A glucose tolerance test shows if one is Type I or Type 2. Blood glucose is tested, usually by finger prick (one should not do the test if blood sugar is too high). Then a test for blood sugar AND insulin level from venous blood. Then a bottle of sugar water. Then tests of venous blood after 1 hour and 2 hours for blood sugar and insulin. If insulin goes very high and blood sugar also goes very high, you are Type 2. Metformin should help. If no insulin, you are Type 1 and need insulin.
Glucose tolerance test would be positive for both untreated T1 and T2. It is not going to distinguish between the two. C-peptide and antibody tests can (though antibody tests will not always be positive in T1, since could be an antibody not tested for).
Totally agree this needs to be treated now. Please do not wait. Diabetic ketoacidosis (DKA) can be life-threatening.
Then, as others have suggested, see an Endocrinologist. I know a Type 2 Diabetic who just was unable to manage his blood glucose levels without insulin. Or as others have suggested, you may actually be a Type 1.
In any case, first things first – treat the emergency now, then see an Endo. Good luck.
As I wrote, a proper glucose tolerance test measures both insulin and blood sugar. A Type 1 who is not taking insulin won’t have any insulin (or not enough); a Type 2 will have a normal amount of insulin.
I was diagnosed as Type 2 by a GP, but did not respond well, so he referred me to an endocrinologist. Since it is strictly prohibited for a specialist to contradict a family doctor, for fear of a lawsuit, the endocrinologist ordered a glucose tolerance test, which measured the insulin I was taking, since (before ordering the glucose tolerance test) the endocrinologist started me on insulin. Straight line. The endocrinologist had to lie that the line was c-Peptide, proving I had plenty of my own insulin and was therefore Type 2, but my own insulin was exactly half what I needed because of my insulin resistance, so I needed exactly twice as much insulin as my body was producing and had to inject exactly as much insulin as my body was producing. This was entirely non-factual, but they figured it would protect them from a lawsuit. Since I am not the kind to sue doctors for normal mistakes, I was slightly more likely to sue for an obvious lie than for the truth (but I didn’t bother: the endocrinologist put me on intensive insulin, and I have been complication free for 30 years).
I met a woman diagnosed as Type 2 by a family doctor, and I insisted she see an endocrinologist who ordered a glucose tolerance test. After the glucose, her insulin rose sharply, as did her blood sugar. The fact that her own insulin rose sharply proved that she had plenty of insulin, but it was not working. The proper glucose tolerance test is not: Take glucose and see if your blood sugar goes up, it is a test of both blood sugar and insulin.
A diabetic who is being treated with insulin will test positive for insulin. c-Peptide is a by-product of insulin production, so a normal c-Peptide test proves your own body is producing insulin, and a Type 1 will have insufficient c-Peptide even if being treated with insulin.
If I am tested for insulin, I have plenty (all of which I injected myself); if I am tested for c-Peptide, I don’t have any.
A physician who orders a patient to take the bottle of glucose and then measures only blood sugar is not doing a glucose tolerance test. Everyone with a fasting blood sugar of more than 126 mg/dl or 7 mmol/L is Diabetic; a person who sometimes has blood sugars more than 200 mg/dl or 11 mmol/L is also considered diabetic, and some doctors check for this by giving glucose and measuring only blood sugar, but this is not considered a very useful test, and is not used by the best endocrinologists, because very few diabetics have fasting sugars that are always less than 126 mg/dl but then have glucose levels of more than 200 mg/dl after a meal. The proper glucose tolerance test, measuring both insulin and blood sugar, should always be used on a newly diagnosed diabetic at any age, since, while there is a correlation between age of diagnosis and Type of diabetes, the correlation is not 100% and a proper glucose tolerance test is the only reliable way to distinguish the Type of diabetes.
I’m sorry for your experience, but please don’t think this standard of care is typical for others. This sounds like complete BS. It’s a completely NORMAL practice for general practitioners to refer someone to a specialist for a more advanced diagnosis and treatment, when they don’t fit the “general medicine” model they’re equipped to treat. That’s not considered malpractice. It’s just the evolution of care in exceptional patients. Diagnoses change and evolve.
Any malpractice lawyer worth their salt could get such a case dismissed (or at least win, if the judge didn’t dismiss it) because the prosecutor has to prove MALFEASANCE… Which is very clearly defined by legal precedent. One part of that is proving that the doctor in question deviated from the standard level of care. Testing for late-onset type 1 is NOT standard care, it is a drastic anomaly from the common Type 2.
Personally, I would take MAJOR ISSUE with any doctor that tampered with my medical records for any reason, let alone such a ridiculous one. Yes, unfortunately people are sue happy. Yes, malpractice insurance is an inherent (and expensive) part of practising medicine… But the professionals still have to do their job to their best of their ability, and operate within board requirements! They don’t get to bend the established rules out of fear of malpractice.
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Looking for an update to see how you are doing. Nancy50
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Yes, Family Practitioners who do not know what to do should refer the patient to a specialist. If, however, the Family Practitioner makes a mis-diagnosis, many patients will sue. The fact that the mis-diagnosis is proven means the courts might or might not award a large sum to the mis-diagnosed patient. And a misdiagnosis of Type 2 for a patient who is Type 1 can result in serious problems, so an award is certainly possible.
Hence, it is very important that the specialist (if from the same medical facility) say that the primary care physician’s diagnosis was correct, but the complete diagnosis is more complicated and required the specialist, so the primary care physician did everything right, from the initial diagnosis and treatment to the referral to a specialist when the initial treatment proved inadequate.
Actually, even if from a different medical facility, medical ethics say the specialist should say the primary care physician’s diagnosis was correct, and the recommended treatment was right as a first step, but the case is more complicated, and requires additional treatment, so the primary care physician was right both in the first assessment, and also correct to refer the patient to a specialist. It is very important that no physician ever say anything that suggests a mistake was made by another physician, given the US court system. (Read Bonfire of the Vanities about what can happen in the courts when a law firm figure they can win a malpractice suit.)
Hi Jungle, we’re hoping that not hearing from you means that you are okay, but those of us who have read this thread are concerned. Please let us know how you are … no details that you don’t want to share, just if you are okay.
574 is about 6 times non-diabetic normal. Blood sugar that high is, by itself, very bad for you, so if it isn’t any lower by now, even if your original diagnosis is totally right, you may need insulin for a short while to bring your blood sugar down.
DKA is diabetic ketone acidosis. When your cells are unable to process glucose/carbohydrates for fuel, they move on to fat and protein. This produces acids, which go into your blood. This extra acid changes the PH levels of your blood, and it doesn’t take a big change to make other processes stop working right. To put it baldly, THIS CAN KILL YOU, and no one wants that. I personally spent 2 days in ICU, and several more days in the hospital, from DKA.
I hope that you’re okay.
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@Jungle, You Ok out there in cyberspace? How are things going? Any updates?
I’m with everyone else, you need a good doctor/ER and insulin with that high of a number. At the least you should get urin ketostix, to check for ketones with that high of a BG. DKA isn’t fun.
Jungle, I think others have recommended you begin insulin therapy and I could not agree more.
The standard MD therapy for newly diagnosed T2Ds is completely inappropriate, and reflects a complete lack of understanding of this condition. Metformin is not in any way an adequate or appropriate primary/sole medication, and is highly questionable even as a secondary med IMO.
Difference between a recently diagnosed T2D and most T1Ds (several years post-diagnosis at least) is that former produces substantial (endogenous) insulin and latter does not. Your endogenous insulin production is likely ~20% (of normal/non-diabetic) now – that is when initial diagnosis occurs and blood sugar is acutely disregulated for first time (in any type of diabetes/diabetic including T1DM), concurrent with the initial (usually permanent) loss of insulin granulation/storage in beta cells.
Once this occurs there is positive feedback in response to carbohydrates (i.e. portal glucose), and those with ~zero insulin production at least do not have (any longer) this highly destabilizing effect during prandial (i.e. meal-absorbing) period.
Eliminate ALL carb’s from diet right away, and learn to apply subcutaneous/peripheral insulin right away. Human insulins are available at Walmart in many or most states over-the-counter.
The reason you must eliminate the carb’s is that these are absorbed through small intestine predominantly as glucose, and this produces the positive-feedback unstable response I noted above.
Those are the basics. There are few, if any, MDs who understand these fundamentals at all – do not trust anyone who does not.
Peripheral insulin is unfortunately a crude form of compensation for endogenous insulin deficiency, but it is the best therapy available by far. Nothing else is worth wasting time with.
With T2DM you will suffer from hyperglucagonemia in response to amino acids (dietary protein) and glucose (dietary carb’s) from now on, for many years if not indefinitely. You must compensate for the dietary protein with adequate injected bolus insulin, and you must NOT even attempt to compensate for any dietary carb’s because this is impossible to do (because of the positive feedback – a non-diabetic has strongly negative feedback).
P.S. Jungle, sorry I did not see your post earlier and am so late in responding. I do not check in very often to the forum.
If you do nevertheless read my initial response I must apologize for throwing a lot at you very quickly, and in very short form.
For what it is worth, while others have cautioned about the risk(s) of ketoacidosis and their warnings should be heeded, I would think it unlikely you are yet anywhere near “insulin-dependent” – that is, at-risk for diabetic ketoacidosis. This only occurs once endogenous insulin production gets close to zero – probably no more than 5% of normal. And as I wrote, for any diabetic the dramatic initial acute loss of BG regulation occurs at about 20% (i.e. loss of 80%) of normal/non-diabetic.
BGs as high as yours are common for initially diagnosed diabetics of both acquired types (T1DM and T2DM). Often they are not as high, but often they are. Metformin often brings BG down a lot in case of T2DM, but not always. It is inappropriate in any case.
Your primary concern should be bolus compensation for meals – this will cause the most tissue damage if left incompletely compensated for. And only insulin can do this, other than oral secretagogues. And you should avoid the latter as these accelerate beta cell loss still further.
Metformin interferes with basal BG regulation, and this is not only ineffective for the main problem which is prandial BG disregulation, but also likely not a good thing in general.
Learn how to prepare all of your own meals from food you select and purchase yourself. You should divorce yourself from eating out from now on, except maybe occasional barbecue if you like. Be careful, but not intimidated, with insulin therapy as you start up. Bernstein’s book is an OK reference, even though a lot of what he writes is incorrect, and this is much more true for diabetics who produce non-zero endogenous insulin too. But it might at least give you a starting reference and help you avoid major mistakes. Using insulin is not difficult at all IMO, once you learn the ropes. Adapting the meals properly will probably be the most difficult for most, and this is crucial for making the insulin therapy work reliably too. Bernstein gets this 100% correct!
I recommend one meal per day. This should not be difficult, but rather natural, if the meals are ultra-low/zero carb in content. Some transition period of a few weeks to a few months will be required.
You must get enough protein – another thing that Bernstein is bang-on correct about. Eat as much as you feel comfortable eating. You also need adequate dietary fat, since the carb’s must be eliminated and those are the only other fuel stored in adipose tissue (i.e. subcutaneous body fat). Excess protein will also be burned (after first AA substrate requirements are met, and then after breakdown of excess AAs to carbon skeletons), but it is vital (and more palatable) to get adequate dietary fat which goes directly and efficiently to FAs (fatty acids) storage (as triglycerides) and oxidative phosphorylation (use as fuel/energy).
Modern patterns of excessive frequency of hunger are due to the same problem (from diet) that caused the T2DM in the first place.
I quite agree with the suggestions made above, These continued high blood glucose readings must be dealt with ASAP.
Going to the ER is a good option but that is your call. But contacting your doctor is a must. You must make it clear to him/her that something more must be done if he/she is not willing to do more it may be time for a new doctor.
Insulin is the best blood glucose lowering agent and like @Mac2 said older human insulins can be had OTC in most states at Walmart. Their use can be tricky and somewhat dangerous without proper knowledge. There is no way I would recommend starting insulin without the guidance of a knowledgeable healthcare professional.
Please remember that diabetes, no matter which type, is a marathon not a sprint. There is time to learn what to do.
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