Ketosis Prone Diabetics are a special group. They start out as T1’s and then become T2’s. I want to talk to as many as I can find.
No, Type 2’s can experience DKA… It’s just rarer, and it generally happens when it is combined with elevated, uncontrolled levels of BG, and illness. If for example, you don’t watch your diet, and often have BG’s over 300… or other situation that has caused or triggered such high blood sugars, combined with a severe illness like a pneumonia, you can develop DKA. It is more prevalent in Hispanics and African Americans. My dad had something like this happen to him, during the many times he was hospitalized. He was Puerto Rican.
Your father had what is called a “provoked” DKA. This is where some precipitating event forces up BG’s. My episode was unprovoked and it actually isn’t that uncommon in Ketosis Prone T2’s. I do find the term “unprovoked” problematic. Obviously, something is going on, probably in the diet, that flips a T2 into DKA.
The point is that T2’s generally have too much insulin floating about. Ketosis Prone T2’s, do to glucostoxicity, beta cells simply shutdown and don’t come back on line until the BG’s are brought back down. They have little or no insulin until then.
This is a far different case from regular T2’s who wear out their pancreases over the years due to overproduction of insulin.
It’s this bizarre twist that gives the Ketosis Prone T2 a very different look from other T2’s.
Mike
Very interesting, Mike. Thanks for sharing. Hopefully someone else will be able to relate. I did try to look up some info on T2 and DKA, but aside from the ‘wearing out your pancreas’ incidents, there isn’t much out there. Diabetes is just so complex, and can have so many variables… We are all so unique in our own experience. 
Maybe you can write a blog post about it… I think it would be very informative, and interesting, for the rest of us. Thanks, again.
Hi
If you want to read up on this here’s one of the best and most readable pieces. As you read it you really have to wonder why this isn’t more widely known being that it actually is very prevalent.
Mike
Oh, thanks so much for the link!
You’re welcome. Tell me what you think.
Mike
Hi Michael,
this discussion made me think. Maybe it is possible that Halle Berry belongs to this group too. She lapsed into DKA coma in 1989 and was classified as T1. Then her classification changed to T2 and she now uses diet and exercise alone to control it.
When I was first diagnosed, the doctor said I was DKA. At the emergency room, my blood sugar was 399. Prior diagnosis, I was having very bad flu-like symptoms, vomiting, high fever, body malaise, etc. for about 3 days. Extremely dehydrated. Initially, they thought I was LADA. Because of unfavorable experiences with the hospital, I requested to be transferred to another. There, I was diagnosed to have pneumonia as well. Two weeks in the hospital, a gazillion blood/lab tests, was on insulin and antibiotics, I was diagnosed type 2. On metformin now for more than 2 years.
What an interesting thread on DKA. I am a T2 or a T1.5, but my doctor can’t decide. However, I never really knew much about DKA nor did anyone (including my doctor or diabetic nurse) ever tell me about it. This is until very recently when I went on the pump, and the Animas book talked about it in detail. Just out of luck, one of the nutritionist I saw mentioned that I should get a meter that can check the DKAs. So I was given a meter which can check both BGs and DKAs. My understanding is that elevated BGs such as 14.0 and higher may cause the symptom, but I rarely go that high and haven’t had the chance to check for it yet.
If they start out as T1s it’s because thery were misdiagnosed - T1’s have NO beta cells and produce NO insulin
This is precisely how Ketosis Prone T2’s start. Without insulin, they die. What is the difference between having beta cells that don’t function and no beta cells. How can you tell the difference? No one has yet and now it appears that there is evidence that the beta cells are completely destroyed in KPD t2’s but spontaneously regenerate.
Where is your difference now. You can say lack of antibodies but some T1’s don’t show antibodies either.
Mike
Thank you, Holger
I hadn’t thought about Berry, I certainly hadn’t seen the video where she says she “weened” herself off insulin. She’s getting vilified for that statement but she’s just following something that others have noted, some “T1’s” can be weened from insulin. I’ve seen this repeatedly. I know of no real example of a person with no beta cell functioning being “weened” from insulin. If they can be then they are KPD T2’s.
Mike
Hi Teena
I’m betting that you weren’t ever told that you were a Ketosis Prone T2 diabetic. Two questions: How do you handle carbs and what type of bg’s are you seeing now?
Mike
DKA is more than high BG’s. I know of some who have gone DKA with blood sugars in the 300’s. I know some who didn’t go DKA and their blood sugar got to 1000.
I have far improved on my numbers since then Michael. And yes they never did inform me that I was. Although I’m also not sure if I am since I attributed the circumstance to the pneumonia and asthma exacerbation at that time as well. I can take as much as 120 grams carbs per day (high protein though) with the majority of 50 grams in the morning (I do most physical activities and exercises in the morning) 30 lunch then 20 dinner. Snacks vary to 10 grams per. My bg will range from 80 to 120. My January A1C last January was 6. I am due for another at the end of the month. My January FBS was not very good though at 6.7. My endo decreased my carb intake at night and recommended “light exercises” in the evening as well. Medication was also moved from morning to noon. So far, I have had better numbers.
The risks of DKA on a pump are a little different. Usually, DKA happens when you are basically have no insulin and your blood sugar goes very high. For a pump user, since their basal is achieved using frequent small squirts of a rapid insulin, any failure in the pump will mean that you don’t get insulin and you run out of circulating insulin FAST. This leads to a DKA risk that can set in relatively quickly (hours) rather than what usually happens with longer periods of increasing blood sugar before it sets in. That is probably a topic for another thread in the insulin pumpers group.
Michael may well be right about Ms. Berry. It may well be that she is a KPD which would explain the seemingly strange progression of her diabetes and also explain why her statements seem confused. In fact, her doctors are “confused” and she is just doing her best to explain what she has been told.
I’m glad you said this, because I was just about to. If someone really is a T1 and then they become a T2, it means they have both. It hasn’t changed into something else.
KPD T2 is defined as unprovoked, meaning no precipitating event. In your case, a flu could have been the precipitating event or it could have piggybacked on the DKA so you might not be. Besides there isn’t a test for KPD.
I ask these questions because there is so little out there, given its prevalence, about KPD. It is thought that this could penetrate to as much as 50% of the diabetics in the Black, Hispanic and Native communities. This would mean thousands of individuals.
There are some tantalizing bits out there but information is at such a point that even if you knew for sure that you were KPD, you would have no idea what it meant or how you would need to be treated.
For instance, I believe that KPD is a type of MODY, (a lot of researchers believe this also), and that it is like a low level hyperglycemia that over decades destroys the body. There are no old people in my family, most die in their 50’s and 60’s.
Me becoming a KPD, I see as a type of gift to othersy and to their futures, if I can find answers and get this out to the world
Actually, If you think about it, they can’t be both. They can be one or the other, which is why some called them 1.5. Could T1’s without antibodies be KPD’s that didn’t regenerate their beta cells from some reason? Who knows?