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.

Sunday, September 19, 2010

Thinking about: A1c Relapse Progression and the Insidious Nature of KPD


These are the graphs from Ketosis-Prone Type 2 Diabetes in Patients of Sub-Saharan African Origin. These graphs especially C & D  are too important not to be seen.






This is my recreation of C for clearer viewing.



Let's recap.
Ketosis Prone Diabetes is known for sudden onset without a precipitating factor. I posted this Here
The A1c at which the diabetes stayed controlled is about 6.3. This is in the previous post.  Here
Spontaneous Remission is the norm where there are no antibodies present. This is posted everywhere on this site.

What we have is a type 1 like syndrome that shows up out of seemingly nowhere then vanishes, leaving a type 2 diabetic, who can maintain blood sugars with diet and exercise.

My speculation is that the KPD syndrome is insidious. I have speculated in other posts using anecdotal evidence that this is the case but it occurs to me that there is enough here to do better.

The graph is important because what we need to wonder about is: what is a KPD before DKA?  This graph puts the regular blood sugars at about 6.3 A1c or 134. Jenny Ruhl's "Blood Sugar 101"  talks about dangerous blood sugars and, the short of it is, that blood sugars above 140 cause damage. She details other blood sugar levels that are considered safe but are bad as well. If you're new to diabetes I strongly advise you to read this site, carefully.

No one's blood sugar is steady. It goes up and down during the day and an A1c is best viewed as an average of blood sugars over a 3 month period. Actually, it's a measure of glycation of blood cells but seeing it as an average will do just fine for my purposes.

As I said, no ones blood sugars are steady and the more metabolic damage you have, the more they tend to fluctuate. Now, for whatever reason, KPD's tend to have great big fluctuations. This means that at 134 KPDs are going to spend considerable time above the dangerous 140. In fact it is so close to 140 as to almost be the same thing. KPDs have another trick that most other diabetics don't seem to have and that's remission. Rather than continue on a path of gradual rise, they can and do drop back to near normal. This would essentially reset their diabetes and they would, once again be back to a gradual rise.

What I'm saying is that the flat portion of this graph represents both the tendency to fluctuate wildly and the tendency to balance this with a fall back into remission. A KPD would get in trouble if the numbers stayed significantly above 140 but even then, if intensive insulin therapy were applied blood sugars once brought down would go back into a range where things would balance.

There is a problem here. Over time, continuous damage would be occurring. It would be small each time but the cumulative effect over decades would cause serious damage body-wide.

If we run this all back, we could start with a normal blood sugar but with a tendency to get large fluctuations from certain types of foods. Whatever the mechanism is for remission would keep pulling blood sugars down but over time they would rise as more and more damage was being done metabolically and to other body systems. The abrupt onset would occur when this remission mechanism itself broke down. Maybe it has a limited range to work in and the KPDs that go DKA have a functionally smaller range.

Okay, this is speculation. There are many ways this could be playing out, all I've done is outline one possible scenario. What isn't speculative is the nearness of normoglycemia to the line of danger and how quickly this takes off.

Once again we visit the ADA guidelines.

ADA Criteria for the diagnosis of diabetes
1. A1C 6.5%. The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.*
OR
2. FPG 126 mg/dl (7.0 mmol/l). Fasting is defined as no caloric intake for at least 8 h.*
OR
3. Two-hour plasma glucose 200 mg/dl (11.1 mmol/l) during an OGTT. 

It isn't said but if the FBG (fasting plasma glucose) is below 126 most medical people will not go to the other tests. Even if they did, the next test would be an A1c and a KPD would pass there as well. The OGTT (oral glucose tolerance test) would catch it but it isn't done if the first two don't give indicators.

Years of damage with an attendant rise in mortality would occur because all those numbers sit in the danger zone for KPD's and the graph shows that DKA could easily be around the corner.

If you're reading this, you're probably KPD. You should recognize that it has a strong genetic component so if you've got family members they are likely to have it or some component of it. This is where I diverge from all the diabetic advice on diet. Screw looking at or adjusting diet. You don't know what precipitates KPD. The only thing that is known is that the blood sugar numbers represented by the "prediabetes" ADA recommendations are, in fact, the launching point for a serious diabetic emergency.

I said that the OGTT would more than likely have shown diabetes but this test tends not to be performed. You can do something similar with a meter, a couple of bowls of breakfast cereal and a glass of juice. Just test someone an hour after they took their first bite of breakfast and see if their numbers are above 160. I think that would catch a lot but since we really don't know what the bad actor in the food is, wisdom dictates testing the blood sugar with all types of food. What puts the blood sugar above 160 should always be avoided because whether you're a KPD or not, damage occurs to the body above that number diabetic or not.




4 comments:

  1. I have a doubt. Do you mean that I could have done a FPG test one year before my diagnosis and my FPG could be in normal range (below 100)? I am KPD.

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  2. Yes. KPD tends to be abrupt. I have heard from quite a few people who thought they were in the best shape of their lives and appeared normal 6 months before going DKA.

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    2. Coud you tell me if you use some medicine or you control diabetes with only diet and exercise?

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