View Full Version : Another one joins the club, sadly.
A person just showed up in ER. He is 68 years old. Glucose of 589. Ketones weakly positive. Positive urine glucose. Probably starting DKA at this point.
No history of diabetes. Obviously, given his age, it's not going to be Type 1 and I assume LADA appears much earlier in life too. Obviously, further testing is needed.
But it still begs the question... Just how long was this poor guy walking around undiagnosed? We all know that this is a progressive disease, it's not like his pancreas all of a sudden decided to quit a couple of days ago.
I don't know all the specifics of this guys particular case. Perhaps he's homeless and was found passed out and hasn't had healthcare for 20 years.
But I see this at least a couple of times per week. It just demonstrates the need for early diagnosis and management of this disease.
Education is the only real tool at slowing this down.
jtausch
10-30-2009, 03:01 PM
I know that i went for a long time undiagnosed My fasting was 304 My feet were already messed up could not feel them and was constantly tired even at one point of almost falling asleep while judst sitting still, But I ignord everything and kept pressing on. Should have been checked out a lot sooner but hindsite is 20/20.
fgummett
10-30-2009, 03:08 PM
Man it's so frustrating... surely the answer is so obvious to everyone here on DF... early detection and proactive treatment has got to be so much more effective and cheaper than waiting till it's so far gone.
An ounce of prevention really is worth a pound of cure in this case.
The cost to the individual and their family -- physical, mental, emotional and financial
The cost to the health system
We're facing a bottomless pit unless something changes
What do we have to do to turn this around?
I really don't know Frank.
Maybe I'm over-reacting because this is a subject that I'm (now) passionate about, but at the very least, I think T2 should be required subject matter in high school. Perhaps a national standardized test on T2. Not a huge or difficult one, maybe something that helps to hammer home the importance of diet and activity. That may sound extreme, but so is the exponential growth of this disease.
I'd actually rather have any money spent on finding a "cure" (which I don't think we are going to find for T2 anyway) go into the national (or worldwide) education on T2. The problem is just waaaaaaaaaaaaay too big.
sarahspins
10-30-2009, 03:33 PM
Obviously, given his age, it's not going to be Type 1
Wow, just wow :mad:
Way to perpetuate those stereotypes. I can't even presume to know what kind of D he has and neither can you, but age alone does not protect anyone from developing an autoimmune disease... unless you're actually suggesting I have some "other" kind of diabetes since I was diagnosed as an adult?
Wow, just wow :mad:
Way to perpetuate those stereotypes. I can't even presume to know what kind of D he has and neither can you, but age alone does not protect anyone from developing an autoimmune disease... unless you're actually suggesting I have some "other" kind of diabetes since I was diagnosed as an adult?
Just curious, at what age were you diagnosed? I understand T1 can hit as an adult. While I freely admit I'm not completely versed in T1, I seriously doubt that T1 is finally going to present at 68 years of age, especially considering the mean age of T1 onset is below 20 years of age.
Also, I did say "Obviously, further testing is needed."
The reason I presumed is because the overwhelming odds are that he won't be a type 1 - considering the ratio of T2's to T1's and the usual age of onset. Can he be type 1? Sure, it's possible. It's also possible that that the specimen submitted me was contaminated from an IV. It's also possible that something else is wrong with his pancreas, decreasing function.
I'll follow up on this particular case and let you know. But I'd be willing to bet 10 grand of my money to a grand of your own that he's not type 1. I've seen enough of this in my years at the hospital to have a strong idea where this is heading. I could be wrong.
But again, as I stated in my original post, more testing will obviously be needed. I'll let you know how that goes.
yannah
10-30-2009, 04:23 PM
and so here we are . my biggest pet peeve. drs should do this cheap test randomly all the time. they should test at the grocery at the drug store, at the mall.
One of our members did not find out till no circulation. and shortly after went blind. it seems this is not that uncommon.
I think only abot 30 percent of people whith type 2 have typical symptoms. i did not. who knows how long I had it. looking abck I think a long time.
I took a random at a fair once. it was 168 mid day. he told me that was fine.
yeah, that needs to change too. I did notice he was wierd about it too. but ever gave it much thought. 168 is not fine!!!!
ADA, that is pretty not okay.
fgummett
10-30-2009, 04:32 PM
Why don't Family Doctors have BG meters in their offices and just do random BG tests... OK they may not be definitive but they may give a heads up that further investigation is warranted... of course that would also mean education that recognises the early signs of developing Type 2, rather than waiting till people pass the diagnostic thresholds...
"OK now you're a diabetic... now I can do something about it"... is too little too late... the dam has already burst!
Granny Shanny
10-30-2009, 04:38 PM
And whacha bet those ubiquitous detail men would provide strips/lancets fer free?!!
Why don't Family Doctors have BG meters in their offices and just do random BG tests...
Ding! Ding! Ding!
Cheap and easy. As you said, not definitive, but it can provide a heads up.
JayDee1950
10-30-2009, 07:11 PM
Everyone is different.
I was in denial, ignored the warning signs and family history for several years - brother/sister/parents/grandparents on both sides/uncle/aunts - just plain stupid.
Loved my sweets, cookies, candy, chocolate, etc. and didn't want to give them up. Was always a poor eater with many food allergies.
Was blowing fasting am results of 475, family and friends couldn't understand how I was still upright and functioning/driving.
fgummett
10-31-2009, 03:37 AM
Everyone is different.
I was in denial, ignored the warning signs and family history for several years...So do we just ignore the problem or do we step up the education, so that people are more aware of the issues and what to do about them :confused:
DeusXM
10-31-2009, 04:15 AM
Way to perpetuate those stereotypes. I can't even presume to know what kind of D he has and neither can you, but age alone does not protect anyone from developing an autoimmune disease... unless you're actually suggesting I have some "other" kind of diabetes since I was diagnosed as an adult?
Put it this way, the odds of a 68-year-old developing T1 are extremely low, a bit like the odds of a 68-year-old woman conceiving.
Yes, older people develop T1 and yes, older woman can get pregnant. But the older you get, the less statistically likely it becomes. As a result, it becomes very easy to make assumptions that are generally correct.
Assuming that a 68-year-old hasn't developed T1 is no different from assuming a 68-year-old woman hasn't become pregnant. Yes, there is that tiny, tiny margin of possibility but it's extremely unlikely - which is why I don't understand why making such an assumption offends you. It's not a 'stereotype', it's a medically reasonable assumption.
Just because there are a few tiny exceptions to a stereotype doesn't mean the stereotype is suddenly completely and utterly inaccurate.
Subby
10-31-2009, 04:31 AM
the less statistically likely it becomes. As a result, it becomes very easy to make assumptions that are generally correct.
If you stick rigidly only to assumptions that have a high statistical probability, I don't think "generally correct" really describes it - "often correct" is probably more accurate. For a majority of the time you will be right, and for a minority of the time you will be completely wrong.
This is not a "medically reasonable assumption", how does that justify not getting to the heart of an individual's physical state? There's no need to denigrate and overlook the minority in that way. It's "very easy" to use or appeal to predefined categories or assumptions, while making it clear you just don't know if it is the case for that individual. Such testing and interrogation of assumptions, is the mark of a good doctor, anyway. In this case, I didn't really think JPS was particularly overstating anyway.
yannah
10-31-2009, 06:46 AM
If you stick rigidly only to assumptions that have a high statistical probability, I don't think "generally correct" really describes it - "often correct" is probably more accurate. For a majority of the time you will be right, and for a minority of the time you will be completely wrong.
This is not a "medically reasonable assumption", how does that justify not getting to the heart of an individual's physical state? There's no need to denigrate and overlook the minority in that way. It's "very easy" to use or appeal to predefined categories or assumptions, while making it clear you just don't know if it is the case for that individual. Such testing and interrogation of assumptions, is the mark of a good doctor, anyway. In this case, I didn't really think JPS was particularly overstating anyway.
for example, if a elderly person developed t1, wouldn't it seem something very wrong may be going on? a sign of something else?
No history of diabetes. Obviously, given his age, it's not going to be Type 1 and I assume LADA appears much earlier in life too. Obviously, further testing is needed.
But it still begs the question... Just how long was this poor guy walking around undiagnosed? We all know that this is a progressive disease, it's not like his pancreas all of a sudden decided to quit a couple of days ago.
Hi JPS...it's not so obvious that he's not T1. I received my T1 diagnosis when I was 53. Only one in my family, no prior difficulty with BG. Autoimmune diseases are tricky little things, as you know, and what triggers them is not so clear. He may NOT have been wandering about that long with failing beta cells. At least he's getting the treatment he needs.
Jen
I'm truly sorry if my assumption offended anybody. That wasn't my intent at all. I was just trying to demonstrate the need for more apt and timely screening and increased recognition/education.
They ordered a host of tests (GAD, C-Peptide, other autoimmune markers) but the results probably won't be in until Monday or Tuesday. For the life of me, I can't understand why they ordered an insulin on a blood sample AFTER he's been in ICU receiving insulin.
No offense taken, JPS. Doctors need to be more aware that adults can be T1, and that it may not be such a gradual progression. It can, as with me, be a pretty nasty systemic assault. We are a small percentage of the diabetes population and it's probably pretty easy to miss.
Jen
[QUOTE=DeusXM;517158]Put it this way, the odds of a 68-year-old developing T1 are extremely low, a bit like the odds of a 68-year-old woman conceiving.
Yes, older people develop T1 and yes, older woman can get pregnant. But the older you get, the less statistically likely it becomes. As a result, it becomes very easy to make assumptions that are generally correct.
QUOTE]
Yeah but my MD looked up LADA and said since I was over 50 (I was 51 for @$@#$) it could not be LADA ... and it is. Statistics are only effective in delaing with large groups, not individual cases. He could have LADA or he could be plain ol T2, either way, it is a tough row to hoe ...
Newdiabetic
10-31-2009, 07:32 PM
I keep my kit with me and I have tested all of my family and friends. To family members have me concerned because they take the meds so that they can eat what they want....that can't be good can it?
mortis505
11-01-2009, 12:23 AM
jps, I will be very interested to know the results of those tests. Considering the state of Ketones and urine glucose, without knowing other factors(i.e. weight loss, How long since last meal) I would be hard pressed to make a guess.
Subby
11-01-2009, 03:54 AM
for example, if a elderly person developed t1, wouldn't it seem something very wrong may be going on? a sign of something else?
Maybe... pancreatitis seems to be a contender for that, although I could be wrong. I'd be interested in other medical candidates for that for my own knowledge if anyone knows. It also appears the old "rules" are flying out the window and we should be aware of that all the time. You get kids diagnosed type 2, and adults older and older getting diagnosed type 1 and 1.5. Either they were being misdiagnosed (or undiagnosed) before, or the boundaries are actually changing... or both... whatever is happening, it seems helpful not to jump to conclusions too solidly.
The diagnostic diabetes tests are not back in yet. However, is pancreatic enzymes (lipase and amylase) are smack dab in the middle of the normal range, so pancreatitis is out. Liver enzymes are all a little bit elevated though.
He's a big man, 5-9, 320. His sugars are starting to get a bit better, down to 250.
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