The accepted knowledge is that Diabetes destroys gradually over years. Ketosis Prone Type 2 diabetes is an acute form of type 2. This type 2 can reach fasting blood sugars of 300 or higher in months. This blog brings together all the documentation that I could find in the world and my speculation of what it means for KPD’s in specific and diabetics in general. I ask you to leave your stories about what happened to you so that we can all gain a better understanding of what we are dealing with.
Saturday, June 26, 2010
Ketosis Prone T2 Diabetics are known for the fact that they can suddenly go into acute insulin failure and essentially become T1's, some will even stay T1's, with no autoimmune factors. The others will recover their beta functioning incredibly fast, we are talking weeks, if given insulin therapy. Even though their IR hasn't receded on bit, they will still proceed to stabilize their blood sugars at or near normal levels. Many, can and do, require only diet and exercise regimens. This is weird enough but this next part is inexplicable to me.
Weight does not really play a part in KPD. There are just as many thin KPD's as obese ones.They both are prone to DKA just as much. The recovery, however, is something different. The KPD's who recover fastest and have the lowest A1c's tend to be the ones who put on weight. Weight gain is the best predictor of near-normoglycemic remission. If we follow the logic, these are people who gain glycemic control by increasing their insulin resistance. How? This makes no sense. The thin ones don't do as well as those who put on weight. It gets better. Those with metabolic syndrome actually do better than those without metabolic syndrome. I can not wrap my head around this. Here are some of the quotes from these papers
We also noted significant weight gain associated with improvement of glycemic control, regardless of what therapy was used. Insulin-treated patients gained more weight than individuals on other therapies.
DIABETES CARE, VOLUME 24, NUMBER 6, JUNE 2001
The glycemic control at baseline was very poor in both groups’ mean Hba1c of 13%; it significantly improved in both groups, but it was significantly better in the +MetS group. Improved glycemic control has been well described in ketosis-prone Type 2 diabetes mellitus
(Balasubramanyam et al., 1999; Banerji et al., 1994; Maldonado et al., 2003; Umpierrez et al., 1999).
Preserved h-cell function is a feature of ketosis-prone Type 2 diabetes (Balasubramanyam et al., 1999; Banerji et al., 1994; Maldonado et al., 2003; Umpierrez et al., 1999). In both groups, the h-cell function was lower on presentation and improved significantly in both groups at 6 and 12 months of follow-up. Based on the C-peptide, C-peptide-to-glucose ratio, and C-peptide response to glucagon stimulation, the +MetS group had significantly higher h-cell functional reserve both at presentation and during follow-up. Autoantibodies against the h-cell were more frequently present in the MetS group.
Presence of the metabolic syndrome distinguishes patients with ketosis-prone diabetes who have a Type 2 diabetic phenotype
Max E. Otinianoa, Ashok Balasubramanyama,b, Mario Maldonadoa,b,
Journal of Diabetes and Its Complications 19 (2005) 313– 318
Don't think that this is some weird or isolated diabetes, a conservative estimate puts the number to be, at least, 1 million diabetics in this country alone, twice as high would be more realistic. Still this doesn't make much sense.
It took me a couple of months but here is my answer to this post.
Tuesday, June 22, 2010
Monday, June 14, 2010
"It is our view that KPD patients (especially those with A forms of KPD) represent only the “tip of the iceberg”; below the surface is likely to be a much larger pool of patients who have early or primary -cell defects in development, expansion in the face of insulin resistance, regeneration in response to injury, or insulin secretion."
Syndromes of Ketosis-Prone Diabetes Mellitus
Ashok Balasubramanyam, Ramaswami Nalini, Christiane S. Hampe, and Mario Maldonado
After a bit more thought and research on this, I realized that DKA is the extreme situation of Ketosis Prone Type 2 Diabetics. Obviously, there's going to be a greater number as we move away from the extremes and more towards the mean. If I took 3 standard deviations, I might have got this up to 30% of Black and Hispanic type 2 diabetics. This would have given me at least 2 million KPD's in this country alone!