DKA, pancreas function and T2 diabetes

Hi everyone, a new question I thought of here.

Some of you know my story but here is a shortened version for those who don’t - I was diagnosed with DKA so severe that I was nearly comatose, blood sugars at 41mmol (720mg/dl) and an A1c of 13.9 three and a half months ago. I was obviously immediately put on insulin because a c-peptide test revealed that my pancreas had zero function. I can’t remember how much the dosage was, but it was pretty high. I also had the classic textbook symptoms of diabetes - weight loss (lost 10-12kg in total), extreme thirst, frequent urination, and a few days before I got rushed to emergency, abdominal cramps, a bad sore throat and an yeast infection gone wrong (ie: some bacteria attacked my flesh and I had surgery to get it removed).

Since then, I’ve had my insulin dosage cut several times and currently I take 20 units of Humulin 30/70 insulin a day. It’s not the most current regime there is, but it has been keeping my sugars under good control - my most recent A1C was 5.4, that’s proof.

Could the cut in my insulin dosage mean that I’m producing some insulin on my own and therefore qualified to be a T2? But I don’t know if I show signs of insulin resistance. Is 20 units of insulin a day quite a lot?\

I don’t experience much of the highs and lows that many Type 1s experience, leading me to suspect T2.

Anyway I got sent for another c-peptide test and I’ll be getting the results next week. I am wondering, is it possible for the pancreas to actually recover and produce some insulin on its own after such a great, huge shock to the body system?

And how many T2 diabetics actually get DKA upon diagnosis? I know it’s possible but extremely rare.

I think this might be just one of the times when my diabetes medical mystery saga gets to me. But any potential answers to my questions are very much appreciated…thanks guys! :slight_smile:

Giving your pancreas a break w/ the extra insulin can actually kind of “recharge” it. You’re probably experiencing a honeymoon period, where you start producing more insulin b/c of the insulin you inject. I believe most adults diagnosed w/ Type 1 go through this. I would guess you are definitely Type 1 with those numbers upon diagnosis. I don’t believe Type 2s get DKA - they can get a similar condition which is called something else, like HDDS(?). Although later on they might get DKA when the pancreas finally stops making insulin. I think you would have to have Type 2 for decades for that to happen.

Just FYI - I was diagnosed almost 3 months ago, take 14 units of Levemir a day and do 1 unit of Apidra per 15 carbs , which usually comes out to 14-15 units of Apidra/day. I think the extreme heat we’ve had in Texas is what has been causing my lows, but I might need to readjust and lower my dose. Will find out at my endo appt tomorrow!

I agree with Kimberly, that it is very likely to be the honeymoon. Did they do any antibody testing? That would be a pretty good indication that it is autoimmune in nature. I know that there is a type 1-idiopathic diabetes that can have intermittent DKA, but usually continue to produce their own insulin. It is usually found in Asian or African Americans, or with a family history - somewhat similar to MODY. Regardless, it is good that it is under control, and I think that matters most. If your treatment is working for you, then I say stick with it. Congrats on your A1C! That’s phenomenal!

Sounds like a honeymoon period to me :slight_smile: Your pancreas is getting a break from your injected insulin so it’s giving all its got for a while. This wont last… but enjoy it for now, it’s so much easier to keep numbers in range when your pancreas is helping out!

my endo sent me for a c-peptide test and fasting blood glucose test. if i am indeed honeymooning and producing my own insulin, wouldn’t my results come back as those typical of a type 2? what are the typical fasting blood sugar test results for a type 1 diabetic? i don’t mean the daily ones, i mean the one where they take your blood to run test with at the lab.

what if my endo decides to put me on metformin? wouldn’t that actually work for a period of time? do you think it’s advisable for me to request an antibody test? i have a feeling she suspects i am type 2 too.

When your blood sugar is extremely high you become very insulin resistant–everyone does, no matter what kind of diabetes they have.

When you bring your blood sugar down below 180 mg/dl all the time, the insulin resistance disappears. That is why you respond more strongly to the insulin.

You aren’t likely to be a Type 2 because Type 2s don’t develop DKA. And they do have C-peptide usually.

Dr. Bernstein claims that if you maintain those normal A1cs you can stay in the so-called “honeymoon” forever. I hope it is true for you!

I posted a reply to your blog, but will add one here also. Type 1s can still have C-Peptide during the honeymoon phase. My C-Peptide was in the normal range and thank goodness that the endo told me that it wasn’t conclusive. The antibody tests would be the most useful way to discover if you are Type 1 or Type 2. It is important to know because insulin is going to be the best way to go if you are Type 1. Let’s see if we can prove Dr. Bernstein is right and stay in the honeymoon forever!

It sounds to me like you are a Type 1 going threw the “honeymoon” peroid. I did that years ago then my daughter done it about 3 months after she took Type 1. Good luck to you!