October 15, 2002
Diagnosis and Symptoms
Question from California, USA:
I was diagnosed a little over two years ago, with a fasting glucose of 389 mg/dl [21.6 mmol/L] in the ER. I was unable to eat for four days before my diagnosis because of nausea, heavy difficult breathing, and constant urination and thirst. I had lost 45 pounds in seven weeks. I was given Glucophage [metformin] and sent home to see my general practitioner the next day.
Over a seven month period, oral hypoglycemic agents did no good, so I was put on insulin for better control, and after reading a bit, I checked for ketones at home, and was running moderate even with eating 200 grams of carb per a day. My general practitioner swears I have type 2 diabetes and says the tests he’s run prove this, but everything I’ve read suggests I have type 1. Do people with type 2 diabetes who are eating high amounts of carb spill ketones in the moderate to large range? I’ve shown him the camera shots of the sticks, and he says this is normal for someone with type 2 diabetes.
Answer:
I think you bring up a good point. However, on insulin, it sounds like you are still having ketones in the presence of adequate carbohydrates. If your body does not have enough insulin to utilize the carbs, they are not doing any good. If your sugars are not high, I am not sure what the reason for the high ketones is. However, if the sugars are high, this could still be from inadequate insulin. If this is the case, I would check an anti-GAD antibody level and your C-peptide levels to make sure don’t have Late-onset Autoimmune Diabetes of Adulthood (LADA).
JTL
