I am 5 feet 9 inches tall, weigh 148 pounds, and I have type 2 diabetes. Recently, I had an infected ulcer on my foot that is now all better, but my blood sugars are very high (300 mg/dl [16.7 mmol/L] fasting in the morning and 350 mg/dl [19.4 mmol/L] at bedtime). I was on Lantus, but my sugars were only better for a very short time (about two weeks). They used to go down overnight, but now they don’t. I am eating under 1700 calories day including a lot of low glycemic foods and have been losing about two pounds per week, so I don’t know why my sugars are so high.

Can someone with type 2 diabetes develop type 1 diabetes? How high do blood sugars run if someone with type 1 diabetes does not take insulin?

A person with type 2 diabetes doesn’t develop type 1 in terms of the way the disease evolves. However, after a person has had type 2 diabetes for a long time, the clinical appearance can look very similar to a person with type 1 diabetes.

People with type 1 diabetes have their beta cells in the pancreas destroyed by an autoimmune attack which leaves them with no insulin to make and absolutely dependant on exogenous insulin for remaining healthy. People with type 2 may start out having insulin resistance in the liver and muscle, but the pancreas has to compensate by making additional insulin. After years of this, the beta cells don’t continue to make insulin appropriately and that is when you see them need exogenous insulin.

I would urge you to take insulin if you need it. Just because your body did not previously require insulin is no guarantee you do not need it now. Type 2 diabetes, consistent with the above description, is a dynamic process and changes over time. Your recent foot infection can cause an aggravation of the blood sugars. I would also use the blood sugars as an indicator of whether there is any additional infection left, especially if they remain high. There is not a fixed level for how high the sugars can go.

JTL