Hi All, I'm new here.
Was looking for a support group and found this place.
This is a little difficult for me because I'm actually a 33 year old physician, and who hears about physicians getting Diabetes and feeling helpless (well I pretty much do).
Had a routine check up on 7/2014. At that time I found out my HGBA1c was 6.0 (Technically Prediabetes range... but as we all know here, it really is just early Diabetes). Initially I was calm, thought, okay, I just need to adjust my diet and exercise. You know all the things I tell my own patients.
I started checking my sugars and I was shocked to find that I have severe glucose intolerance. A bowl of rice or a sandwich (40g of carbs or so), would raise my blood sugar to around 200 at 1 hour. The number would plummet by the 2 hour mark to around 120. Spent a long time moping, depressed, in denial. This was a shock because I'm 33, 5'8 and I'm only 105 lbs Male. Not typically what she you see in a lot of newly diagnosed Type 2s. I thought maybe that I had Type 1 or Type 1.5, checked myself for GADA which came back negative. My insurance unfortunately did not have the other types of Antibodies to check. My picture (to me however) seemed more early Type 2 Diabetes?? (Thoughts anyone?)
So I decided to go on a VLCB diet (even though I weighed 110lbs at the time of diagnosis). Lost 5 Lbs, thought maybe I was doing better. CHecking my sugars 8-10 times a day and trying to keep my postprandials 1 hr less than 140. 3 months later I repeat my blood test, disappointingly enough HGBA1c was still 6.0, but worse my Cholesterol went from normal to 300+ with an LDL of 220. Apparently had went into Sick Euthyroid Syndrome which sometimes happens on people with very low carb diets. I checked my Thyroid, and my RT3 which is reverse T3 levels came back high. Didn't know want to do. knew I had to try an add some carbs back in my diet. So have been doing that for the last few weeks.
Right now, I'm totally perplexed as to what to do, I can't go too low carb because of my thyroid, so I'm sticking to 100g of sugars per day. And I'm still thinking if I could be early LADA or I have a type of MODY.
It's been a depressing few months and would love to hear any advice anyone has?
I suggest that you read this one-year old (and still active) post by Melitta. It covers well the misdiagnosis of actual type 1 diabetics as type 2 diabetics. Melitta has written extensively on this topic and she talks about all the anti-body tests that should be run. I would pay for these tests out-of-pocket, if needed. The penalty for delaying the actual diagnosis is entirely on you and your health. Some misdiagnoses go on for years!
I eat a low carb, moderate protein, and high fat diet to help control my type 1 diabetes. I also have high cholesterol numbers. I don't believe that treating a number that has no proven causal connection to cardio vascular disease is a rational act. I think it has more to do with the multi-billion dollar statin industry. I also don't trust that statins are safe for everyone. That's a controversial topic that you'll have to assess for yourself.
I'm also hypothyroid. It's another autoimmune disease that many people with type 1 diabetes have. I would suggest that you do a TuD search for thyroid topics. This subject has been discussed extensively and there's a lot a to read here about it. The local search engine is not the best but you can try various search terms to usually good effect.
Doctors are just people, too. You now have the unique perspective to have lived on both sides of a serious diagnosis. I used to be angry with some of the things that doctors withheld or were ignorant about. My position moderated over time to a kinder one. Doctors are not gods; they're not perfect. The ultimate responsibility for someone's health is the patient her/himself.
Knowledge is truly power. You need to discover all you can about your various issues. Luckily the internet is a potent tool to do that, despite the rollings eyes of some doctors when the subject is raised. The key thing is that you need to be a discriminating consumer of information. Your medical trianing is ideally suited for this. Be well!
hello sey, sorry to hear that you are one of us now. diabetes is rubbish but better than so many other autoimmune diseases!
as terry says, i would get the rest of the antibody suite or tests out of pocket.
good luck and let us know what happens.
i fully agree with terry.
that being said, i would also kind of try to get off that physician thinking of what bloodsugars have to look like. try to keep them in range as well as you can, but most of us diabetics are happy to just keep them running more or less (pp of 140? i am happy if i am under 200 after 2 hrs ;)…)
melitta has written another great post about the top ten tips for people dxd as adults, and i think they work for both kinds of types:
if you are indeed a T2, do not think that going on insulin is a failure, but it is actually a great tool to maintain good blood glucose control. i know many T2 who wish they had gone on insulin earlier.
good luck on your journey!
Sorry to get the cart before the horse. Welcome to TuDiabetes! This is a knowledgeable and competent community when it comes to living with diabetes, no matter the type. We live with diabetes 24/7/365.
I hope that you continue to participate here. You bring a unique perspective! Good luck and please let us help, if we can.
After your reply (and feeling more motivated), I looked into it a little bit more with my insurance and I found out they can order the Anti-Insulin, Anti-Islet Cell and IA-2 antibodies so that was good news. They don't have the ZNT8 antibody though (has anyone here tested for that?) I'm going to try and get those tests done this Friday, and I'll probably look for a lab that can test for MODY if those tests come back unremarkable. I'll retest my thyroid and cholesterol this friday as well hopefully and see where it's at. Will post those when I get those back.
Thanks pancreaswanted! I'm bouncing back and forth between denial and acceptance still (and depression). :)
I think it's because I've read so many small articles on the effects on glucotoxicity and how blood sugars above 140ish tend to kill beta islet cells which has been freaked out enough to try and always get it below 140 after an hour (And failing half the time and feeling miserable when I fail). And it seems like so many people here are successful and able to do it.
Sey - I don't know if you've had time to read Melitta's post that I linked. She makes a comment on page three of that thread that may interest you. Here's a screen shot:
Anne Peters, MD, is a well respected endocrinologist is southern California. Her video would be worth the time to view. Go back to Melitta's active thread to get the video link.
I'm sorry to hear that you are diabetic. Thirteen years ago at age 22 I was diagnosed as a type 1 diabetic. I went through many different emotions after being diagnosed and I found comfort in the fact that this is a manageable disease.
No, you won't have the same numbers as a non-diabetic, but as long as you keep it under control you can live a long and full life. Being a physician you already know a lot about the disease and it will help you to manage it; just don't let the knowledge control you. While good number are the goal, you need to achieve them in the best way for you. I personally enjoy all kinds of foods, but check my blood glucose very frequently and correct often with insulin. Exercise also does wonders to control my diabetes.
Find the balance that works best for you and stay well.
Hi Sey: Although it is a good idea for most people to stay under 140 mg/dl, at least while you are figuring things out it probably is not possible. And for most people with Type 1 diabetes, the reality is that we go above 140 mg/dl. IMO, the tools do not yet exist for a person with T1D to not have excursions above 140 mg/dl. One of the main promoters of the "magical 140" is BloodSugar101. But if you actually read the papers that BS101 uses to support this "damage occurs above 140 threshold," the papers all are studies on Type 2 diabetics and if you read through the actual papers you find that nowhere in any of the methodologies, results, or conclusions do the papers actually say anything about finding, or even looking for a threshold blood glucose, where damage starts to occur.
Hi Sey: First, I am sorry to welcome you to the club, but here you are. I personally think the most difficult aspect of diabetes is the emotional aspect. I was devastated when I was diagnosed with Type 1 (after a brief misdiagnosis as Type 2 due to my age, 35, not etiology). Someone else supplied the link to my top ten tips for the newly diagnosed blog; many people are relieved when they read that and I hope it helps you.
As I am sure that you are aware, it is highly unlikely that you have Type 2 diabetes. Not impossible, just highly unlikely. It is important to get the full suite of autoantibody tests (here's my blog on testing), but ZnT8 is not yet tested outside of research studies. The c-peptide test is also useful. Endocrinologist Dr. Anne Peters, one of the editors of The Type 1 Diabetes Sourcebook (ADA/JDRF, 2013), treats her new-onset lean patients as if they have Type 1 diabetes, even if they are autoantibody negative (link to Dr. Anne Peters's Lean Adults with New Diabetes).
I am very sorry for what you are going through--the grieving process is really hard. But you have found a place, TuDiabetes, where people truly understand.
Thanks for the welcome. Terry did send my to your link, and I read your blog entry on autoantibody testing and it motivated me to get the rest of the autoantibody tests and I read your top 10 tips which helped. Unfortunately the lab I use doesn't have ZnT8, did you end up testing for that too? I'm also going to check my Fasting insulin and C-Peptide levels this Friday am. I am lucky in that I can get these done at the lab in the clinic where I practice.
Thank you for all the support. It helps to have a place like this to talk it out.
I have not had the ZnT8 test done; ARUN labs in Utah does it. It's quite expensive, as it seems to only be done in research studies at this time.
Welcome to our very supportive community.
My non-professional opinion is that most likely you are adult onset type 1.
Note that when testing c-peptide you should also test blood sugar at the same time as it has to be read in conjunction with blood sugar (in case you're not planning to test that too). A low or normal reading combined with high (above 95 or so) fasting blood sugar would tend towards ruling out type 2.
Not so fun for you, but after going through this process and learning what you can on this community, you are going to be much loved by your diabetic patients as you will truly be able to give them valuable management advice for their diabetes.
I recommend reading "Diabetes Solutions" by Dr. Richard Bernstein, even if you don't end up going extra low carb as per his approach.
If you are type 1 then low dose insulin (to support your pancreas) will worth considering.
Although everyone here has suggested you are type 1 (T1), you really don't know unless you do all the tests and come up positive for T1. Being a health care professional you also realize that being diagnosed with Type 2 diabetes (T2) is somewhat of a misnomer. Type 2 diabetes is really a diagnosis of exclusion. There is no test for T2 and it probably should just be called "diabetes of unknown type." And unfortunately some ethnicities are prone to T2 even when you have normal weights (including asian).
As to your problems with a very low carb diet, I hope you remembered to eat a very low carb high fat diet. Eating a very low carb normal fat/protein diet essentially puts you in starvation mode which can result in the thyroid imbalance you noticed. Also, do not bother with cholesterol when making strict dietary changes like this, you won't find you normalize for 6-9 months.
the most predictive genetic test for diabetes concerns testing for the risk T allele in the TCF7L2 gene. the presentation of having this allele(s) seems to mix aspects of T1,T2, and LADA. The risk allele(s) cause insufficient insulin secretion. I like to know the cause of things, but whatever the cause, getting your bg down into safe ranges is the end game.
i also disagree about not shooting for the magical 140. the risk outweighs the benefit if you can do it the bernstein way and not have dangerous hypos. if is is eventually found no damage occurs at 140, what have you lost by not going over that number (given that you can get to that target without hypos)? if you spend significant time over 140 and it is found conclusively that that is the starting number for complications to accumulate, then you will have lost a great deal by not shooting for being under it.
I am perhaps in denial but I don't get too depressed about diabetes. It's a large chore but that's about it. I don't know anything about thyroid issues myself however as a comorbidity with diabetes, I've heard people suggest that getting their thyroid levels balanced helps their BG control. It's great that you're able to expedite the bloodwork however you may also want to consider getting a "second opinion" from a specialist?
Thank you for the advice. I will be sure to check my C-peptide level and my fasting blood sugar. I gotta say that I'm hoping it's more type 2, it's frightening to think it could be type 1, but I do admire all the courage all the type 1s here have.
I have read Dr, Bernstein's book as well. He brings up a lot of good points and I do think a low carb diet is a good idea, if I can balance it properly.
Yes, but who's going to test the effects of glucotoxicity for T1's, whose beta cells are already being killed?