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From Canada:

I have a question about my condition. I am 20 years old, and we are not sure if I am diabetic yet or not. I started out having severe hypoglycemia for a year, and now my sugars keep climbing higher and higher (I test my blood and now, my urine). Sometimes, two hours after meals, I will be at between 126mg/dl (7.0mmols) and 180mg/dl (10.0) and my fasting is always about 6.0mmols (108mg/dl).

I saw an endocrinologist several months ago who gave me a glucose tolerance test and figured out that I am producing six times the normal amount of insulin, and I am only using a small portion. He said something about my receptors not accepting my insulin. He also said that he figured I would become Type 1 soon.

Now, I am having these highs after meals, so I went back to him. He did another 2 hour Glucose tolerance and only took samples at the beginning and end. I only went up to about 9.5mmols (171mg/dl) at the highest and at the end I was about 6.5mmols (117mg/dl). I know these numbers are pretty good, but I am wondering why I did not shoot up way high like I always do after meals (I am on a 1750kcal diabetic diet). Also, I went home and tested my urine (my physician wanted me testing for ketones with my highs) and I had severe ketones in my urine. The ketones continued for 2 days straight, and then now I still have them after meals (lots) and after exercise. My sugars aren't that high to be causing that many ketones. I phoned my endo and he said something about a "starvation ketosis" and told me it would go away. I am eating lots and I don't understand the ketones. His office is supposed to call me sometime soon. Why am I having these ketones? I have been consuming 3 meals and 2 snacks (if needed) a day.


Although the fasting blood sugars which you have recorded are only a little above the upper range of normal, some of the two hour post prandial ones are definitely above normal. There are however some puzzles in the story that you give. First of all a daily calorie intake of only 1750 cal seems low for an active 20 year old woman in comparison with a more usual figure of around 40 cal/kg/d. If you are taking a lot of exercise it is possible that you are using up fat stores and generating ketones in the process, as your doctor suggested. A quick way to eliminate this possibility would be to increase your calorie intake for a few days and to see if the ketones disappeared.

This leaves the issue of interpreting the blood sugars. If the ketones are not due to a low calorie intake then taken with the hyperglycemia this certainly suggests Type 1 Diabetes as your Doctor has indicated. On the other hand the high serum insulin levels in relation to the blood sugar is much more indicative of Type 2 Diabetes. It is important to distinguish the two because Type 1 Diabetes needs to be treated with insulin right away and not just simply for the purpose of controlling blood sugars. If you have Type 2 diabetes on the other hand your present diet may be more appropriate and may also need to be supplemented with one of the oral hypoglycemics.

If you have no family history to help you, probably the best way to make the differential diagnosis would be to ask your doctor about getting antibody levels done. If they are present then you are almost certainly Type 1 and if they are not then you are likely to be Type 2 or just possibly one of the much less common case of Maturity Onset Diabetes in the Young (MODY).


Original posting 15 Mar 97


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Last Updated: Tuesday April 06, 2010 15:08:54
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