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.

Thursday, September 9, 2010

Thinking about: Eating. Maybe one size does not fit all

Though most of the testing of KPD's tends to involve obese participants, it should be noted that many KPD's  are not only not obese, they are lean. Typically, when I look at papers where the participants aren't chosen, the lean members comprise a quarter to a third. Even in childhood DKA episodes, the obese number about fifty percent.

What does this tell us about KPD's and weight? I keep hearing and seeing ads telling parents to make sure their children are active and eating right. This is the answer to childhood obesity, exercise and diet. Okay, I am a fan of both sloth and gluttony, I tend to be good at them, but I have to admit there's nothing wrong with having children out there physically engaging the world without a candy bar in their mouths.

KPD is showing us something, however. What do you say to a person who is a thin diabetic? You obviously can't ask him or her to go on a diet nor would you put them on exercise schedule to help burn calories. We don't give the same advice to the thin KPD simply because it doesn't make obvious sense. They are thin. We give it to the heavy ones because they are fat. It's still the same condition with the same underlying causes. It gets expressed differently but the numbers between fat and thin are pretty much the same. I'm saying this because, I believe we have to look deeper than this. There is something going here and the range of body types it effects doesn't seem to point at behavior.

The people of sub-Saharan Africa have a much bigger problem with Ketosis Prone Diabetes but this tends to be more in urban environments. There hasn't been a study but I would hazard a guess that you could draw a trendline representing length of urbanization of KPDs and their families and find quite a correlation.

Another thing to note is it tends to cluster in people of color, not that whites don't get it, they do, but the prevalence is far higher in people of color. Now I'm pretty sure you don't want to say that all these people of color are lazy and eat too much. Besides, how could that be true if a good many of them are thin?

I believe that most of this is a response to diet. It is, after all, about metabolism. Its higher rate of prevalence in urban areas suggests that it has something to do with the moving from traditional diets to more modern diets. It would be logical to point out that there are many things that go with urbanization that could just as readily be pointed as a cause. This is true but I would say that this exists worldwide in varied modern environments so I would have to ask: how many things could this be? To tell the truth, I don't know nor does anybody else. What I do know is purely anecdotal and the KPD's I've talked to have had to change their diets significantly to hold their blood sugars down with diet and exercise, those on insulin, generally, have not.

This difference in insulin using KPD's and non-insulin using KPD's suggest that some element of diet is effecting blood sugars. Think of it as some sort of intolerance. What is it? I really can't know. I list a bunch of blogs I follow that are all about nutrition because I'm trying to find out.

I ate a very healthy diet before I was diagnosed but now I find I can't eat that same diet without a significant rise in blood sugar. Would I say that, simply because I can't eat it, no one should? No. What I will say is that KPD is different and pretending that it isn't does not work. We can not assume what is healthy. We must verify.

I've just read the usual recommendations of the ADA and others about what is healthy to eat but does it include KPD? I think not. If these foods are fine there is really only one way to know and that's to test the blood sugar. I see all these recommendations about what to eat but, one size does not fit all and this is especially true of KPD. What should be recommended is that all families get a meter and test what their food is actually doing to them. If there is a significant intolerance, blood sugar will exceed 140. If this was the recommendation of the USDA there would be far fewer DKA events in this country. It would also provide important data about what is safe and what is not about a whole range of products.

To repeat, there is something in the KPD diet, that may not effect others but which is probably poisonous to KPDs. We can't identify who is KPD but if people were checking their blood sugars and correlating it with what they ate, the KPDs that are out there, who aren't diagnosed, could see this truck coming


  1. I was diagnosed KPT2/in DKA in June. Had been overweight most of my life but lost and kept off 50 pounds off 180 peak weight. BMI of 24 at dx. For almost the first time, none of the doctors told me I had to lose weight to improve a medical condition. I get so angry when I hear people go on about how losing weight can 'cure' diabetes. I don't have an answer to what you have outlined above but I know exactly how you feel.

  2. Hi Anonymous

    I think you're the first KPT2 that has ever made a comment. Thanks, it's been hard working in vacuum for all these months.

    I hope some of what you've read will help you up the road and even more I hope that you use what ever you learned to inform others.

    We are very much at sea. Most docs don't know we exist and even if they do, there isn't a treatment regimen.

    Come back anytime and if something is confusing (and boy, is this confusing), you're more than welcome to leave a question.

  3. Dear Michael,

    I'm sure I'm not the only KPT2 out there who follows your blog. And let me tell you, I jumped up and down with excitement when I found your blog in the week or two after I got home from hospital. It certainly got me through some of the darker, more depressing moments. So, thank you for all you do - I am sure I am not the only appreciative reader out there!

  4. I'm glad I helped but all of you can help too by sharing your experiences. I know mine but I'm sure it's different from others. I think it would also help to frame some of the scientific information and what it might mean.

    My big question for you: how did you find out you were KPD? Most docs have never heard of it.

  5. Hi Michael,

    I had the 'good fortune' of presenting with DKA in a big research hospital linked with a major university. Apparently my case is so exotic and unusual that it is of research interest - which is fun in a dark humour sort of way but doesn't help allay the depressing existential questions...

  6. I recently did a short presentation on KPD to the regional diabetes people and I was amazed that they were amazed. These are people setting policy on diabetes but they never heard of KPD.

    What really gets me is our numbers are counted due to going DKA. This is somewhat like figuring the number of people with arms by counting those who show up in the hospital with broken ones.

    As to its existential nature,when I asked him, "Why me?", my endo said, "You're standing next to a building and a brick falls off and hits you. Don't take it personal."

  7. From my perspective it sure felt like a ton of bricks!

    I'm looking for your email but can't seem to find it...

  8. Good brief and this post helped me alot in my college assignement. Say thank you you as your information.


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