I don’t know that it’s that weird that you weren’t in DKA. There was a 3-4 week period before DKA when my daughter probably could have been diagnosed if we had recognized the warning signs. I thought her symptoms were part of a growth spurt. Hindsight is always 20/20 right? She was also diagnosed with Strep at the same time as T1 - the strep could have pushed her into DKA. You and your wife were wise enough to see the symptoms before you hit DKA.
If that is all you want to know, the answer is easy. Insulin keeps your liver from producing glucose and ketones. You still have insulin production and that suppressed the overproduction of ketones which leads to DKA. Some T2s who still have insulin production, when they have extremely high blood sugars, they end up in a state called Hyperglycemic Hypersomolar State (HHS). But be assure HHS is as deadly as DKA and an untreated high blood sugar is very serious.
And I was denied a c-peptide because an A1c of “only” 6.5% is not a “bad” case and most people with diabetes are T2 (and the plain fact was that my doctor probably did not feel competent to interpret a c-peptide).
I’ve borrowed Natalie’s type weird classification for myself. My body behaves like a T1, my dx right now is T2, but my good endo nurse practitioner is looking at changing it to LADA mostly for insurance purposes. I haven’t had a c-pep (and really don’t care except for the dx for ins), but I DO have good treatment, good docs, pretty good numbers finally thanks to my Ping.
My med ID says T1; if I’m ever not able to speak for myself I don’t want to get tx as a T2. Apparently the ‘why’ of my D is months of chemo and pretty massive doses of steroids which I’m told destroyed most of my beta cells. No, there’s no scientific evidence, just symptoms. Frustrating, and the *$&^ ins companies make it a minefield. I’m waiting for approval for a CGM; if I were dx T1 I wouldn’t need pre-approval.
I had 1.25 mmol ketones in my urine (should be a flat 0), acceptable range is up to .26mmol… my C-pep at Dx was .4ng/mL, non-diabetic is .8-3.5ng/mL, and my fasting insulin level was .1uIU/mL, Ref. Range is 3-19uIU/mL. Urine pH was below 5… way too acidic, meaning I was producing only trace amounts of insulin and was already out of the honeymoon phase at diagnosis. My endo is still confused as to why I wasn’t DKA. I understand what DKA means, how the liver functions, and its relationship with insulin and the pancreas.
That really sucks about the c-peptides. I suppose it’s for a somewhat good reason that you were refused anyhow. Maybe its time for a new doc =)
OK, if you’d waited a little longer you would have gone into DKA. Easy enough explanation.
An A1c of 6.5 correlates with an average BG of 140-154 depending on what chart you look at. So you are definitely not in the 80-120 range as much as you think. How often do you test?
But you don’t seem to be a textbook Type 1.
Took the blood test 4/20 and am waiting. Thanks!
Left the rest of that last sentence out by accident… I meant to put between 70 and 120 in the morning. I test 3 times/day.
Hey man- i just got to my page and saw your message - you’re probably en-route to your FPEB right now - it looks like you’re pretty well controlled and have a good handle on things - I think you’ll probably be OK for the board. Mine literally only took about 20 minutes! My wife is a Dietitian, and they asked her a couple questions too, but nothing major.
My story is almost identical to yours - almost 30 lb weight loss in 2 months, and an initial A1c of about 14. I was also put on metformin and actos right away, with little results. C-peptide was 1.2, and fluctuating, so they thought maybe the ‘skinny T2’, but it pretty much ‘withered and died’ in the months that followed.
I also have no family history of diabetes—and we’re pretty sure the RAMPANT vaccinations that I’ve had are blame. More on that later…Another shining star for military medicine.
You’ll probably be surprised to see that you’re not the only one at the Board for diabetes on your visit. I was one of FIVE that day that they were seeing. The Air Force is getting pretty used to seeing this, and if you can show that you’re serious about controlling it, and you’re not a dirtbag at work, you’ve got a pretty good shot at staying in. I know a C-130 Nav at Ramstein that went, and the board didn’t even see him. He just brought his records in, and they looked at them for 10 minutes then told the lawyer he was good to go. Unreal.
Shoot me an email at firstname.lastname@example.org -or- email@example.com when you get there or when you’re done. There’s a building coalition of Type 1s in the Air Force that keeps each other up to date on developments - I’ll add you to the list.
Very best of luck, man - Hope it all works out! You’re luck to have an RN ‘on staff’ to help you through the ups/downs!
It’s not weird that you weren’t in DKA. DKA happens only when there’s no insulin at all, and if you’re still producing even a little, it’s enough to suspend the possibility of burning fat for fuel. In fact, given how high your A1C is, it seems likely that’s precisely what happened – you were still producing just enough to keep your cells from signaling the need for extra energy but not enough to clear away or store any of the additional glucose.
NOBODY knows what the trigger for Type 1 is, but it’s almost surely NOT vaccinations, because there are tons of people who DO carry the genes for autoimmunity, and DON’T get Type 1, in spite of getting vaccinations. In your case, you’ve got the genes, and you encountered the trigger, whatever it was, but you REALLY don’t know what it is.
And just because it has never occurred in your known family means nothing – you are a unique combination of genes from your mother and father, and they just happened to configure in the way that made you vulnerable. And it may well have occurred in your UNKNOWN family – who knows anything about their ancestors more than 2 generations back?
That’s probably why I went into Hyperosmolar Hyperglycemic Coma last year – I WAS taking insulin, but not enough, because my needs had changed radically, and I didn’t catch on. And my endo was too dumb to catch on, either, so he didn’t do anything about it a week before I went into the hospital. It was only when I went to a new endo after I got out of the hospital that immediately raised my insulin doses that I got back in control again.
Well, not having ketones means that she has at least a little insulin in her blood, whether from a previous shot, or possibly making a little bit herself. Type 1’s DO vary in the amount of insulin they make – it is never enough to sustain life (except during the honeymoon period), but it is enough to be detectable. Only rarely does a Type 1 truly make NO insulin.
It has recently been shown that the pancreas DOES make new beta cells, but, of course, in Type 1, the autoimmune attack is still there. So the new beta cells make insulin for a little while until they are killed, but newer beta cells take their place. Too bad the body can’t make enough to actually function in spite of the autoimmune process, but the formation of new beta cells is just too slow.
And, of course, you should continue to check for ketones, because her function could change, and you don’t want DKA sneaking up on you!