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

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.

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.

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.