Ketosis Prone Type 2 diabetes in Black People

This one of the best pieces on KPD T2 in Black peoples.

Diabetes in African Americans - M C Marshall Jr

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743410/pdf/v081p00734.pdf

Atypical diabetes may constitute 10% of African American diabetic youth and is

quite similar to the atypical diabetes in African American adults (vida infra). Unlike classic type 1 diabetes or MODY, 50% of African American youth with atypical diabetes are obese. Also unlike type 1 diabetes, these patients lack islet cell autoantibodies and have a subsequent clinical course that is similar to type 2 diabetes. However, unlike typical type 2 diabetes, atypical diabetes generally presents acutely, often with weight loss and ketosis.

ATYPICAL DIABETES

A review of diabetes in the African American community would not be complete without a discussion of the ‘‘atypical’’ diabetes that has been described in this population. African Americans with type 2 diabetes have been found to have two distinctive atypical features. The first is that adult African American diabetics may present with classic signs and symptoms of DKA and thus look like type 1 diabetic patients. However, unlike type 1 diabetic patients:

(1) these patients have no autoimmune markers of type 1 diabetes;
(2) they are often obese;
(3) there is evidence of insulin resistance; and
(4) most importantly, after intensive therapy, spontaneous remission is the rule, with restoration of b cell
function within months and maintenance of normoglycaemia with oral agents or only dietary treatment.

These patients have impaired insulin secretion when admitted with DKA, but their subsequent clinical course is typical of type 2 diabetes. Recurrence of DKA is infrequent. Among those patients who remain insulin-requiring, recurrence of DKA is most often caused by non-compliance with insulin therapy. The other unique feature of diabetes in African Americans is that spontaneous remission is also seen among patients who are not ketotic. When adult African Americans with newly diagnosed type 2 diabetes receive an average of three months of intensive, multidisciplinary therapy, 30%–40% of these patients will go into remission—that is, they will achieve normoglycaemia without pharmacological therapy. Those who remit have a significantly greater return of b cell function. However, there are no clinical characteristics that can differentiate those who will remit from those who will not. There is evidence that these atypical features are also present in African American children and adolescents with type 2 diabetes. It bears remembering that the African American diabetic patient who is initially controlled with insulin need not necessarily remain on insulin therapy, and the African American diabetic patient who is initially controlled with oral agents need not necessarily remain on pharmacological therapy.

Mike

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Remission

Even if my fondest wishes are met.

I can't go back.

I will have caged a tiger but there will always be that tiger and I will never let it out.

Vigilance is my defense and having seen the destruction of this beast,

I can never consider myself safe.

There is a type of remission but having seen its cold yellow eyes, I think not.

I can not ever go back.

My innocence is lost in that regard but is that so bad?

I have played carelessly in a dangerous place and been mauled.

Now I know this place and wish to forever avoid it.

I have lost my ignorance but why would I wish to reclaim it whilst a tiger paces near by.

Carbohydrates and diabetes

I didn't know about the civil war until I became diabetic. No, not the war of northern aggression, I mean the one between diabetics and the American Diabetic Association. It has several aspects but the one I'm concerned with now is ADA carbohydrate recommendations.

They recommend a high carbohydrate - low fat diet. The problem is most diabetics can't handle carbs. It makes your blood sugar shoot up. The ADA response was to promote medications that would keep the blood sugar down even while you were pushing it up with carbs. Their recommendation comes to about 200 grams of carbs a day. I can't handle more than 20 at any given meal but I'm a KPD and we are very poor handlers of carbs. This is something I'm going to show you later but for now we'll just stick with carbs and anyones diet.

This link is to Gary Taubes, who, if you know any physics, ripped the heart out of "cold fusion". He is probably the most respected science writer in the English language. He has reluctantly become the point man in the diabetic's war with the ADA. He has challenged the accepted dogma with clear good science and, if there is a god, will probably get the Nobel Prize for Medicine some day. The book that this talk is based on is called: Good Calories, Bad Calories. The book is rough but worthwhile sledding and should be force fed to all diabetics as soon as they are diagnosed.

I believe he's correct but I think it is more important that all diabetics learn to trust their meters, even if the meters can have a 20% error rate. I ate to my meter and found that virtually everything I was told by my well intending diabetes educator was wrong. I believed my meter and followed it to a Low Carb - High Fat diet. My triglycerides dropped by 100, my HDL's rose fifty percent and my A1c dropped to 5.2. I had to resist all that I was told to get there. It was in my search to find some scientific backing for my results that I fell across Mr. Taubes. He got everything that I was looking for. Listen for yourself - http://video.google.com/videoplay?docid=4362041487661765149#

Mike

High Fructose Corn Syrup or Hard Corn Porn

This is a link that anyone should see but especially diabetics. It is Robert Lustig, a highly respected endocrinologist researcher. http://www.youtube.com/watch?v=dBnniua6-oM

His idea is that HFCS is a poison and should be eliminated from all ingestion. The video can be a bit much. He gets pretty technical and specific but it is probably the best 70 minutes you're going to spend.

Mike

Diabetes - The gift that keeps on giving

I'm on the Diabetes Forum and I would recommend this site to anyone, especially those who are new to diabetes. There is a intro section to the forum and inevitably the person will be distraught with a sense that their life is over.

As far as I know, Ketosis-Prone Type 2 is a silent killer. It lives quietly in the background unraveling your life thread by thread. You might have slightly high blood pressure, be a bit overweight, have a bit of cholesterol, virtually nothing that the average American doesn't have. What you don't know is that the life that you were planning is not going to happen. The children and the grandchildren are not going to part of your life. Those magic moments that you look towards ain't going to happen. You are traveling a different road and you won't know it until you're staring from a hospital bed watching your destination recede.

That is unless, of course, you get diabetes. This is me. I was tooling along pretty good even with the thought that I come from a short-lived family. Nearly sixty and headed to seventy, I thought I was doing everything right and I would get through. Diabetes changed that.

Everything that I thought was the case was wrong. I needed a serious change in diet, one that reduced my dearly loved carbohydrates. I needed to see what my blood sugar was doing so that I could control it. I needed to have my eyes opened so that I would learn more about my metabolism and how I existed in the world. Things were going on beneath my notice but no more. I'm a diabetic and the blinders are off.

I've got a chance now for those moments. My life, that I surely would have lost shortly, now is on the road that I envisioned. I get to do something that people in my family rarely do. I get to be old. Who do I have to thank for this: Diabetes, the gift that keeps on giving.

Mike

Guest at the funeral or the three D's

I am 57 and I am going to a family reunion in August of 2010. If you came with me one thing that you would notice is the lack of old people. There will be a few but "few" is the operative word here. You see we don't tend to live beyond the age of seventy.

My aunt Dimple, who passed away a few years back, when she reached seventy one you would have thought she had won the lottery. She was calling all around blathering to anyone who would listen how she had made it.

In my family, we die of stroke, colon cancer and heart attack. What I like to call the three Deaths or three D's, for short. I always wondered why my family was so snake bit then I became diabetic. You would think this wouldn't be such a big surprise, after all I am Black and over fifty. But you would be very wrong. I'm a life long cyclist. I'm very fit. From the neck down, I could pass for a twenty year old. There is almost nothing about me that says, " type 2 diabetes", but I am.

It gets weirder. I am not only a type 2 diabetic but I'm prone to ketosis just as if I were a type 1. If my blood sugars get high my pancreas will simply shutdown and without insulin I could easily die from ketoacidosis much the same as any type 1 would.

This gets even better. If given insulin, overtime my pancreas will recover and I will begin producing enough insulin of my own and go back to being a type 2. The American Diabetes Association has two big classifications for diabetics, there is none insulin dependent and insulin dependent, which we call Type 2 and Type 1. I get to be both depending on which way my metabolic winds are blowing.

The more I learned about Ketosis Prone Diabetes, the more I began to reflect on certain aspects of my life and my family's. Like I said, I'm an avid cyclist and on average I would put 3000 to 4000 miles on the road in any given year. Cyclist get very use to listening to what is going on with their bodies. As we ride our bikes, we have to monitor ourselves and provide food and water at critical moments or we lose all of our energy. This habit of self-monitoring got me to a doctor before my situation got bad. I just didn't feel right.

I had the signs of ketosis: great thirst, tiredness, aching muscles and blurred vision but I didn't see those as important because, ever since my twenties, I've always had those. I would drink until my stomach hurt but I would still be thirsty. I long sense learned to push passed any tiredness or stiffness that I felt and since I've got terrible vision anyway, a little blurriness was no big deal.

Now that I'm diabetic, I look back and see that these things have been with me for awhile. One of the big keys for me was that these symptoms are the symptoms of winter. I'm from Detroit and I still live in Michigan. Michigan weather has been described as 9 months of winter and 3 months of bad sledding. Typically, I would get forced off the bike from late November into early March. During this time, I always lost weight and the previously mentioned symptoms would come marching back. Basically, I felt terrible during the winter months. I solved this problem by becoming a year round cyclist. The diabetes came on strong when I attempted to do a project at home last year and hardly got on the bike.

Here is the last piece of the puzzle. My diabetes is characterized by itching. Suddenly, I get itchy all over my body, if my blood sugar goes above 150. Now that I use a meter, I know that the itching occurs, not when my blood sugar is high, but when it returns to normal. I felt this itching years ago. Like most cyclist, I tend to load up on carbs before a ride to have energy. Carbs, however, drives up blood sugar and I carb loaded like mad before I rode. Always during the ride just when I started breaking a serious sweat, I would get this brief moment where I would feel intense itchy all over but I would ride through it. Strenuous exercise brings blood sugars down. This suggests to me that I've been diabetic since my twenties but due to all the exercise, it never showed itself.

This is where the light comes on. The only way I could be diabetic at that age was because it was inherited. What if my whole family, like me, carried this time bomb in our genes? It would work like this somewhere in young adulthood (When I first started feeling these effects.)our blood sugar begins to move outside of normal range, not much but enough to get us up past the 140 mark where damage is known to occur. I've already mentioned that high blood sugars causes the pancreas to shutdown in KP T2s. The initial part of that shutdown is always the first phase insulin response.

The body has two insulin phases. The first phase occurs when you eat and your blood sugar began to rise. The liver constantly puts glucose into the blood but when you eat something it shuts down and insulin is supplied to blunt the sharp rise in blood sugar. The second phase is the insulin supplied by the pancreas during the daily routine matching the supply of glucose being put forth by the liver.

What if, over time, this first phase slowly began to shutdown? Blood sugars would rise but the second phase over hours would slowly bring it back to normal. The problem with this is that the time above 140 is the point in which damage occurs and the pancreas loses more and more ability to respond. Eventually, a deadly spiral upwards would begin to occur. The more the blood sugar rose, the less the pancreas would respond and so on. Imagine if this process took place over 20 to 40 years. Damage would be occurring across the body. It would feed the formation of cancers and the inflammation of the circulatory system. You would expect to see deaths from heart attacks, strokes and colon cancer which has shown itself to be attuned to fluctuating blood sugars. Guess whose family dies in its forties, fifties and sixties from stroke, heart attacks and cancer?

This, I believe, is the guest at the funeral whose shadow falls across the coffin.

Michael

In the begining

http://www.annals.org/content/144/5/350.full.pdf+html

I've not done this before so you will just have to bear with me. I'll try to have scientific citations and I will also try to explain them to the best of my understanding.

Here's a common story.

You're about fifty years old and you've been working in the back yard. It's been pretty hot so you've been drinking iced tea. Over the last week, you've been kind of drinking to much tea and having to go to the bathroom at night so you've been trying to cut back but you have been thirsty.

You come back into house and stand in the kitchen munching on a few teacakes. You're thirsty, got to go to the bathroom and you're a bit woozy. You wait a little bit, probably a bit of blood pressure. Suddenly, your wife pulls you into a chair and calls your name. You snap out of it. You're nauseous, weak and you're having a hard time catching your breath. 911 is called and the next thing you know you're in a hospital with all kinds of tubes running out of you and they're telling you you're diabetic and you're in ketoacidosis.

Diabetes? You were at the doctor's office six months ago for your checkup but you're blood sugar was fine. I mean, were having some problems with being stiff and tired but, let's face it, fifty means a certain amount of aches and pains.

A couple of days later you're home and are taking blood sugar readings and giving yourself insulin shots. You have to admit you're feeling better and your blood sugars are going down. The surprise is that they keep going down and now after only a month or so from joining the diabetic masses you are introduced to a new term - hypos.

The same dose of insulin that brought you down to normal is now taking you to low blood sugars. This is just great. You almost go into a coma from not having insulin and now you almost go into a coma from having too much. The docs tell you to keep reducing the insulin till finally they have to take you off insulin completely. They give you Metaformin and tell you to watch your diet and get some exercise and off you go.

Two months ago, you were a regular joe then you became a type 1 diabetic. Another month later, you're off insulin and now you're a type 2 diabetic. What nexts, type 3?

Welcome to the world of Ketosis Prone Diabetes! Pull up a chair, sit down because we have a lot to talk about.

Mike

Ketosis Prone diabetes

I'm starting this blog because I see almost no information on this syndrome. It is estimated that more than half of all new onset DKA cases of African Americans with diabetes are of this type. To make matters worse, this is the type of diabetes that is fairly prevalent in ALL peoples of color.