Caution on NSAIDS

I've pointed out a NSAID as the drug I was using to effect my 1st phase insulin response but anyone who is thinking about trying this should be aware of the risks involved. Beyond the usual issues of stomach and intestinal distress, there are other issues. You can read about many of them here.  Jenny's Blood Sugar 101

One thing that she doesn't cover is that NSAIDs are NOT recommended for those who are G6PD deficient because of the chance of hemolytic anemia. If you've been reading this blog you should know that KPD's have a very high rate of this deficiency. So I do urge caution in their use.

How I got normal blood sugars for 60 cents a week

Being that I'm still on assignment, I've decided to let you in on the experiment that I did on myself to try to understand the nature of Ketosis Prone Type 2 diabetes or as I call it Abrupt onset type 2 diabetes.


Okay, a bit of a review. Ketosis prone type 2 diabetes is an abrupt onset type 2 diabetes though highly prevalent in people of color it can and does pop up in any group. The fact is that KPDM is actually a subset of this form of diabetes. I know LADA's that have gone DKA. There is a real question in my mind whether Abrupt onset T2 (AOT2) is a type of diabetes or simply a mechanism through which diabetes is expressed.


At any rate, this is a diabetes that comes on very strong because the body simply quits producing insulin. It is therefore classified as a type 1 diabetes, T1b. It comes out of nowhere. In 6 months time a person can go from near normal blood sugars to DKA. I talk about this process in these posts. Relapse

It has also been shown to vanish just as quickly, if handled correctly. In the space of a year, a person can go from near normal blood sugars  to close to death from DKA and then back again. This not a regular diabetes and so far has failed serious classification. It is so fantastical that most people don't know it exists, even those most susceptible to it such as people of Latin, African and Asian descent.

I, however, got lucky. About six months ago, I found myself with a revived 1st phase insulin response. I wasn't content with this. I had to find out what happened and how this could be and I kept experimenting until I not only found it but was able to manipulate it. I could turn it off and on with a simple manipulation. You can read about this process through this link, This is a dialogue on diabetesforums where I talk about this experiment

Here are some of the citations that I dug up to back up what I believed to be the cause of my suddenly restored 1st phase insulin response.
Non-steroidal anti-inflammatory drugs increase insulin release from beta-cells by inhibiting atp-sensitive potassium channel

EFFECT OF NAPROXEN ON GLUCOSE METABOLISM AND TOLBUTAMIDE KINETICS AND DYNAMICS IN MATURITY ONSET DIABETICS

Effect of selective cyclooxygenase-2 (COX-2) inhibitor treatment on glucose-stimulated insulin secretion in C57BL/6 mice

Use of Salsalate to Target Inflammation in the Treatment of Insulin Resistance and Type 2 Diabetes


Targeting INflammation using SALsalate for Type 2 Diabetes.

Potential Role of Salicylates in Type 2 Diabetes

This got me to thinking about KPDM and its quick rise and fall which you can read here. Here

Now you know. It was a NSAID called Sodium Naproxen taken as needed. The net cost was about 60 cents. More when I have the time.

Roux-en-Y gastric bypass

I, in no way, endorse this procedure but it does have some bearing on Abrupt T2. It was orignally thought that much of the gains from this surgery was due to the limiting of / and types of food that people could eat once this surgery was performed. The citation below, however, shows that, in this case, there are far ranging effects on the hypothalamus that suddenly take effect. These effects proceed weight loss and involve the whole series of hormones that influence metabolism.

My point for Abrupt T2 is that this shows that the hypothalamus is a higher order mechanism that can certainly effect, if not control, the whole insulin cycle. Once again, there is no change in the underlying beta cell structure. The change isn't there but higher up. 

http://journals.lww.com/annalsofsurgery/Abstract/2004/08000/The_Early_Effect_of_the_Roux_en_Y_Gastric_Bypass.7.aspx

Facebook Page for Abrupt Onset Type 2 Diabetes

People have suggested that I put up a Facebook page so that people can easily comment and add information.

Okay, I've done this and I'll be adding more in the future. Hopefully, while I'm off on this project, this will keep the dialogue going.

Abrupt Onset Type 2 Diabetes

Obviously, I just got this set up before I went off on my latest assignment. I really didn't know what it was going to be but now I think I'm getting it. I don't have time to seriously go through scientific papers at this moment. I still am thinking about things and interesting citations still come across my desk. What I plan to use facebook for are these clues about Abrupt Onset that keep arising. 


This will give me a chance to talk about and hopefully get feed back on ideas that you might find interesting.

Who gets KPD T2? Everybody!

I've decided to keep updating this with citations as they come in.


Thai
Indian


Peruvian

Bangladeshi

Turkish

Hispanics have higher rate of KPD
http://care.diabetesjournals.org/content/26/8/2485.1.full.pdf

Adult-Onset Atypical (Type 1) Diabetes: Additional Insights And Differences With Type 1a Diabetes In A European Mediterranean Population. Http://Www.Ncbi.Nlm.Nih.Gov/Pubmed/15111529

Severe diabetes in remission: a Singapore's perspective - Malay
http://www.ncbi.nlm.nih.gov/pubmed/11817290?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=5&log$=relatedreviews&logdbfrom=pub

Clinical characteristics of Korean patients with new-onset diabetes presenting with diabetic ketoacidosis.http://www.ncbi.nlm.nih.gov/pubmed/19477546

Ketosis-onset diabetes in Tunisian adults: immunological markers and β-cell function 

http://www.emro.who.int/publications/emhj/1601/article12.htm

High Frequency of Type 1B (Idiopathic) Diabetes in North Indian Children With Recent-Onset Diabeteshttp://care.diabetesjournals.org/content/26/9/2697.1.full

[HETEROGENEITY OF TYPE 1 DIABETES MELLITUS] - Brazilian

http://www.ncbi.nlm.nih.gov.proxy1.cl.msu.edu/pubmed/18438531
A Subtype of Markedly Abrupt Onset With Absolute Insulin Deficiency in Idiopathic Type 1 Diabetes in Japanese Children

http://care.diabetesjournals.org/content/25/12/2353.2.full

South Asian version of flatbush diabetes mellitus- A case report and review article
http://www.acadjourn.org/IJMMS/abstracts/abstracts/abstracts2009/Sept/Khan%20and%20%20Akram.htm

Ketoacidosis in Apache Indians with non-insulin-dependent diabetes mellitus
http://www.ncbi.nlm.nih.gov/pubmed/9382666

Cetoacidosis diabética:una complicación frecuente de la diabetes tipo 2 en hispanoamericanos
http://www.sediabetes.org/resources/revista/00011519archivoarticulo.pdf

The Occurrence of Diabetic Ketoacidosis in Type 2 Diabetic Chinese Adults
http://www.tsim.org.tw/journal/jour10-6/P10_230.PDF

Characteristics of Caucasian type 2 diabetic patients during ketoacidosis and at follow-up
http://www.ncbi.nlm.nih.gov/pubmed/10842773

The prevalence of ketosis-prone type 2 diabetes is not known, but observational studies suggest that this type of diabetes accounts for a substantial number of patients with diabetic ketoacidosis. In the United States, the prevalence has been estimated to be between 20% and 50% in African-American and Hispanic patients with new diagnoses of diabetic ketoacidosis . In addition to ethnicity, clinical features predictive of future near-normoglycemic remission are obesity and a family history of type 2 diabetes. Among 154 consecutive African-American patients admitted to the hospital with diabetic ketoacidosis, we observed that obesity was present in 29% and that the prevalence of obesity was higher among those with newly diagnosed diabetes (56%). More than 80% of patients have a family history of type 2 diabetes. The mean body mass index at presentation in African-American patients with ketosis-prone type 2 diabetes has ranged between 28 kg/m2 to 37 kg/m2 . A high rate of obesity is also reported in Hispanic and Chinese persons and in sub-Saharan black African immigrants to Europe. Obesity in persons with diabetic ketoacidosis from minority ethnic groups is more common than in white persons, in whom the rate of obesity is less than 20%.

Balasubramanyan and colleagues reviewed the clinical profiles of 141 adults admitted to the hospital with diabetic ketoacidosis. At presentation, 39% of patients were considered to have type 1 diabetes, 53% were considered to have type 2 diabetes, and 8% were not classified.Twenty-eight percent of patients had newly diagnosed diabetes, 93% of whom were reassessed at least 2 years after their initial episode of diabetic ketoacidosis and were considered to have type 2 diabetes. More recently, Pin˜ero-Pilon˜a and Raskin  reported that the incidence of this type of diabetes among persons with new-onset diabetes with diabetic ketoacidosis was approximately 60%. In agreement with the U.S. experience, African studies have reported that 42% to 64% of patients with diabetic ketoacidosis initially treated with insulin therapy do not have classic type 1 diabetes and may experience prolonged remission. The prevalence of ketosis-prone type 2 diabetes seems to be lower in Asian and white persons and may represent fewer than 10% of cases of diabetic ketoacidosis.

Narrative Review: Ketosis-Prone Type 2 Diabetes Mellitus
http://www.annals.org/content/144/5/350.abstract

The extent of the prevalence of this syndrome really isn't known. As far as I know, there is no ready test for KPD T2. What we have is hospital admittance records for DKA. The numbers quoted for Mexican and African Americans is about 60% of all the DKA cases. What this means in terms of the general Mexican and African American population is in question but you have to recognize that for every case where it is bad enough to cause hospitalization there has to be many multiples of it in existence.

Mike