Type 2 Becomes Type 1 and Weight Gain. (Input needed)

LeeDahlen38

Hi All,
I've been dealing with a good bit of health issues lately and want some input of the latest hurdle. First a little background. I became a Type 2 Diabetic about 10 years ago and was able to manage it with diet and metformin. My (then) Dr said "If you would lose about 100lbs this will reverse itself and now is the time and its urgent you do so. So I did.. I joined MFP, went all in and About 2 years later I had lost the 100lbs prescribed... Let me just say "Dr's Lie" (In my opinion) The T2 never went away, I was on meds ever since, even adding Glyburide to the Metformin to keep it in check. Fast forward to 4 weeks ago, I had gotten lazy, and more or less gave up trying to manage the sugar levels. I ended up in the hospital with a 600+ Blood Sugar, Loss of vision (About 50%) and totally broken. (Hang tight there's a positive end). I'm home and recovering very well, Vision returned, and sugar is Back to a manageable level (120-145 daily) but it required a major change and issue. The doctor has said "in english terms" you are now a type 1 as your Pancreas has gone into retirement, and you are now on shots. Ok.... So now I am on Lantus AND Fast acting insulin to keep it all in check. And I'm ok with it. I feel so much better again.
Here's what I am NOT ok with.... I'm gaining weight.. Not just a pound or two here and there, but I'm up a total of 9 lbs since the hospital visit 4 weeks ago, and I am up 28 lbs since my goal was reached.

I've done some reading, and it "seems" while the insulin(s) remove sugar from the blood cells, the sugar "Attaches" itself to body fat thus causing the weight increase. GEEZE!! If this is true it seems I can't win..... My Diet is cleaner than it ever was. The Dr gave me the parameters of Carb reduction to "less than 50 per snack and less than 100 per meal" Look at my diary. (It's open) I haven't exceeded this in 4 weeks. Really not even close except for 2-3 occasions. I'm open to thoughts on how to get the weight under control and back down. Thanks in advance! Lee

neanderthin

Just for clarity, is that 50 and 100 grams of carbs your Dr. prescribes per snack and meal, or 50 and 100 calories per snack and meal? I suggest a lifestyle clinic where they specialize in people with similar struggles.

And no, sugar doesn't attach to body fat causing weight gain and that's more than likely just a misinterpretation of the science, which even Doctors get wrong, excess calories do that and ultimately, you're going to need to be in a calorie deficit if you want to lose weight.

LeeDahlen38

Carbs….

Wynterbourne

I'd be looking for a new doctor. Type 2 diabetes can't turn into Type 1 diabetes. That's a myth. They are two separate conditions with distinct causes and can't transform into the other one over time. It's possible that you were initially misdiagnosed with Type 2 when you were actually Type 1. Type 1 is thought to be an autoimmune reaction where your immune system is attacking and destroying the insulin-producing cells in your pancreas. You cannot make your own insulin. Type 2 is brought about by lifestyle and can lead to your body not making enough insulin or producing insulin that doesn't work properly. A Type 1 diabetic is insulin depend for life. A Type 2 diabetic can get it under control via diet, exercise, and medication. Type 1 has no cure. Type 2 can be put into remission.

neanderthin

Wynterbourne wrote: »

I'd be looking for a new doctor. Type 2 diabetes can't turn into Type 1 diabetes. That's a myth. They are two separate conditions with distinct causes and can't transform into the other one over time. It's possible that you were initially misdiagnosed with Type 2 when you were actually Type 1. Type 1 is thought to be an autoimmune reaction where your immune system is attacking and destroying the insulin-producing cells in your pancreas. You cannot make your own insulin. Type 2 is brought about by lifestyle and can lead to your body not making enough insulin or producing insulin that doesn't work properly. A Type 1 diabetic is insulin depend for life. A Type 2 diabetic can get it under control via diet, exercise, and medication. Type 1 has no cure. Type 2 can be put into remission.

Yeah, poor description from the Doctor. A C-peptide test will see the state of the pancreas and its insulin production or lack thereof. Insulin injections for type 2 diabetics should be a wake up call. Cheers.

LeeDahlen38

@Wynterbourne If type 2 can't "turn into" type 1, and the C-Peptide and blood work comes back and says the pancreas is not producing anymore What would you call that? I mean not to be argumentative, but it seems we are picking nits. I have to follow the same treatment as a type 1 and didn't used to have to.
Just asking. BTW, was just tested for Type 1.5 yesterday (LADA) and awaiting the results.

sandraws

It might be time to see an endocrinologist to help you understand and deal with your health issues. It doesn't seem like you are getting the best medical advice at this point.

sandraws

I had wanted to include this article (perhaps you've already seen it) regrading weight gain and insulin
https://www.medicalnewstoday.com/articles/325328#insulin-and-diabetes

autobahn66

Hey Lee, sorry you are having such a difficult time, and glad to hear you are feeling better.

With regard to your weight: one thing to consider is that the weight of a person going into hospital will have been artificially low if they are in a hyperosmolar hyperglycaemic state. As their blood sugar is so high, the sugar in their blood will pull the water out of every other space in the body and created a total body water deficit of 100-200ml/kg (which equates to about 20lbs of weight).

Much of this will have been reversed during a hospital stay, but reaching a normal state of hydration after a situation like this can take some time: so some weight gain after a hospital stay may be regaining a normal state of hydration.

But absolutely insulin therapy can lead to weight gain. Before starting insulin, the blood of a person with diabetes requiring insulin will have had a very high sugar level that their body couldn’t use, and was damaging their nerves, kidneys and blood vessels. Now their body is doing what it’s supposed to: stashing that glucose into cells in the form of fat and glycogen. This is much less harmful than having a high blood glucose, but certainly leads to weight gain.

This is also one of these occasions where CICO has been inaccurate: whatever they were eating before, a large amount of those calories were likely passing directly out of their body in the form of glycosuria (sugar in the urine). Now those calories are being stored: and in fact, these calories will be stored in a non-physiological way. Usually, the body controls insulin very tightly, minute by minute. The body of a person taking additional insulin doesn’t control their insulin in such a sensitive way: basal-bolus insulin mimics physiological insulin production imperfectly.

But, over time, and with good team work, the amount, timing and preparation of insulin can be optimised to find the best balance for an individual, where blood sugar is well under control, diet and calorie intake are controlled and weight remains stable.

With regard to the type I vs type II – as you say it’s nitpicking and somewhat loose language from the doc. A person who has ever had a blood glucose of >600 has a gross mismatch between their effective insulin (be that insulin secretion (as in type I or type II with pancreatic insufficiency) or insulin resistance (as in type II)), and has an indication for management with insulin.

In summary:

Weight after this type of hospital admission is unstable and unpredictable. Some time needs to pass before an accurate estimation of changes in weight can be made.

Insulin needs after an emergency start on insulin under these circumstances is imperfect. Early on the focus from the medical team is likely to be getting and maintaining a normal blood glucose to prevent severe illness, as you experienced. Longer term weight goals may take a back seat for a time.

Your calorie needs may be changing and hard to predict as your body is using the energy you put into it completely differently now. It may take some time for this to stabilise and for you to know how to manage your diet in the longer term.

Finally: no-one here can know what the best approach is for you. It is too complicated, with too many unknown variables. The best diabetes management is an active partnership which includes nurse specialists, endocrinologists, diabetes dietician, psychologist, podiatrists, ophthalmologist etc. and they are the people who can assist best with this type of issue.

Wynterbourne

LeeDahlen38 wrote: »

@Wynterbourne If type 2 can't "turn into" type 1, and the C-Peptide and blood work comes back and says the pancreas is not producing anymore What would you call that? I mean not to be argumentative, but it seems we are picking nits. I have to follow the same treatment as a type 1 and didn't used to have to.
Just asking. BTW, was just tested for Type 1.5 yesterday (LADA) and awaiting the results.

I'm sorry you are having health issues, but my statement was not my opinion, it was 100% scientifically based, medically undisputed fact. I don't know where this "doctor" got his medical degree, but if he actually told you that you had T2 diabetes and now it has become T1 diabetes, he needs to have his medical license revoked. It can NOT happen. Do your research. Look at respected medical sources, peer-reviewed articles, etc. It's medically impossible. Again, it's possible that T1 was originally misdiagnosed as T2. Type 1.5 is a subtype of T1 and has nothing to do with T2. I've even seen articles discussing the fact that people with LADA are frequently misdiagnosed with T2. I'm willing to bet money that is what happened. You've always been T1, but we're misdiagnosed. Respectfully, get a new doctor, or at least get a second opinion.

ghrmj

The doctor probably meant that the OP's diabetes is now insulin dependent, and phrased it awkwardly. Sometimes doctors say things in a way that is meant to convey a concept to a patient in a way they will understand. I hardly think that means they need to have their license revoked.

paperpudding

yes to be fair the Dr did say " in english terms"....

ie in laymen's terms you are now like a type 1 diabetic, on insulin

I'm sure the doctor knows that isnt actually the case but is a way of explaining it in simple terms

I dont agree on the liklihood OP could of been misdiagnosed as type 2- not if he was controlled by oral meds only for 10 yrs.


Far more likely he is type 2 which has now progressed to type 2 needing insulin - a not uncommon scenario over time.

OP I think it would be good to get a referral to a diabetic educator or a dietician experienced in diabetics on insulin.

nicsflyingcircus

Type 2 diabetics can become completely insulin dependent once their pancreas is damaged enough.

I'm an RN, I work in a hospital setting and I routinely (like multiple times a day) deal with patients who did not manage their type 2 diabetes appropriately and are now completely insulin dependent.

They often continue to not manage it appropriately even on insulin and begin the slide with non-healing wounds (to the feet in particular), which leads to multiple debridements, infections, amputation of toe, toes, partial foot, whole foot, below the knee, multiple revisions, then above the knee amputation. Meanwhile their other foot has either joined the fun or soon will.

Not to say this will happen, I also see diabetics in the 60s or 70s having surgery for other reasons whose type 2 diabetes is well managed. But it is a scary and slippery slope.

autobahn66

Wynterbourne wrote: »

LeeDahlen38 wrote: »

@Wynterbourne If type 2 can't "turn into" type 1, and the C-Peptide and blood work comes back and says the pancreas is not producing anymore What would you call that? I mean not to be argumentative, but it seems we are picking nits. I have to follow the same treatment as a type 1 and didn't used to have to.
Just asking. BTW, was just tested for Type 1.5 yesterday (LADA) and awaiting the results.

I'm sorry you are having health issues, but my statement was not my opinion, it was 100% scientifically based, medically undisputed fact. I don't know where this "doctor" got his medical degree, but if he actually told you that you had T2 diabetes and now it has become T1 diabetes, he needs to have his medical license revoked. It can NOT happen. Do your research. Look at respected medical sources, peer-reviewed articles, etc. It's medically impossible. Again, it's possible that T1 was originally misdiagnosed as T2. Type 1.5 is a subtype of T1 and has nothing to do with T2. I've even seen articles discussing the fact that people with LADA are frequently misdiagnosed with T2. I'm willing to bet money that is what happened. You've always been T1, but we're misdiagnosed. Respectfully, get a new doctor, or at least get a second opinion.

You're not wrong here, but you're missing the point of what the doctor said.

There is a very fundamental way in which type II diabetes with pancreatic insufficiency is like type I diabetes: without insulin the patient will become extremely unwell, possibly quite quickly.

Furthermore, the clinical presentation of HHS indicates that the fundamental pathology is the same (i.e. pancreatic failure). The only differentiation then is the mechanism (autoimmune vs the milieux of issues that cause this in type II). Diabetes is complex: how do we describe people with MODY? The diabetes UK website doesn't class LADA as type 1 or type 2 but merely states that it straddles both diseases.

The doctor's role here is not necessarily to explain the exact underlying pathophysiology of diabetes with perfect accuracy. It is to explain the significance of what has just happened, and what that means for the patient and the options for how to manage this going forward. Using convenient or generally understood language that is scientifically inexact is appropriate if it adds to the OPs understanding of how to actually avoid ending up in hospital from their diabetes.