What is Diabetes

Chances are that if you found my website you already know a little something about diabetes. But, you might be like me and always want to learn more. And there's ALWAYS is more to learn about diabetes. In this page/post I will attempt to give you my interpretation of diabetes. But I will also refer to medical people who can get more technical. I will also talk about the symptoms of diabetes, the risk factors and different types of diabetes. Diabetes is not easy to explain and it usually requires more than a short sentence, which means people's eyes glaze over and you lose them before you get to the "good" stuff. But you still have to try right.

It's important for all of us, people with diabetes, to not only explain our type correctly but when we are asked about other types that we support those people well too.

Let's start with the basics. Most of the medical definitions I've used here came from the Canadian Diabetes Association's website.

Diabetes is;

Diabetes is a lifelong, chronic, and sometimes fatal disease about the struggle to manage glucose levels in your bloodstream. The body either cannot produce insulin or cannot properly use the insulin it produces.

What do we need insulin?

Insulin is a hormone that turns the glucose (sugar) in our blood into energy for all of our cells to function. The glucose comes from a couple of sources, mostly from foods known as carbohydrates and a stored supply in our liver. Diabetes leads to high blood sugar levels, which can damage organs, blood vessels and nerves - every where our blood goes means that's an area excess sugar can damage. - See more here.

There are a bunch of different types of diabetes.

Type 1 Diabetes

My (non scientific, non-medical) description; Type 1 diabetes happens when, for some unknown reason, our immune system goes "terminator" on our insulin making cells and wipes them all out. My body now has no way to convert the food I eat, in particular the good stuff that comes in the form of carbohydrates, into fuel for my body to exist. Or the glucose that is constantly being released from my liver to keep energy levels up in between meals.

About five to 10% of people with diabetes have type 1 diabetes and it can happen at any age. Type 1 diabetes generally develops in childhood or adolescence, but can develop in adulthood. And type 1 diabetes is always treated with insulin."

For the more medical explanation of type 1 diabetes click here. "The risk factors for type 1 diabetes are still being researched. However, having a family member with type 1 diabetes slightly increases the risk of developing the disease. Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes." Source - International Diabetes Federation (IDF)

Symptoms of Type 1 Diabetes:

The symptoms of type 1 diabetes can develop very quickly (over a few days or weeks), particularly in children.

The main symptoms of type 1 diabetes are the 4T's :

• Excessive  Thirst
• Excessive trips to the Toilet
• Excessive Tiredness
• Thin; losing an excessive amount of weight

Other symptoms can be vomiting or heavy, deep breathing can also occur at a later stage. This is a dangerous sign and requires immediate admission to hospital for treatment. For more information on the symptoms of type 1 diabetes, click here.

LADA (latent autoimmune diabetes in adults) or Type 1.5

My (non scientific, non-medical) description; LADA is very much like type 1 diabetes but it tends to occur in older adults. It is very often mistaken for type 2 diabetes. It's a slower destruction of the insulin making cells. Maybe it's something to do with the "Terminator" being older and slower moving!?! So the symptoms present over a longer period than they would for a person with type 1 diabetes.

LADA is also known as slow-onset type 1 diabetes and type 1.5 diabetes. Like other forms of type 1 diabetes, people with LADA require insulin injections to normalise their blood glucose levels.

For the more medical explanation of LADA click here. Symptoms are very similar to those of type 1 diabetes.

Type 2 Diabetes

My (non scientific, non-medical) description; Type 2 diabetes happens when your insulin has developed a dementia. It's old and tired and not quite sure what it's suppose to do. So, sometimes it works and sometimes it has to put twice as much effort in to work. To me, it's like the insulin has dementia - sometimes it's sharp and works well and other times it just can't figure out what to do.

In general, people who develop type 2 diabetes are older but this isn't always the case. it's the most common type of diabetes.

The treatment options for type 2 diabetes include managing physical activity and meal planning, or may also require medications and/or insulin to control blood sugar more effectively. It can be a series of trial and error to find the right treatment plan for a person with type 2 diabetes.

For the more medical explanation of type 2 diabetes click here.

Symptoms of Type 2 Diabetes:

The symptoms of type 2 diabetes can be very slow to present and often you can have type 2 diabetes for a number of years before it is picked up.

The most common symptoms of type 2 diabetes include:

• excessive thirst
• frequent or increased urination, especially at night
• excessive hunger
• fatigue
• blurry vision
• sores or cuts that won’t heal

Risk Factors for Type 2 Diabetes (from IDF):

There are 10, that's TEN risk factors for type 2 diabetes. Not just the two/three that we ALWAYS hear about.

• Family history of diabetes
• Increasing age
• High blood pressure
• Ethnicity
• Impaired glucose tolerance (IGT)*
• Overweight
• Unhealthy diet
• Physical inactivity
• History of gestational diabetes
• Poor nutrition during pregnancy

Impaired glucose tolerance (IGT) is a category of higher than normal blood glucose, but below the threshold for diagnosing diabetes.

Gestational Diabetes

The other description from IDF; is a form of diabetes consisting of high blood glucose levels during pregnancy. It develops in one in 25 pregnancies worldwide and is associated with complications to both mother and baby. GDM usually disappears after pregnancy but women with GDM and their children are at an increased risk of developing type 2 diabetes later in life.

Approximately half of women with a history of GDM go on to develop type 2 diabetes within five to ten years after delivery.

Other Types.

There are other, much rarer forms of diabetes that are monogenic, meaning a change in only one gene is responsible for the condition. There are two types of conditions in this category: Maturity Onset Diabetes of the Young  (MODY) and Neonatal Diabetes Mellitus (NDM).

For these types of diabetes I have to call on the words of experts because I'm not very familiar with them and don't feel comfortable giving a description of something I don't know much about.

MODY Maturity Onset Diabetes of the Young

I would love to take credit for this explanation of MODY but I couldn't do any better than Morag (Twitter: @SparklyRedShoes) on GBDOC ; MODY happens when there is a mutation of a gene and is most often hereditary. It very often is confused as type 2 diabetes in a young person.

"MODY is diagnosed by genetic testing. It may be worth testing for MODY when a person with diabetes doesn’t fit the profile of the more usual types. For example, somebody who actually has MODY may not require as much insulin as most people with Type 1 (and will have measurable C-peptide), even long after the honeymoon period, but they will generally not be of the age and weight you might expect to see for Type 2. In fact, at diagnosis, people with MODY are often young, slim and active. "

Being genetic, it runs strongly in families; if one parent has it, then the chances of a child inheriting the gene are 50/50. People with a MODY gene generally develop diabetes as young adults, and most are diagnosed by age 45.

For the more medical explanation of type 2 diabetes click here.

The key features of MODY are;

• Being diagnosed with diabetes under the age of 25.
• Having a parent with diabetes, with diabetes in two or more generations.
• Not necessarily needing insulin.

NDM Neonatal Diabetes Mellitus

From Diabetes UK; Neonatal diabetes is a form of diabetes that is diagnosed under the age of nine months. It’s a different type of diabetes than the more common Type 1 diabetes as it’s not an autoimmune condition (where the body has destroyed its insulin producing cells). Like MODY it's a genetic mutation.

 The key features of neonatal diabetes are:

• Neonatal diabetes is caused by a change in a gene which affects insulin production. This means that levels of blood glucose (sugar) in the body rise very high.
• The main feature of neonatal diabetes is being diagnosed with diabetes under the age of 6 months, and this is where it’s different from Type 1, as Type 1 doesn’t affect anyone under 6 months.
• As well as this, about 20 per cent of people with neonatal diabetes also have some developmental delay (eg muscle weakness, learning difficulties) and epilepsy.
• Neonatal diabetes is very rare, currently there are less than 100 people diagnosed with it in the UK.
• There are two types of neonatal diabetes – transient and permanent. As the name suggests, transient neonatal diabetes doesn’t last forever and usually resolves before the age of 12 months. But it usually recurs later on in life, generally during the teenage years.  It accounts for 50-60 per cent of all cases. Permanent neonatal diabetes as you might expect, lasts forever and accounts for 40-50 per cent of all cases.
• Around 50 % of people with neonatal diabetes don’t need insulin and can be treated with a tablet called Glibenclamide instead. These people have a change in the KCNJ11 or ABCC8 gene and need higher doses of Glibenclamide than would be used to treat type 2 diabetes. As well as controlling blood glucose levels, Glibenclamide can also improve the symptoms of developmental delay. It’s important to know if you have/your child has neonatal diabetes to make sure you’re/they’re getting the right treatment and advice (eg stopping insulin).
• Genetic testing for neonatal diabetes is offered free of charge for all people diagnosed with diabetes before 9 months of age. Confirming the diagnosis by molecular genetic testing is essential before considering any change to treatment.
• More information about neonatal diabetes can be found here.

So if you were/your child was diagnosed with diabetes before you/they were 6 months old, ask your diabetes team for a test for neonatal diabetes. Your team can take a blood sample and send it to the Peninsula Medical School based at the Royal Devon and Exeter Hospital for analysis. The test is free. Go to www.diabetesgenes.org. This site will also tell your doctor how to take your blood and send it to the team at Exeter.

Ketone - Scary or Not Scary?

**** I am not a health care professional nor do I have anything that looks remotely like a medical degree. So take anything I say with a pinch of salt.

For this piece I have combined information I found on;  Diabetes Daily written By Ginger Vieira on January 4th, 2016, from Beyond Type 1 WRITTEN BY: Kyla Schmieg, BSN, RN and from The Type 1 Diabetes Network Australia Type 1 Diabetes Starter Kit

When I was diagnosed in 1993, I don’t remember hearing the word ketone back then. In fact, I don’t think I hear it until the early 2,000’s. Remember, diabetes education didn’t exist in Ireland before then - not to my recollection anyway.

In my 23 years with type 1 diabetes I have never tested for ketones. Firstly I don't often get sick. And secondly, when I’m sick I take all the recommended actions that deal with both being sick and flushing out ketones.

However, I hear a lot of talk about ketones and began to think that, maybe, I'm a bit too relaxed about them and need to know a bit more.

So, first, what is a ketone?

When our body can’t access glucose, it looks to burn fat for energy. Burning fat results in ketones.   

“Ketones build up can lead to Diabetic Ketoacidosis (DKA). Signs of DKA include nausea, vomiting, abdominal pain, fruity or acetone (think nail polish remover) breath, rapid breathing, flushed skin, and lack of energy.“ http://beyondtype1.org/ketones-the-6-must-knows/

Why are they so scary?

Ketones usually build up in a person with diabetes if they do not have enough insulin taken and can be fatal.

If ketones happen “too much too fast, it is not natural and it’s important to understand that ‘normally’ produced ketones are very different from ketones that develop due to insulin deficiency.

Moderate or large amounts of ketones in your body are very dangerous. They upset the chemical balance of the blood and lead to a condition called diabetic ketoacidosis or DKA. Some people also experience fast and heavy breathing and exaggerated beating of their heart. It is scary! If you experience DKA, you need to go to hospital to be rehydrated and monitored while the ketones in your body reduce to a safe level.

Many people with type 1 diabetes have never had an episode of ketoacidosis, but you may have already experienced DKA during diagnosis. Unfortunately, DKA is life threatening, so you need to understand what it is and what to look out for.” (from the Type 1 Diabetes Network’s Starter Kit page 37)

OK, I’ve got it so far.

This much is easy to follow but when I started hearing about the different type of ketones that were I got a bit lost. Especially when I heard that you can have ketone when you are not sick and have normal blood sugar levels. Until I did this research, I didn’t know if that was a “freak-out” or “not-to-freaky-out” situation.

Different types of ketones.

Illness-Induced Ketones

Illness-induced ketones can be very dangerous for a person with any type of diabetes. People with diabetes who are sick, especially with an infection, a stomach bug, or the flu should always test their ketones while they are sick.

A mild illness can cause low level ketones that are usually not life-threatening or severely serious. If ketones are at low levels, the general suggestion is to consume plenty of fluids and talk to your healthcare team about increasing your background insulin doses.

Even if your blood sugars appear in-range but you are producing ketones when sick, an increase in background insulin can help eliminate the ketones without dropping one’s blood sugar.

On the other hand, a person with diabetes, who is vomiting repeatedly will almost always need to get to the ER as quickly as possible. Vomiting, no matter the cause of the vomiting, will likely induce large ketones and can be life-threatening. Vomiting leads to severe dehydration which will escalate ketones further to a state of DKA.

Since severe ketosis will likely make a person extremely nauseas in addition to their illness-induced nausea, it can be nearly impossible to consume enough fluids at home to re-hydrate the body. An IV drip of saline at the hospital is essential to rehydrating the body, reducing or eliminating ketones, and stabilizing blood sugar levels.

Consult your healthcare team if you have concerns about your state of ketosis.

Starvation Ketones

Starvation ketones are simply the result of not eating enough food over the course of several hours. Both diabetics and non-diabetics can easily produce very low levels of ketones overnight, seeing a faint pink color on a urine ketone strip first thing in the morning. These are not dangerous unless, of course, this person continues to starve themselves.

Nutritional Ketones

Nutritional Ketosis is a state where the body is using ketones as a fuel source efficiently and safely. In individuals without diabetes or in those with controlled diabetes, having insulin on board to maintain healthy blood sugar levels keeps ketone production in the safe range.

This is achieved by reducing carbohydrate-intake to below 50 grams, because when glucose from food is limited, but blood sugars are still in a healthy range and enough insulin is present, the body will begin to burn body fat for fuel instead, producing low levels of ketones in the bloodstream.”

As long as blood sugars are maintained in the normal safe range with insulin, someone with diabetes can very safely be in Nutritional Ketosis.

When you’ve been in Nutritional Ketosis and not even known it:

• when you skip breakfast and don’t eat until lunch or later, your body is burning body fat for fuel and likely producing low-levels of ketones
• when babies are born, they are often in a state of nutritional ketosis for the first few days or week of life because they are consuming very little breast milk until the mother’s breast milk production ramps up
• when you eat a low-carb meal (eggs and bacon) for breakfast and don’t eat again until late lunch or afternoon…or…when you eat a low-carb breakfast followed by a low-carb lunch, your body is producing a low level of ketones until you eat a more significant serving of carbohydrates at dinner, etc.

Can you get ketones with a high blood sugar?

Ketones typically accompany high blood sugar. Ketones indicate your body needs more insulin. Most often if your body needs more insulin, it means your probably have a high blood sugar. Also, when an illness is present, your body releases hormones in response to the stress. These hormones lead to elevated blood glucose. That is why it’s recommended to test ketone levels during illness.

Can you get ketones with a normal or low blood sugar?

Ketones can also be present when your blood sugar is normal or low. These are sometimes referred to as “starvation ketones” or “nutritional ketosis.” During an illness or extreme diet change, if you have a significant decrease in carb intake, this can lead to the body using fat for energy because there are not enough carbs present to burn. Your blood sugar could remain normal or even be low in this case but your body could still be producing ketones.

From; http://beyondtype1.org/ketones-the-6-must-knows/

Conclusion

My conclusion is that, like diabetes, ketones need to be treated seriously. They are not always scary but you need to know why, when and how. And remember, if in doubt call your D-team. A quick phone call equals peace of mind.

Sources of information about ketones;

• https://www.diabetesdaily.com/blog/2014/11/dka-nutritional-ketosis-are-not-the-same/
• http://beyondtype1.org/ketones-the-6-must-knows/
• http://www.healthline.com/health/type-2-diabetes/facts-ketones#1