangerous condition associated with very high blood sugars is the

hyperosmolar hyperglycemic State.(HHS) Untreated this condition leads to

coma and death.

It happens when people with Type 2 diabetes become severely dehydrated at

the same time that they are experiencing very high blood sugars. This can

happen when they have a serious diarrhea and vomiting syndrome like that

caused by norovirus or e coli, or in elderly people who are prone to

dehydration. With HHS, the patient will not be spilling ketones. But if it

occurs it is more likely to be fatal than DKA. Estimates of its fatality

range from 10-20%.

HHS may develop over a course of days or weeks, unlike DKA which develops

suddenly. Symptoms include very high blood sugar (over 600 mg/dl) and:

drowsiness and lethargy, delirium, coma, seizures, visual changes or

disturbances, hemiparesis (one sided paralysis), and sensory deficits.

Patients with HHS do not typically report abdominal pain, which is often

seen in DKA.

What these conditions have in common is that if you develop them, you can go

from fine to dead very quickly though they can be treated successfully with

intravenous insulin and fluids at the ER.

Not everyone whose blood sugar goes over 500 mg/dl develops either

condition. And if you have been diagnosed with diabetes of either type and

see an occasional reading over 300 mg/dl, which most people will, it isn't

likely to kill you. Nor does one very high reading mean you have to head for

the emergency room if you have tools at hand that you have used in the past

that you know will lower your blood sugar.

If your high blood occurred because you forgot to take your insulin, because

your insulin spoiled due to exposure to high temperatures, or because your

needle or cannula got blocked and the insulin you used didn't get into your

body, all you may need is another dose of insulin, possibly one from a new

vial or a new cannula for your pump.

But if your blood sugar does not come down swiftly in response to your usual

techniques, or if your blood sugar is over 300 mg/dl and you are vomiting

and cannot keep down liquids, or having a lot of diarrhea, you do need to

head to the ER.

And if you are new to diabetes and your meter is reading " HI " or in the 500s

and you don't feel well, you most certainly need to head to the ER.

It's possible you'll end up being told your high blood sugar isn't a crisis

and leave, as I did, with a huge bill. This is what eventually happened to

the gentleman who contacted me. The ER confirmed that his blood sugar was

very high, gave him an emergency shot of insulin, told him he had Type 2

diabetes, prescribed metformin, and referred him to a doctor. I don't know

what labs were done, but I would hope assume his urine was checked for

ketones.

He may be thinking that his trip to the ER was a mistake, but it wasn't. He

was feeling unwell and until a doctor determined he wasn't going into DKA or

HHS, with the high blood sugars he was experiencing there was a significant

risk he might.

You don't want to end up like my uncle. Much better to guess wrong and end

up with an ER bill than to guess wrong and end up dead.

RE: hope for type 2's

Cy,

The highest BS I've ever heard of, back when I was a medical

transcriptionist doing an Emergency Room account, was 1,250 or so, but to

qualify thisit was a 725 pound man. amazingly, he was conscious and even

more amazing, he brought himself to the ER (or at least that is what the doc

was led to believe.) Wow! I can't imagine that high a reading. Isn't

anything above 600 usually fatal? In fact I knew a man who drank and smoked

constantly and he was definitely diabetic, who supposedly went into a

" diabetic coma " with a reading of 850. (This confused me, I thought you only

went into a coma on low blood sugars, not on high ones, yet I can tell you

that on the few times my sugar has gone really high I've felt very sleepy.)

Bill

[Guest guest]

can you ever be told you are type 2, when you are really type 1, I ask, because

I think they seen a fat lady and just said type two, but I use to have lows and

such before I ever started meds, and a bowl of non sugar cerel would make me go

over 400. also, non of the oral meds helped. I have gained some better control

on insulin, I eat very well and work out four days a week. and my a1c last

checked was 6.9 but has been up to 14 before.

Kell

MSN: Kell@...

Skype: KlarssonNY

" I have never been able to find out precisely what feminism is: I only know that

people call me a feminist whenever I express sentiments that differentiate me

from a doormat or a prostitute. " -- West

Re: hope for type 2's

Bill, and all, " roller-coaster " is pretty much the word with most type 1s.

I doubt any type 1 on this list, many of whom I believe represent the

smaller segment of diabetics who really take control of their disease, are

ever free of this roller-coaster ride that is inescapable at times.

As far as the dawn phenomenon, yes, type 1s are quite susceptible. In fact,

throw in the roller-coaster just for some extra fun, and it is really a

pain! Most of the time, my bed-time Lantus and checking my bg in the middle

of the night helps me from having too much trouble with the unwanted dawn

affect.

Dave

[Guest guest]

You might want to look into LADA, which is slow-onset type 1 in adults.

Below I've attached another article which I have sent to this list before

about the different types of diabetes and how they can sometimes be

confused. There is a test called a c-peptide test that measures the amount

of insulin your body is able to make, and another test which measures the

amount of autoantibodies to insulin in your bloodstream. Together these

tests can be used to differentiate between type 1 and type 2.

Jen

What Type Of Diabetes Do I Have?

Really Know Your Diabetes Type? You May Be Surprised

by Ruth , M.A.

When you were diagnosed, you were probably told you had either Type 1 or

Type 2 diabetes. Clear-cut and tidy. Since diabetes occurs in two types, you

have to fit into one of them. Many people do fit clearly into one of these

categories, but some do not. Those who clearly fit a type at diagnosis may

find the clear lines begin to smudge over time. Are there really only two

types? Are you really the type you were told you were? Could you even have

more than one type of diabetes, and is your original diagnosis still correct

after all these years?

Misdiagnosis or an unclear diagnosis of diabetes can create problems in

treatment. Misunderstanding the causes and changes in the disease as you age

also can lead to mistreatment. For these reasons, a clear understanding of

the types of diabetes is essential.

A Short History Of Types

Differences In Diabetes

Adapted from Using Insulin C 2003,

J Walsh PA, R MA, T MD, and C Varma MD

Described and treated since ancient times, diabetes has certain

characteristics that have long been recognized. Before the discovery of

insulin, people found to have sugar in their urine under the age of 20

usually died in their youth, while those diagnosed when over the age of 40

could live for many years with this condition.

Beginning in the mid 1920s, those who got diabetes when young (juvenile

onset) were put on insulin, and those who got it when older (adult onset)

often were not. However, the mechanisms that led to this difference in

treatment were unknown. The only marker that differentiated the two types at

that time was the presence in the urine of moderate or large levels of

ketones when blood sugars were high. If significant ketones were present,

the person could not make enough insulin, needed injected insulin to control

the blood sugar, and was called insulin-dependent.

In the early 1980s a breakthrough was made in understanding childhood onset

diabetes. It became clear that this early onset form was actually an

autoimmune disease in which the body destroyed its own beta cells. The

antibodies that the immune system put out during this attack distinguished

it from adult onset diabetes. For the first time, one type of diabetes had a

clear cause that made it different.

Definitions became clearer. Type 1, called IDDM (insulin-dependent diabetes

mellitus), now was recognized as an autoimmune disease that appeared

primarily in childhood or adolescence. Near the final phases of the attack,

the person stops producing insulin and requires injected insulin. At the

time of diagnosis, such a person often has excessive thirst and urination,

has lost a lot of weight, and has an extremely high blood sugar. This person

is normal weight or thin when Type 1 diabetes starts and may stay relatively

trim through life. Type 1 occurs in about 10% of all people who have

diabetes. Treatment for this type revolves around adjusting the dosages and

number of insulin injections to match diet and exercise.

Type 2 or NIDDM or non-insulin-dependent diabetes mellitus, on the other

hand, was described as high blood sugars occurring in a person over 40 who

is overweight and sedentary and also has a family history of this type of

diabetes. At the time of diagnosis, there may be no symptoms, or the person

may have mild symptoms, such as blurred vision or more than normal thirst

and urination. The person continues to make insulin, but the insulin

production is not sufficient to keep blood sugars normal. Treatment for Type

2 diabetes revolves around varied combinations of diet, exercise,

medications, and/or insulin injections.

Note that the use of insulin does not make someone " insulin-dependent " or a

Type 1! Some 30 to 40% of those with Type 2 use insulin, but even when

insulin is used, this type of diabetes continues to be non-insulin dependent

diabetes mellitus or NIDDM, because death will not occur if insulin is

discontinued. Some 90% of people with diabetes are considered to have Type

2.

In the early 1990s the definition of Type 2 was further refined to

distinguish those with and without Syndrome X. Syndrome X is strongly

associated with insulin resistance and with high total cholesterol (over

200), high triglycerides (also over 200), low HDL (under 40 mg/dl), high

blood pressure, and gout.

Those with an apple figure, who carry excess weight predominantly in their

abdomen, are at the highest risk of developing Syndrome X. The cholesterol

and blood pressure problems associated with Syndrome X trigger accelerated

cardiovascular disease, which can lead to heart attack, stroke, and kidney

disease.

Syndrome X includes all those people who have resistance to insulin. Some

25% of Americans fall into this high risk category, although only about 30%

of them will develop Type 2 diabetes at some time in their lives. Type 2

diabetes occurs when the body can no longer produce enough insulin to keep

up with the increased need for insulin. People with Syndrome X also tend to

develop high blood pressure because of this insulin resistance.

Not all of those typically classified as Type 2 have insulin resistance and

Syndrome X, however. As evidence of this, a study of people with Type 2 was

done in Bruneck, Italy, and published in Diabetes in October, 1998.

Eighty-four percent of the people in the study had insulin resistance, while

16% did not. Are these 16% nonetheless to be called Type 2?

When " Type 2 " occurs without insulin resistance, it may be referred to as

Type 1.5 or Type 2-s (for insulin sensitive) or Type 2-d (for insulin

deficient). Type 1.5 occurs in adults who usually are lean or normal weight.

These people have normal insulin sensitivity but, like other people with

Type 1, their insulin production is deficient. When their blood sugars are

controlled, they usually do not have the high risk for cholesterol, blood

pressure, or cardiac and vascular problems typically found in true Type 2

diabetes. This type of diabetes shares characteristics of both Type 1 and

Type 2. Of all the people with diabetes, roughly 10% will have classic Type

1, 75% will have Type 2 (insulin resistant), and another 15% will have Type

1.5.

In their book, Diabetes, Type 2 and What To Do (revised October, 1998),

Virginia Valentine, June Biermann and Barbara Toohey relate that in their

1993 edition of the book, they described June who developed diabetes in her

sixties as a lean Type 2-d. She was similar to the many people in the 16%

group in the Italian study described earlier. In 1998, they defined June as

a Type 1 who got diabetes later in life. They feel this description more

closely follows the American Diabetes Association revised system, as

published in Diabetes Care, January 1998, in which Type 1's are insulin

deficient and Type 2s are basically insulin resistant. I prefer to keep the

third category, Type 1.5, which clearly defines a group that represents a

sizable portion (about 16%) of those who have diabetes but are neither

ketosis-prone nor insulin-resistant.

Other forms of insulin resistant diabetes also can be seen in gestational

diabetes, polycystic ovary disease, acanthosis nigricans, and maturity-onset

diabetes of the young or MODY. Insulin resistant diabetes can also be

unmasked by medications like prednisone. In rare cases, nonresistant forms

of diabetes may also be seen following trauma to the pancreas or pancreatic

surgery. This last form is insulin dependent because no insulin can be

produced once the pancreas is removed or severely damaged.

Most people with diabetes have Type 1, Type 1.5 or Type 2. As more is known

about the causes of diabetes and more treatments are developed, more types

or sub types are certain to be defined.

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Why Is Knowing Your Type Important?

Properly understanding your type of diabetes lets you know whether you have

been correctly diagnosed, but more importantly, it makes you aware of

whether or not you are receiving correct treatment. For example, a person

diagnosed with Type 1 diabetes needs insulin right away since destruction of

beta cells has been going on for awhile. Not until about 90% of the beta

cells are destroyed does someone typically begin to have symptoms. If the

person does not clearly fit the model for Type 1, a diagnosis of Type 2 may

be made and oral agents may be prescribed, even though little insulin

production capability remains.

If they are lucky, these agents might stimulate the few active beta cells to

produce more insulin for a short time, and the blood sugar may be controlled

temporarily. However, soon an oral agent will fail, and injected insulin

will be needed. If the oral agent does not work, the person will continue to

be very sick until insulin is started. If Type 1 had been recognized right

away through an antibody test, using insulin immediately might lead to fewer

problems with control, since this often allows insulin production to

continue for a longer period of time. Blood sugar control is easier when

beta cells continue to work.

Knowing your diabetes type can also give you a better understanding of the

changes that may occur to you as you age and your disease progresses. For

example, if you have had insulin-resistant diabetes for several years and it

has become harder to control on a sulfonylurea medication, you may find that

your C-peptide level is now low, and insulin may now be required. If your

C-peptide is normal, adding another oral agent and paying closer attention

to your food and exercise choices may be all that is needed. Both situations

can occur as the disease progresses and are not necessarily a result of poor

practices on your part.

Dr. Bell, a clinician and researcher in Birmingham, Alabama, wanted to

see if he could take a group of people with Type 2 diabetes who were already

on insulin and eliminate insulin use by substituting a combination of oral

medications. He first tested C-peptide levels and chose only those who had

normal levels. Of the 130 people with adequate C-peptide levels in his 1997

study, 100 were able to discontinue insulin use altogether and control their

diabetes on various doses of glyburide and metformin, medications that were

not available when many of the patient's insulin use was begun. Dr. Bell

found that their overall control, measured by a HbA1c level, was better on

these two oral medications than it had been on two doses of insulin a day.

Other people in the study were able to improve their hemoglobin levels by

using glyburide, metformin, and one dose of insulin at dinner or nighttime.

Researchers have determined that the Type 2 patients who are most likely to

control their blood sugars on a combination of oral agents alone are those

least overweight (BMI of 30 or less), with shortest duration of insulin use,

and C-peptide levels normal or only slightly low.

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Who Is Most Likely To Be Misdiagnosed?

Many people with Type 2 diabetes are not diagnosed at all. This rampant

problem means some 8 million Americans do not know they have this disease.

Symptoms are usually minimal or nonexistent, sometimes for years, and so the

person is simply not treated for diabetes. An elevated blood sugar is only

picked up when the person goes in for a routine physical exam or visits the

doctor for another problem, like a cold or a flu.

Among people who are diagnosed with diabetes, misdiagnosis of the type

happens most often when the person does not have the body type or age

expected for Type 1 or Type 2. For example, a person who is 38 and slender

has mildly elevated blood sugars. Is this person Type 1 or Type 2? He is

older and his blood sugar may not be as high as a typical Type 1, but he is

too thin for a true Type 2. Perhaps he has Type 1.5 with diminished insulin

production but no insulin resistance. If the older person who is slim has

very high blood sugars when diagnosed, the type more likely will be thought

to be Type 1.

Or consider a child of 14 who is 40 pounds overweight and has high blood

sugars. Does this child have Type 1, Type 2, or MODY (a different type of

diabetes genetically predetermined)? Due to overeating, poor nutrition

habits and a sedentary lifestyle, more and more children are now developing

Type 2 at an early age. In fact, Dr. Gerald Bernstein, president of the

American Diabetes Association, says one-fourth of new cases in people under

age 20 are now Type 2. In the Journal of the AMA, November, 1998,

researchers are recommending that diabetes screening be considered for

sedentary, overweight people as young as 15 as a way to prevent the

complications that years of high blood sugars can cause.

What about the person who is 50 years old, has high blood sugars, is 15

pounds overweight, but has a pear shaped body? Is she Type 1 or Type 2? She

could be an older-than-usual Type 1 or she could be a Type 2 with a strong

family background of diabetes, meaning that a modest weight gain is all that

was needed for diabetes. This is especially true if body fat is high and

deposited intraperitoneally (in the gut).

These cases indicate that people often do not fit into clear profiles. When

the traditional profile does not match the person, understanding what may

have caused the diabetes and determining how it should be treated is often

problematic.

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Does Your Type Ever Change?

Blurring of the lines between Type 1 and Type 2 diabetes is becoming

increasingly common. Due to aging or the general progress of the disease,

people with one type of diabetes tend to take on characteristics of the

other. As a result, some people with diabetes may have characteristics of

both types.

If Type 1's begin to exercise less and gain weight around the middle, as

many people do when they age, they may become not only insulin deficient but

also insulin resistant. They then can develop the cardiac risks associated

with Syndrome X and require medications to lower cholesterol and blood

pressure. They will require more insulin to control their blood sugars, and

certain medications typically used in Type 2 diabetes, such as Glucophage,

may help in their control.

On the other hand, as Type 2 diabetes progresses, especially if it is not

well-controlled and the pancreas is placed under additional stress, insulin

production may diminish to a point where it can no longer keep up with need.

A sulfonylurea may no longer be able to stimulate the beta cells to produce

enough insulin. Medications in addition to sulfonylurea, such as Precose or

Prandin, may be needed. As insulin production falls further, injected

insulin will be required to keep blood sugars from rising. Some people with

Type 2 eventually become totally dependent on insulin and can go into

ketoacidosis if insulin injections are stopped.

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How Can You Know Your Type At Any Age Or Stage?

When a person does not fit into a clear profile, a diagnosis of Type 1, Type

1.5, or Type 2 is not obvious. A variety of lab tests and clinical signs

help to provide the critical information needed to correctly determine which

type of diabetes the person has.

* Ketones: Ketones are a byproduct produced when the body uses large amounts

of fat as fuel. This occurs when carbohydrate is no longer available as fuel

due to a lack of insulin. When a urine or blood test shows large amounts of

ketones, that person definitely has Type 1 or insulin dependent diabetes.

(One rare exception is young, black males who can have ketones at diagnosis

but regain insulin production.) If insulin is injected before the ketone

test is administered, the opportunity to find large amounts of ketones may

have passed. The urine can easily be tested for ketones at home with

Ketostix or Ketodiastix anytime the blood sugar levels are high.

* Antibodies: Type 1 diabetes is an autoimmune disease, so 80 to 90% of the

time when Type 1 exists, the person is producing antibodies characteristic

of Type 1, such as the islet cell antibodies and GAD 64 antibodies. The

blood can be tested to see if any of these antibodies are present. If

antibodies specific to Type 1 are detected, the person already has or is

likely to develop Type 1 diabetes. These tests are currently used in the

DPT-1 trial to test relatives of those with Type 1 diabetes and detect who

will develop this disease.

* High triglyceride and low HDL: Cholesterol problems characterized by high

triglycerides and low HDL are typical of insulin resistance. These markers

for Syndrome X are commonly found in Type 2 diabetes. A detailed cholesterol

test or lipid profile test will determine this.

* Uric Acid: The high uric acid level often found in people with gout is a

component of Syndrome X. If a person has a high uric acid level and high

blood sugars, he usually has insulin-resistant, Type 2 diabetes.

* C-peptide: If other tests fail to indicate the type of diabetes, a

C-peptide test can reveal how much insulin the person is producing.

C-peptide is half of the precursor molecule to insulin that is split off

when insulin is produced by the body. If C-peptide is normal or high, Type 2

diabetes is likely. If the level is significantly low, Type 1 diabetes is

likely. If the level is near normal but low, the results are inconclusive.

This person may have early Type 1, Type 1.5, or long-term Type 2. When

external insulin is controlling the blood sugar, the C-peptide may read low

due to suppression of insulin production by the beta cells. This test should

be done after insulin has been reduced or discontinued, and the blood sugar

has risen to 200 mg/dl or over.

When should these tests be used, since lab tests increase health care costs,

and no one wants unnecessary tests? Use them when a person who is not a

clear type is diagnosed with diabetes or when treatment is not working for

unclear reasons. Although these tests often do not tell everything needed

for a complete understanding, they can provide more of the clarification

needed to properly diagnose and treat diabetes.

In summary, our understanding of diabetes and the lab tests useful to us

continues to evolve. To understand your situation as information changes,

you want to ask specific questions about your diagnosis and treatment. An

informed, questioning approach will increase your likelihood of receiving

the best care.

Mis-Typing Is Common

When you were diagnosed, you were probably told you had either Type 1 or

Type 2 diabetes: clear-cut and tidy. Since diabetes occurs in two types, you

have to fit into one of them, or so it used to be thought. Many people do

fit clearly into one of these categories but not everyone. Even those who

clearly fit one type at diagnosis may find the lines begin to smudge over

time. Are there really only two types? Are you really the type you were told

you were? Could you have more than one type of diabetes? And is your

original diagnosis still correct after several years?

Misdiagnosis or an unclear diagnosis of diabetes can lead to problems in

treatment and health. Misunderstanding changes in the disease as you age can

also lead to mistreatment. The lack of a way to clearly define the different

types of diabetes has allowed people to be misdiagnosed, especially if

clarification is based on the typical body type or age. Today we have better

lab tests to differentiate Type 1 and Type 2, but they often are not done

and even when they are, the diagnosis may not be definitive.

When a person does not match a typical profile, mistakes can be made in

creating a treatment plan. People who have Type 1 diabetes must have

injected insulin to live because they produce little or no insulin

themselves. People who have Type 2 will need oral medications or insulin,

depending on their lifestyle and the severity of their disease. Although

they make take insulin for good control, they are not insulin dependent as

is the person with Type 1.

In fact most people who use insulin are not actually insulin dependent. The

number of people with Type 2 diabetes who use insulin is two or three times

as large as those with true insulin dependence or Type 1. Some 30 to 40% of

people with Type 2 diabetes require insulin to maintain control, but even

when insulin is used, this type of diabetes continues to be non-insulin

dependent diabetes mellitus or NIDDM, because death will not occur over a

few days if insulin is discontinued.

Re: hope for type 2's

can you ever be told you are type 2, when you are really type 1, I ask,

because I think they seen a fat lady and just said type two, but I use to

have lows and such before I ever started meds, and a bowl of non sugar cerel

would make me go over 400. also, non of the oral meds helped. I have gained

some better control on insulin, I eat very well and work out four days a

week. and my a1c last checked was 6.9 but has been up to 14 before.

Kell

MSN: Kell@...

Skype: KlarssonNY

" I have never been able to find out precisely what feminism is: I only know

that people call me a feminist whenever I express sentiments that

differentiate me from a doormat or a prostitute. " -- West