Tip of the Iceberg
"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
"Idiopathic type 1diabetes is highly common in major cities whose populations include large numbers of African-Americans."
Idiopathic Type 1 Diabetes in Dallas, Texas -ANTONIO PI ˜NERO-PILO ˜NA, MD, PATRICK LITONJUA, MD LARISSA AVILES-SANTA, MD PHILIP RASKIN, MD
One of the things I keep trying to figure out the prevalence of KPD in the diabetic community. I'm obviously getting no help from the medical community, in this regard. Since we have not championed our cause, medicine has been allowed to shrug and let things go on as they are. All I can do is take the few hints out there and make a supposition.
In various papers I have quoted, the concensus is that 60% of new diabetic emergency admissions are Ketosis Prone T2. The rest of the cases can be attributable to poor diabetic management, T1 admissions and stress related type things, such as illness.
I must state here again the basic rule of our secret diabetes. "Ketosis Prone Type 2 Diabetes can not be distinguished from either Type 1 or Type 2." What does this mean? It means that all or most of those admittances could have been KPD. KPD is recognized due to its acute onset and then restoration of some semblance of beta cell functioning. This is to say that it has been allowed to be known only by its consequences. There is a car crash. It is noted as such but no cause exists or is considered. This is pretty much where we are now.
What we have been getting is the car crash equivalent of stating that all side crashes are KPD and the others are T1 and T2. They are being distinguished by no real criteria except result. It means nothing in terms of actual cause. Where can we go from here? I think we can go anywhere we wish.
What we can say about its prevalence, at least in terms of Blacks and Latinos, is that it represents 10% of diabetics. This is a guess made by researchers based on hospital admissions. This is the car crash equivalent of saying that the problem only exists when there are accidents. All driver error and equipment malfunctions cause accidents. If there is no accidents then those things did not occur. Basing prevalence on acute incidences, strongly under counts all things that don't reach that level of acuteness.
Where would I put the number for prevalence? Since there is no test, the best I can go from is my experience with Black diabetics. Most of the people I know, had symptoms and went to their doctors and were diagnosed as T2. These symptoms typically involved the usual thirst, excessive urination, tiredness, blurred vision and tingling in the feet. This onset could have been due to a undiagnosed T2's pancreas finally giving out or it could have been the beginnings of KPD onset.
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!
I've decided that a goodly percent were actually KPD. Most hadn't been diagnosed as even prediabetic. The fasting blood sugar isn't generally going to pick up most KPD's. One of the hallmarks of KPD is the sense that it came out of nowhere. Their fasting blood sugars, like mine, were typically near or above 300 with spikes passed 400 when diagnosed. Now, even without weight loss, their sugars are near normal, controlled mostly by diet and exercise with a little Met.
These are going to be my KPD's. They didn't reach acuteness and maybe never would have. These would be mild KPD's. What would prevalence be now? Well over 25%. This would put the overall number into the millions.
Most would argue that I've played a little fast and loose here. My point is that, we don't know. I could be wrong and I would love for somebody to do the research and prove me wrong. People should know if they have a time bomb ticking inside them.
Showing posts with label African Americans. Show all posts
Showing posts with label African Americans. Show all posts
Monday, June 14, 2010
Thursday, February 4, 2010
Western Diet Implicated in African American Diabetes
PUT THE SODA DOWN, NOW!
Okay, now that I've got your attention, I want to tell you why. Diabetes has a very large footprint in the African American community and researchers have been looking for the reason why. Here I have a novel paper that says that it is genetic and that we are the victims of the FDA food pyramid. To put it concisely, people of African descent have a problem with processing carbohydrates at a genetic level. This may very well be the cause of a good deal of the metabolic problems noted in African Americans.
Stable Patterns of Gene Expression Regulating Carbohydrate Metabolism Determined by Geographic Ancestry
Individuals of African descent in the United States suffer disproportionately from diseases with a metabolic etiology (obesity, metabolic syndrome, and diabetes), and from the pathological consequences of these disorders (hypertension and cardiovascular disease)...
...Differences in expression of several carbohydrate metabolism genes suggest both genetic and transcriptional mechanisms contribute to these patterns and may play a role in exacerbating the disproportionate levels of obesity, diabetes, and cardiovascular disease observed in Americans with African ancestry.
The KPD's I've spoken to all have lamented their problems with post prandial spikes. This specifically refers to the hour after a person has taken their first bite of a meal. This blood sugar should never go over 140. A normal blood sugar doesn't and there is a very good reason why. Research has shown this is the point where damage begins to occur throughout the body.
This link is to "Blood Sugar 101": http://www.phlaunt.com/diabetes/14045678.php . It is run by Janet (Jenny) Ruel and any time you spend there will be profitable if you're really interested in the ins and outs of diabetes.
If you have a genetic problem handling carbohydrates and have the added problem of being Ketosis Prone this combination will eventually move you into hyperglycemia and / or DKA. The eating of carbs will force your blood sugar up which will create glucostoxicity. This is glucose poisoning. Beta cells in the pancreases of KPD's are very sensitive to this and will slowly shutdown. The more carbs ingested the worse the condition will come and god help you, if you drink soda or juice to try to slack your thirst because they are almost pure carbs and filled with High Porn Corn.
The truth is there is almost no average American meal that will not push your blood sugar beyond the 140 mark. I can't handle better than 20 grams of carbs at any setting and those carbs need to be very complex to keep me from spiking my blood sugar. Even the supposedly healthy diet is problematic here. Whole grains, potatoes, brown rice, apples, bananas, oranges and pastas are just a few things that I have to avoid.
This doesn't match what you would get from a dietitian but you have to recognize that most of the research has been done on Europeans and the minority communities have not been factored into this. Some might claim this is racism but it more neglect than anything. We, much like the LADA and MODY community, must look after ourselves here. I've got one more piece of the puzzle that I want to put out and then I can really lay this out in a logical fashion.
Mike
Tuesday, January 19, 2010
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
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
Thursday, January 14, 2010
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
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
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