Saturday, November 20, 2010

Early Detection Saves Lives

Fact: Undiagnosed diabetes is untreated diabetes.

It is estimated that by the time they are diagnosed, 50% of type 2 diabetics and 5% of type 1 diabetics already have complications- most commonly peripheral neuropathy and microalbuminuria.

Of small children diagnosed with type 1 diabetes, a third are diagnosed in DKA. Of adults diagnosed with type 1 diabetes, a fifth are diagnosed in DKA.

Even with the best medical care, patients who are in severe DKA at diagnosis often die within the week.

A higher HbA1c at diagnosis- meaning a diagnosis later in the disease course- predicts more complications.

A lower HbA1c at diagnosis -meaning an early diagnosis- predicts a longer honeymoon in which blood sugar is easier to control.

Individuals who do not have a close family member with type 1 diabetes are at thirty times the risk of being in DKA at diagnosis compared to those who have family members diagnosed before them. That suggests that being educated about the signs and symptoms of type 1 diabetes, as well as being diligent about reacting to them, can prevent at least twenty nine out of thirty cases of diabetes from being diagnosed while in DKA.

As a general rule, onset is faster in younger people, regardless of type of diabetes. But there is a huge variation in the amount of time that will pass from the time that a person has enough of a problem to benefit from treatment until the time that a person will die without it.

I was diagnosed in DKA after having been symptomatic for over a year and suspect that I had diabetes for multiple years before my diagnosis of type 1 diabetes. My HbA1c at diagnosis was off the charts (somewhere above 16%). My symptoms at the time I was diagnosed were no worse than they had been two weeks earlier.
Less than three years after my diabetes diagnosis, I had peripheral neurpathy. My feet tingle tingle tingle all the time. They don't hurt and I hope they never will. Tingle tingle tingle. Would they tingle if I had been diagnosed while my A1c was still below 10%? I don't think so.

You can detect diabetes painlessly with a simple ketodiastix test of the urine. These will test for the presence of sugar in the urine and ketones in the urine. Trace to small ketones may be present in a person under great stress who is healthy. Moderate to large ketones indicate dangerous dehydration and possibly diabetes. Sugar in the urine almost always means that a person has diabetes, although diabetes is possible without sugar in the urine.
For optimal detection of diabetes, the urine test should happen after a meal (say, dinner) because some people develop trace ketones overnight and in early diabetes the blood sugar falls to normal after hours of not eating.
You can buy 100 strips for 24 dollars.

There are no symptoms that are present in every person diagnosed with diabetes, except for high blood sugar. I misread a list of symptoms of diabetes in the month before I was diagnosed and thought that because I didn't have ketone breath (in fact, I did have ketone breath, I just couldn't smell it) I couldn't have type 1 diabetes.

Symptoms of high blood sugar include:
thirst, hunger, fatigue, needing to pee a lot(proportional to drinking a lot), blurry vision, lightheadedness, weight loss, dehydration despite clear pee

Symptoms of ketoacidosis include:
shallow breathing, fatigue, ketone breath (smells like rotten fruit, I'm told), confusion, disorientation, stroke, coma, death

Complications of having high blood sugar for months include:
urinary tract infections, weight loss, lingering illness, slow healing wounds, stronger glasses prescription, headaches upon waking, bloated stomach, peripheral neuropathy (especially painful feet), sensitivity to light, exhaustion

1 comment:

Reyna said...

Great post Jonah. I have tested my daughter Bridget with the Ketone Strips. I used to be nervous when she would become thirsty and/or wet the bed...so I would check.