Transient Diabetes?

Hello all... I don't post here very often but I posted the below in another forum and would like your opinions as well =)

I had a disucssion with a very good friend of mine who is a doctor and she was mentioning that it is possible that there are people out there that has trancient diabetes even if their dx bg is sky high and needs insulin or meds to bring it down and control through D&E.

She said looking at my history and bg numbers, and generally my lifestyle and meds changes... she said it is possible that my case was a case of transient diabetes that was triggered off by something (probably stress at that time)?

Looking at my bg log... my numbers has been in non-diabetic ranges for the last 6 months or so... even after high carb meals... yes i do spike but from what i understand, normal folks do spike as well but my numbers drops by the next hour too...

So what say you on this? and no i don't considered myself "cured"

I remember talking with you a long time ago about Type 1b idiopathic diabetes, or alternately, Ketosis-Prone Type 2. This occurs mostly among blacks and occasionally among Asians. At the time, you seemed to fit the picture perfectly, and the fact that you are getting normal or nearly normal numbers now still fits the picture. So, yes, you still DO have diabetes, but at the moment, your beta cells are not being stressed, and you're doing fine. That doesn't mean you'll always be fine, though, because whatever it is that stressed your beta cells in the first place can come back again, and you can get sick again. So you will always have to be vigilant. But enjoy the reprieve while you can! :-)

And meanwhile, Google Michael Barker's page, called Ketosis-Prone Type 2 (or something like that) -- he has wonderful explanations about it. And he's a member of TuD, so friend him -- I'm sure he'll be happy to talk to you.

Yes I recall you mentioning this to me before on DD?? (or not =) ) and had a lookup on that... it was an interesting read and yes I do somewhat fit into that picture.

Recently I had my appendix ruptured and was kinda expecting BG to shoot up sky high... but it was not so and I was still maintaining good bg levels even with glucose iv ... and with no meds to control the bg

I guess as you said... I will always have to be vigilant and continue to do whatever I need to do to keep it at bay! =)

All depends on what I eat actually... I'll say generally malaysian food (esp the yummy ones) are diabetic nightmares as they will always be hidden carbs ... but most of the time my 2 hour pp will be less than 7 (126) and I aim to be below 7.8 (140) as much as possible... I do get occasional spikes to 8s or 9s but very rare

It is good to see you again. I always thought you were a model. Your A1cs really went to "normal" dropping below 5% if I recall. Many of us would consider diet and exercise a "success" if we could maintain an A1c of < 6.5%. I actually think that it is probably normal for non-diabetics to get occaisonal spikes to 8-9s (145-160 mg/dl) particularly with high carb meals. You have probably seen the chart on what a normal blood sugar around a meal looks like.

My understanding of malaysian food is that it is based on the staples of rice, noodles and bread, so on top of that, with sweetened dishes, it is easy to have over 100g of carbs in a meal. So it might not be surprising that even a non-diabetic might have a pretty large blood sugar rise.

So that being said, it is possible that when you were diagnosed, you just "overwhelmed" your pancreas. And once you got you diet in order you still made enough insulin, lost enough weight and improved your fitness enough that you essentially became symptom free. It is really kinda hard to know except doing an experiment and trying to get your blood sugar out of control again (I would not suggest this).

There are other forms of diabetes, ketosis-prone is one. There are also genetic forms of diabetes (MODY), these are usually handed down from our parents (autosomal dominant), so there is a 50% chance of having the condition. Do you have relatives with diabetes?

In the end, we all are often left with questions about what exactly is wrong with us. I've never quite figured out myself. What really matters is that we treat ourselves appropriately to try to stay healthy, and you can clearly look at what you have done with pride. Even if your initial diagnosis was a transient event, it makes you much more likely to be vulnerable to another transient event, so it is prudent to keep up what you are doing.

And besides, even if you never were diagnosed diabetic, your health and fitness is so much better now, why would you change a thing?

Yes, there is type 1B or idiopathic diabetes. No antibodies are present and insulin needs change over the years (from requiring no insulin to needing insulin like a typical type 1). It is predominantly seen in people of Asian and African descent I believe. However, even when BGs are in normal range, you still technically "HAVE" diabetes. It's just at that moment, the disease isn't causing a need for insulin.

I know having those spikes are not advisable and I do generally try and avoid them at all cost... I'm generally still very watchful on what I eat although its been more relaxed the last few months... rest assured I'm still checking my bg to make sure its not out of whack =)

My doctor has never said I'm cured even when my A1c has been in the low 5s and 2 times below 5% in the last 3 years since dx... and I'll be too ignorant to think that i'm cured totally... while my doctor friend is suggesting that it may be possible that I have transient diabetes, but she has never said that I'm "cured" and must still watch out on it... I know that I have a messed up pancreas and no matter how controlled I am... I still have a messed up pancreas =)

When I was dx... I was put on insulin due to dx bg very high and it took them quite an amount of insulin to bring down my bg to decent ranges during the time I was in the hosp... was on meds for 1.5 years before I finally went off it completely to try out diet and exercise alone... I guess the increased activity level and weight loss helped a lot in this aspect =)

Definitely good to see you too Brian! =)

Yep... I had 2 A1cs below 5%... a 4.4% about 6 months after dx in 2009 (mainly due to me bordering on hypo levels a lot from the meds) and a 4.6% just 6 months ago in Sept 2011... which surprisingly happened after my appendix surgery... like removing it stimulated the pancreas or something LOL

I would believe that non-diabetics do spike up to 8s-9s or even 10s after very high carb meals... which is pretty common here in Malaysia... and you're quite right that the staple food here are mainly rice and noodles that is taken alongside with dishes that tend to be coated with flour for batter, starchy and/or sweetened sauces... and yep sugar and starch are common ingredients in the various dishes... so a meal could easily be 150g - 200g carbs if you add in the sweet drinks often drank together with the meals?

As I mentioned on DD... I did an OGTT in 2010 after I got off all meds and tried just D&E and I passed the test (although my meter told me I failed.... but the labs said I passed! ... dirty hands? =P)

Both my maternal and paternal side are full of diabetics... maternal grandparents both are D (but dx at an older age) and paternal grandmother is a D (from an early age too)...and quite a number of relatives are D too... so yes I have very strong diabetic genes... kinda can say i hit the jackpot in the D genes pool? LOL

True in a way that since being dx... my health and fitness is sooooo much better now compared to before... and i'm way more active than before too (which is a very good thing ... until my parents are complaining i'm too active now LOL) ... so i guess there's always a positive side to everything... eventhough it wasn't so pretty at the start during dx time

I do think they are discovering lots of forms of diabetes. There are 9 or 10 versions of MODY diabetes, each one presenting differently and some less serious than others. Some versions are not Insulin Resistant or Insulin Insufficient but there is some genetic defect in how you produce insulin. There is also Gestational Diabetes which sometimes disappears after the baby is born but may reappear later. I have had diabetes for 5 years and now have near normal bgs. I aim for 100-110 after meals and below 100 for fasting. I can do this because of the way I eat. So my numbers are probably below many non diabetics but I will always be diabetic. If I eat a normal meal I will be around 140-150 but then my fasting will increase the next morning.

I think one of the most surprising thing I've seen while participating on this forum is the number of people who don't fit into either of the traditional "type 1" or "type 2" diabetes categories. I definitely think that the medical community is too quick to put people into buckets, failing to admit that there's still so much that IS NOT known about diabetes.

And I learned a new ( 2 ) word : " transient diabetes " ...thanks Hannah ! well

Hear, hear!!! My friend Ann Williams, who is an RN, PhD, CDE says that there are probably LOTS of forms of diabetes that have not, and never will be described, due to rarity or lack of money. That's probably why some researchers are beginning to recognize that diabetes is a spectrum, not an either/or. You can be totally insulin deficient WITHOUT autoimmunity, AND you can have clearly autoimmune diabetes WITH extreme insulin resistance. And that doesn't even take into account all the other things that can go wrong, like disorders of gut, adipose and brain hormones, glucagon secretion, adiponectin secretion, and lots more that I don't even know about.

So I think we should let the academics go about their business -- what WE have to concentrate on is getting the appropriate treatment that allows us to control our diabetes as best as we can, regardless of the ostensible cause. When doctors are too encapsulated in their boxes, we need to take the bull by the horns, and tell them only what they need to know in order to treat us properly -- we truly have to be the masters of our own fates! :-)

On, December 26, there is a discussion of yet another type of diabetes, Mitochondrial Diabetes. Fascinating.

Oh I love this discussion!! Copying my own personal notes here:

I was sick with some kind of virus in 2009. A "doc in the box" put me on antibiotics and on prednisone. A couple of days later, I had to call an ambulance and wound up in the ER, and then in the hospital for a week. Blood sugar was 769. They ran all the diabetes tests (including the tests indicating the autoantibodies against insulin). All the symptoms had been there for about a year before (constant thirst, constant urination, blurred vision, unexplained significant weight loss, etc.). Diagnosis was Type 1 diabetes-at the age of 43 years old, and I was in Diabetic Ketoacidosis (DKA).
.Fast forward to March-June of this year. Another illness. A different reputable doctor (from an established practice) swears that I have pneumonia-put me on antibiotics and prednisone. But the x-rays come back clean as a whistle. I start wondering if this isn't an allergy. Buy an air purifier-no change. Start removing things from my diet-no change-until I removed dairy products. Once I completely eliminated dairy products, all the pneumonia-like symptoms disappear.

Then, to top that off, I started having frequent and serious lows. Figured that it had something to do with removing dairy, so I lowered my bolus shots. Still having lows-started eliminating bolus shots. Still having lows, so today, I didn't even take the Lantus shot. Glucose level as of right this minute-97!!

I Have now been off insulin shots for two weeks today. The only thing that changed was removing dairy. My lowest Blood Sugar was 85. I did notice that if I eat something like spaghetti with meat sauce, my sugar can go up to 171. But 90% if the time, it falls between 85 and 140, no matter what I've eaten, no matter what time of day or night.

Had a bunch of labs and an ultrasound done last week. Should have the results on Thursday!

Hi Deb. Is there any possibility of your having Celiac Disease? Gluten causes a dairy problem with those who do have Celiac. You have very interesting Diabetes!

Deb, sure sounds like you AREN'T a typical anything -- my self-invented category is Type Weird. :-P

But I do think part of the problem is that prednisone can cause ANYONE's BGs to elevate. It's a well-known side effect.

Other than that, are you sure the antibody tests came back positive? In your case, it would be interesting to do them again, because completely going off insulin would cause a true Type 1 to get very sick in a matter of hours or even a day or two at most. For me, just cutting back on insulin -- not even omitting it completely -- caused a steady rise in BGs until I almost died. So maybe the first test was a false positive?

I have never heard of elimination of dairy causing a remission of any kind of diabetes, but you may be the unusual one, which I think might warrant a discussion with your doc. Maybe you would be worth writing up as a case study, if your continue not to need insulin for a more extended period.

I don't know, but sure is interesting! :-)

Still no insulin shots and will have all 13 labs and the ultrasound results tomorrow. I will tell you that since being off the insulin shots (and off of dairy and slightly reducing my intake of gluten-started that this week), my physical well being and energy have shot through the roof! I haven't felt this good since 2006!!! Natalie, my nickname for myself right now is "freak of nature"!! :-) And I would love to be a case study, but we will see what the results are tomorrow first.

I have a friend who has Celiac Disease and we talked about this possibility. But from what I understand about Celiac, blood sugar spikes too high and then drops below normal after eating. The lowest blood sugar I've had since I got off my insulin shots was 85, so I don't think it's Celiac. Of course, no disease out there fits right now LOL :-)

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Hi Deb. I discovered Celiac and had to quit gluten at about the same time as getting Diabetes, so I don't know exactly how it would affect my BG. However, Celiac destroys the villi in your gut, making digestion difficult and changing the timing of the digestion, also causing the lactose intolerance, which probably does result in altering one's BG. It also messes up the absorption of vitamins and minerals, so it actually does one's body a lot of damage. If one has Celiac, it takes time to heal the villi and just a little bit of gluten can damage them again. The tradeoff for the nuisance in giving up gluten (if you have Celiac or are intolerant of gluten) is that you actually feel good again!