Dentist Diagnoses Diabetes

Moonbear

I'm still failing to see a connection with his diet here. The diet sounds like one you would put a diabetic on to control it, which is generally a healthy diet anyway, not something that would cause ketosis. And, since they didn't seem to be worrying about that when he saw the doctor, how could it be the diet? It sounds more like it was nothing, or just some odor that wafted the way of his chair that wasn't his breath at all.

Anyway, I'm glad it all worked out to be a false alarm. Not that all that stress is good for you with the worry it put you through, but at least it turned out to be nothing in the end. Too bad you couldn't have gone in sooner just for the 10 second test and put your mind at ease a couple days ago. Maybe MIH was right, you just grabbed the nailpolish remover instead of mouthwash that day.

Ivan Seeking

Good news Zooby, diabetes is not the end of the world but it is no fun.

At this point I am managing by watching what I eat. I was on Precose for about a year but that stuff is really hard to tolerate. Luckily, after taking it for a time I was able to back off, but how long I can keep this up, I don't know. It is a constant struggle and I don't feel well much of the time.

DaveC426913, when I was diagnosed [edit: cripes, it has been over eight years now! ] it was simply called "adult diabetic syndrome". Beyond that I don't know what else it might be called. I ended up having to go to one of the nations leading specialists before it was diagnosed. At the time there was no literature available.

Another interesting side note: When I finally landed in the office of a true expert, the difference was like night and day. Not only did he nail it withing a few minutes, he also explained all sorts of things that I had never understood. For example, I thought that I was allergic to alcohol. It affected me differently than everyone else, and eventually I realized that I just can't drink. Even one beer was enough to make me feel absolutely terrible. But it was the blood sugar all along.

zoobyshoe

Thanks you guys.

Cyrus, I'll look at art later. I'm de-stressing here.

I think you are probably right. It is my main suspect.

From the Wikipedia article you linked to:

"The breath of people in a ketagenic state commonly contains acetone, detectable as a sweet smell that may be mistaken for ethyl alcohol."

That article describes two ketogenic diets: 1.) the high fat ketogenic diet for treating epilepsy in children, and 2.) the low-carb (Atkin's type) diet. I'm pretty sure that what I've been eating amounts to the latter, low carb diet. The bulk of the carbs I eat probably come from the, approximately 1 cup of rice and 1 cup of beans I eat almost every day. I eat no bread whatever, nothing made with flour, no potatos. I usually snack all day long about once an hour: an apple here, a carrot there, a stalk of celery, a nectarine, a fistful of raw green beans, and so forth. There's just no doubt I've been burning fat off. When they weighed me today while taking vitals I found out I'm now 40 lbs lighter than when I started.

My limited understanding is that carbs convert easily to fuel for energy. If you don't eat many carbs you force the body to convert stored fat into ketones which are the fuel. This is ketosis. Not the same thing as ketoacidosis, but produces the same fruity/acetone breath.

The only other suspect is the med I take. If I burp after taking it it has a strong chemical taste in my mouth. The thing is, I've been taking it for years, and also going to that same dentist for years, and she's never noticed any smell before. Also, since this visit was 9 AM, I hadn't taken any of it that day, so there was none in my stomach to burp up.

zoobyshoe

I'm certainly relieved. I'm a pretty chaotic person with a wandering mind and the prospect of my life depending on me checking something on a regular schedule was pretty scary.
The side effects of some meds are so bad the person ends up feeling they've just exchanged one disease for another. I've heard a million stories.

DaveC426913

Um. I hate to be a poopiehead about this, but ...

Your GP has not done a proper test - she has not eliminated Diabetes at all.

Diabetics are perfectly capable of having normal blood sugar levels.

She needs to do a proper 3-hour glucose tolerance test.

One of the most challenging things about Diabetes is outdated knowledge - including doctors. Your doctor is basing her test and conclusion on stuff she learned a decade or two ago.

Zoob, I hate to tell you this, but you DO need to get a proper test.

On the plus, side what the test has indicated is that, if you DO have Diabetes, it has not put your glucose levels out of the control, i.e. you are not in imminent danger of damage.

Moonbear

Having 1 cup of rice and beans daily isn't an Atkin's style low carb diet. All those fruits and vegetables also have carbs/sugars in them. The extreme form of the Atkin's diet that puts people at risk of ketoacidosis eliminates even vegetables and rice. Though, I guess that depends on how much of the other foods you're eating. How quickly have you lost that weight? It may not be the choice of foods so much as that you're eating so little and losing weight so quickly that you're basically forcing your body into "starvation" mode. But, if it was the diet, don't you think that would still be apparent when you saw your doctor? Unless you decided to modify your diet between the dentist and doctor visits.

Who knows, maybe it wasn't an acetone odor at all, but really a fruity odor from eating fruits! Or, some receptionist was doing her nails while the dentist was seeing you and she didn't realize she really was smelling acetone, but it wasn't coming from you. It would have been nice if your doctor had spent a few more minutes with you so you could have asked about the diet and rate of weight loss to make sure it's okay.

Moonbear

It's possible his diet is helping to keep it in control. My grandfather had part of his pancreas removed due to cancer years ago, and only about two years ago did someone realize he should have been getting monitored for diabetes regularly! (I had been under the impression it was only partially removed, so the remainder was able to compensate, but then the story was suddenly that it was entirely removed...I've never liked his doctor because it seems things like this get miscommunicated too often, but he insists he's a great doctor and keeps going back to him ). I'm still sure he HAD to have some pancreas left or he'd be dead from lack of insulin, but definitely his diet helped keep his blood sugar well under control even with a deficiency so that it took many years before the diabetic symptoms showed up. His diet is very similar to Zooby's, and he really didn't need to modify very much after the official diagnosis other than to cut out some of the sweet snacks he was sneaking in the middle of the night (my grandmother has always been anti-sugar in her house...she's not the fun grandma).

Evo

It wouldn't be a bad idea to do a "glucola" test. I turned out to be mildy hypoglycemic and I don't even pay any attention to it.

Although Zooby doesn't seem to be having any symptoms, at our age, it's not a bad idea to get a complete check up, something I need to do.

zoobyshoe

Strictly speaking, you're right: I wasn't given the definitive test. What her statement was meant to convey to me was her certainty that nothing she'd heard gave her the slightest suspicion I actually might have it or need further testing. She was saying "You may put your mind completely at rest about this."

Now, I think when I tell the dentist what the GP said she's going to say: "Glad you had it checked. That smell alarmed me somewhat, so I thought I should tell you about it." I think her concern is that she doesn't want patients passing out in the chair while she's working on them.

Now, the GP just didn't have time to answer the dozen questions I would like to have asked, but I'm guessing her certainty was based on knowing something to the effect that a person probably cannot have diabetic acetone breath without also having incorrect blood sugar. That's my speculation, anyway.

My brother-in-law is an ER doctor, and has online access to any and all current info that's for doctors only. I've kept my sister, his wife, up to date on all this. I'm positive he'll get back to me if he thinks there's still any reason to be concerned about it.

zoobyshoe

I'm not sure you're seeing the difference between ketosis and ketoacidosis. According to that wikipedia article the low carb diet induces ketosis which also produces acetone breath. This is low-carb not no-carb. Ketosis seems to be the normal, non-pathological way the body turns stored fat into energy when it lacks other, more immediate fuel. Ketoacidosis also produces acteone breath, but is exclusively pathological and seems to be ultimately triggered by the insulin problems (in the case of diabetics) not by diet.

(I think, incidently, we'd expect to find acetone breath in anyone following the high fat ketogenic diet for epilepsy as well. This seems to produce ketosis by utilizing mostly fatty foods as the daily energy source.)

At any rate, what I eat now relative to the huge amounts of bread, doughnuts, starchy soups, baked potatoes, popcorn etc., that I used to eat, constitutes a huge drop in carb intake now that I look at it, though my deliberate intention was merely to avoid fats. My body has, indeed, been ridding itself of fat stores, and I assume it's doing this by turning them to ketones. That seems to be the normal way.I wouldn't be the least bit surprised to find out I'd been in ketosis many times during the past 4 1/2 months, burning body fat, rather than anything I'd eaten that day. Otherwise, where did this fat go? Secret nocturnal alien liposuction?

Moonbear

Ketosis is just the earlier stage of converting fat to ketones. When enough ketones, which are acidic, accumulate, you end up with ketoacidosis, which is life-threatening. If you're experiencing ketosis with your diet, you're playing with fire. You can burn fats without becoming ketotic. As you described your diet, which may or may not be what you always follow, it is not low carb. Rice and vegetables all have carbohydrates. Just because you're leaving out the refined sugars found in bread and doughnuts doesn't mean you're not getting carbs. Your diet is really just low fat. The rice and beans tells me you're not cutting out protein either, so really, it's just the fats you've cut out. You've reduced your carbohydrate/sugar intake, but you haven't eliminated it or entered into what's considered a low-carb diet, mostly you've just changed from a high-carb/high fat diet. It shouldn't be causing ketosis at all, because you're still providing enough carbohydrates for your body, unless you are also cutting back calories/portions to an extremely low level. But, to have lost that weight over 4 1/2 months sounds like a reasonable rate, not too fast at all. Really, you sound like you're on a very sensible diet for weight loss and overall health.

zoobyshoe

Yes, this is how I understood it. A neutral thing. Likewise, the term "in ketosis" simply means your body is performing this function, as I understand it.

Here it seems to me, you're throwing the terms ketoacidosis, ketosis, and ketotic all in together as if they're equivalent.

From the link in Evo's first post:

I haven't actually looked into how many carbs you have to be eating in order for the term "low carb" to apply. The main point here is not to figure out if the term "low-carb" applies, which, I grant, it may not, but if the way I've been eating could produce acetone breath.

Somehow the way I've been eating has produced fat loss. It seems to me that all this fat must have been turned to ketones to be burned away. Turning fat to ketones is called "ketosis". Therefore, It seems to me I must have been in ketosis many times during this diet. Not "ketotic" or "in ketoacidosis", just in ketosis: turning fat to ketones.

Here and there, I'd imagine, when I was burning more calories than other days, or waited longer than usual after waking up to eat my first meal of the day, I might easily have turned enough fat to ketones to make my breath smell. The Atkin's and epilepsy diets seem to do this without it being dangerous in any way.

Moonbear

Sorry zoob, but the only place you'll find support for ketosis not being dangerous is on low carb websites. The ketones produced in ketosis ARE acidic, and their build up is what leads to ketoacidosis. Biochemically, there is no distinction between ketosis and ketoacidosis. The build up of ketones is a last-ditch effort by your body to preserve brain function while reserving any other glucose for the function of other vital organs. The physiological distinction between ketosis and ketoacidosis is that ketoacidosis occurs when the ketone bodies have built up even beyond the point where the blood and bodily fluids can still provide a buffering effect, and the blood becomes more acidic. If you are ketotic and excreting ketones, you are also losing other important electrolytes with it (in diabetics, that's a major contributor to the insatiable thirst).

The Atkins and epilepsy diets are dangerous. Most people don't really stick to the Atkin's diet very faithfully, which helps protect them from the worst symptoms. The epilepsy diet is not generally used except as a last resort when medications fail...it works because it DOES change the way the brain functions, but in that case, the other health risks are considered acceptable because the alternative of uncontrolled seizures is worse.

Developing ketosis means your body is NOT fully metabolizing fatty acids, due to a lack of carbohydrates to sustain precursors needed for the Krebs cycle, and ketone bodies accumulate rather than being metabolized. You can utilize fat reserves without developing ketosis.

However, if you were developing ketosis due to your diet, you would also have very low blood sugar to accompany it. That is when the body starts producing those ketone bodies, when there is not enough sugar/carbohydrates around. In diabetics, the opposite is true; they will have very high blood sugar to accompany ketone production because despite having lots of sugar in their body, their cells can't use it.

The diet sites trying to promote low-carb diets are spreading misinformation. They are trying to convince the public that ketosis is totally normal and healthy so they can keep making money off their diet books and diet foods, etc. When you see them making claims like, "even physicians and scientists confuse the terms..." don't you think maybe there's some fibbing going on? They're trying to tell you, "Ignore those nutritionists and biochemists who know the science and believe us and buy our product."

Evo

I agree with Moonbear, low carb diets aren't healthy because they are not balanced. I only furnished the link to explain why a low carb diet would cause ketosis.

I live alone and I'll buy a ham and end up eating nothing but ham (zero carbs) for two weeks and will develop ketosis. I'm not advocating eating this way, I just get lazy, and I like ham.

Low carb is considered an intake of 30 or less grams of carbs per day.

zoobyshoe

OK. All this is finally coherent. It wasn't clear to me before that you had any objections to these diets. Your main point seemed to be that I wasn't actually on one. So I assumed what it said was OK with you, and I was trying to assimilate apparently contradictory statements.

Still, I remain confused about what to call the normal, healthy conversion of fat stores to ketones.
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If the smell came from some source external to me, like the receptionists nail polish theory, I would have smelled it too.

The thing about this dentist is that she's remarkably calm and even tempered. The notion she imagined the smell, or mistook something else on my breath for acetone, suggests something out of character for her.

In the interest of science I have slaughtered one of my meds to smell it's innards. These are gel caps with liquid inside. All I can detect is a faint oder reminiscent of mineral oil.

My other theory is that it is the meds and she has always smelled this on my breath, but didn't learn this smell was associated with diabetes till recently, since my last visit.

zoobyshoe

And yet you wonder why you're not allowed within 1000 feet of a synagogue.
The reason I eat the rice and beans is because someone told me this combination constitutes a "perfect" protein, whatever that means. I'm wondering if when eaten together like this they cease being carbs and become proteins. That would leave just the carbs in the raw vegetables and the fructose (considered a carb, right?). Several times I've added lentils, after someone told me they're packed with protein. It's occured to me once or twice I should be concerned I don't lose muscle mass in this process.

I mentioned tuna fish. I also eat sardines (packed in water only) and kippered snacks now and then. These are the leanest meat proteins I could think of. I went for a couple chicken kebobs once but they were just too greasy for me to keep in the diet.

The rice and beans I heat up in a skillet with chopped onions and garlic, and top off with even more granulated garlic. I add a chopped celery stalk and a cut up tomato half. Sometimes I add soy sauce to this. I use a bare minimun of olive oil to sautee the onions and garlic, maybe half a teaspoon. Without the garlic and onions it's too bland. I really pour on the granulated garlic.

Moonbear

They're still carbs, at least the carb part. The reference to a complete protein is that together, they provide all the essential amino acids the body needs for making proteins. If you ate either of them alone, you'd wind up with a protein deficiency due to lack of essential amino acids (the ones your body can't make itself out of precursors, so need to be included in your diet).

Sounds pretty good. I make a very simple black bean dish...just sautee a chopped onion and minced garlic (I use a little butter, but you could substitute a little olive oil...you only need a small amount to get the onions and garlic sauteed), add the beans, and some oregano. The oregano really gives it an extra kick.

For other types of beans, I cheat and use some flavoring packets. I use the Adobo and Jamon seasonings that Goya makes to help with flavor.

I put a heaping teaspoon of Recaito (you can find it in jars also made by Goya, maybe other brands in the freezer section if you're in an area with more of an Hispanic population...my ethnic food choices are limited where I live, so it's jars for me) to about a teaspoon or two of olive oil in a large sautee pan. I add a packet of each of the seasonings, plus a little salt and pepper, then about 3 cans of beans (I prefer pink beans, but it's also fine with white or red navy beans). Leave some of the liquid from the cans of beans (depending on whether you like lots of "sauce" or very little liquid, you can decide how much to add...usually I add one can with all the liquid and then drain the other two a bit). I then add a small can of tomato sauce (I think they're 4 oz cans...the really little ones). Bring it to a boil, then reduce to a simmer while you make the rice. Again, you can add a bit of hot sauce if you prefer. I'll eat that as a meal, but you can also use it as a side dish.