I just took my sugar b/c I was having excessive thirst and polyuria. My meter said 520! I've never had a reading that high. I've been pretty moody the last couple of days which is probably due to running high. I take metformin 1000 mg bid and 30 mg actos daily. I use novolog and levimir but I'm not very compliant with my insulin use...I hate it. I just gave myself 30U novolog and am drinking a lot of water. Any other advice? Should I be worried?
Yes I am aware of the difference. Whether or not it is "1B or ketosis prone Type 2" would be diffucult to say as I am not aware of a specific clinical way to differentiate between this and regular type 2 that would more than likely present itself as HHNKS. If you have a way to tell the difference I would be interested to know what that is. All I can say is that I see DKA in Type 2's more often than you can explain by happenstance.
See my reply to Emmy's message below. Are you a nurse?
As far as treatment of either DKA or HHC (also called HHNKS, as you said) goes, there is really no difference, but the presentation is definitely different.
Type 1b and Ketosis-Prone Type 2 are the same thing.
If I saw an ostensible Type 2 in DKA, I would suspect something else was going on, unless it was a long-term Type 2 who truly had very low to no insulin production.
When I had my coma last September, which was HHC, I didn't get appropriate care until my CDE told them I was a Type 1 -- basically, she saved my life. I'm actually NOT a true Type 1, but I will take whatever I need to get appropriate care.
I understand that Type 1b and Ketosis prone Type 2 are the same but what would allow me to differentiate between those and a regular type 2's besides the presence of moderate to large ketones? I guess is what I am asking is what is to say it is these individuals are true Type 1b versus an overall pattern of DKA in regular Type 2's?
I am not sure where you hail from but in the practice I am involved with there is a larger number of Type 2's, who have little to no insulin production as confirmed by a c-peptide lab draw (required by Medicare to be approved for an insulin pump), than there is Type 1's.
I am glad that your CDE was there to "push" appropriate care for you. I hope I can provide the same service if the opportunity presents itself.
As to your post below I would again caution against Type 2's disregarding ketones vs. just paying attention CBG results with the main concern being HHNKS. There are enough Type 2's out there with little to no insulin production, that to disregard ketones would be a mistake. MOST early stage Type 2's will not present with glucose in the 500+ range. Most (not all) who present this way will have a deficiency in insulin enough that they will require exogenous insulin to adequately control their DM.
Hi - I am a Type 1b. As I presented in DKA (BG of 30+mm/ol or 540-ish, A1C of 20+) I was first diagnosed Type 1. I was spilling huge amounts of ketones and my blood was vinegar. They didn't find any antibodies later so I was re-classified. Type 1bs/KPT2s tend to be persons of colour; all the ones I know of are anyway.
As Lila said, Ketosis-prone Type 2's are almost always black or Asian, occasionally Latino. They are often slim (but not always), and when the BG is brought down, they can usually control with d+e (like Halle Berry, who is often accused of not really having diabetes), or oral meds. Sometimes they need insulin. Read Michael Barker's site on Ketosis-Prone Type 2 -- I don't have the URL, but you can google it.
I was told that, too, when I took my first diabetes education class. But I've done a lot of reading since then, and while it is true that Type 2's on the verge of HHC will show trace or small amounts of ketones, it's not the same thing as the high amounts shown by Type 1's. If you were in DKA at diagnosis, I would wonder if you weren't really a LADA -- have you been tested for antibodies? Although not all Type 1's themselves show antibodies, DKA points to an almost total lack of insulin production, and early stage Type 2's usually have higher than normal insulin production (even if it isn't very effective). Do you know what your BG was?
For Type 1's, BGs over 250, and feelings of nausea, vomiting, stomach pain, sleepiness, and rapid breathing (called Kussmaul respiration) indicate the presence of ketones and possible progression to DKA. In Type 2's, there is thirst, urination, hunger, sleepiness and confusion, and the coma comes on more gradually. The BG is also usually higher -- above 600 is usually the case, and some Type 2's have had comas with BGs of 1000 or 1500.
The exception for Type 1's is when they are first diagnosed, they can have very high BGs -- I heard of one person who had a BG of 2100 -- but the symptoms are the same.
HHC has a significantly higher mortality rate than DKA. However, the treatment is basically the same -- get the BG down gradually while keeping track of electrolytes like potassium, chloride and sodium to make sure they are neither too high nor too low. Either high or low potassium, in particular, can kill you.
Anyway, I'm glad you recovered, and are here to talk about it! :-)
You've been given some good advice here, but to the people who are saying "oh my god! you went high! go to emergency!", I really think this is overreacting. If you feel REALLY crappy, then by all means go. Highs are not good, but they happen, and if you feel relatively OK, then you are OK! Just take your insulin, don't take too much at once but monitor for a while after your initial dose and take more, in smaller increments, if the first dose wasn't enough. Drink water, that's good. If you feel OK to move, then do that a little teeny bit. 'They' recommend against exercise when you are high, but personally I find that moving helps the insulin to circulate. I myself am a T1 with insulin resistance/hormone issues and go high a lot no matter how hard I try to control it, so I know what it feels like, and I know my insulin never works better than when my muscles are moving it around.
As for the insulin compliance, that's all up to you. I can't tell you how to think or feel about it. I personally don't mind insulin; it's a quick thing I do to fix an issue, nothing more. It's the other side effects of diabetes that get annoying, but again I have a lot of stuff to live/work for in my life so I press through it.
Good luck! :o)
I have to say I totally agree with you. Although DKA should be taken seriously a BG of 520 in and of itself is not necessarily immediately life threatening. . I have seen some people with diabetes be in quite severe DKA with a blood glucose of 300mg/dl while I myself do not produce ketones at 450 mg/dl (I am a type 1). I certainly think it is worth anyone's time to get some ketone sticks to see what their usual "tipping point" is. I also think the severity of DKA is also a product of how long the blood glucose has been that high. By and large if you are in DKA there will be no question as to if you need to go to the ER or not- you will feel badly enough you will just go.
When I had my coma in September, my BG was in the 500's -- 600 at the hospital. There were only small ketones, and I was deemed to have Hyperosmolar Hyperglycemic Coma. This is the most common coma that Type 2's get, and since Scott said he was a Type 2, this was a much more likely scenario than DKA.
A Type 1 can present with small ketones if he has been taking insulin to get the BG down, but it's still a different ducky.
While I agree with you that HHNKS is the more likely end product for a type 2 with hyperglycemia I think it would be unwise to disregard DKA completely.
As for the type 1's, for me (not saying this is what is the norm for all type 1's) the confirmation that no ketones were spilled at 450 mg/dl came from a missed lunch bolus so there was no insulin "on board" besides basal given through the pump.
Although certainly not the case in all circumstances I see that often times DKA presents as prolonged hyperglycemia.
As a side note I once saw a Type 1 who had an A1c of 19% present with a lab confirmed glucose of 650 mg/dl with no ketones whatsoever. I puzzled over this for some time. I dug a litttle deeper and found this patient had a BMI = 13. This person had no fat to burn!! Goes to show not all people will present as would be expected.
I do appreciate your sharing your experience! :-)
I just learned something new! Sorry if I led you astray, Scott, by referring only to DKA and not to the comas that occur more commonly for type 2's!