Many people believe there are only 2 types of diabetes, most notably type 1 diabetes (T1D) and type 2 diabetes (T2D). However, diabetes is actually a spectrum. Other forms of diabetes don't fit into either of the 2 common categories. That means some people are diagnosed with the wrong type of diabetes.
How does a misdiagnosis happen?
We know how each type of diabetes shows up in the body and what it looks like on lab work. This information, along with specific details about a person (body size, medical history, age, etc.), helps medical professionals make a diagnosis.
However, as helpful as all those guidelines are, they aren't exact. Sometimes diabetes doesn't always show up the way we expect it. For example, I've worked with several hospitalized patients with type 2 diabetes in DKA (diabetic ketoacidosis). DKA is something that happens most often in people with type 1 diabetes.
Sometimes this led to a medical provider misdiagnosing the patients with type 1 diabetes. Some people have problems with their pancreas that causes diabetes to develop. Most of the time, these folks are misdiagnosed with type 2 diabetes when really the correct diagnosis is type 3c diabetes.1
How common are misdiagnoses?
Being wrongly diagnosed happens more than you might think. Studies show that developing type 1 diabetes after age 30 means you're more likely to be misdiagnosed with type 2 diabetes.2
Another form of diabetes, latent autoimmune diabetes in adulthood (LADA), is considered a slower-developing type 1 diabetes. Because of the slow changes, it may look more like type 2 diabetes to providers. Researchers estimate that up to 15 percent of people with type 2 diabetes actually have LADA. Type 3c is even more challenging, with studies showing many people end up with a type 2 diabetes diagnosis instead.3,4
What are the types of diabetes?
There are many other forms of diabetes. Here are just a few outside of the type 1 diabetes and type 2 diabetes categories:
Type 3 diabetes
Type 3c diabetes
Gestational diabetes
Latent autoimmune diabetes in adulthood (LADA)
Maturity-onset diabetes of the young (MODY)
Why does the proper diabetes diagnosis matter?
The wrong diagnosis can lead to delays in medical care and higher risks for diabetes complications.2,4
In my experience as a CDCES, I've also seen patients experience delays in care because of the stigmas around type 2 diabetes. I observe that people with type 2 diabetes are wrongly considered "non-compliant" by medical professionals, thus further delaying their care.
I believe some of this relates to the incorrect stigma that "type 2 diabetes is your fault." Also, I see some bias against those with type 2 diabetes by health insurance companies. Unfortunately, diabetes technologies such as insulin pumps or continuous glucose monitors can be harder to get covered with a type 2 diabetes diagnosis. Getting the correct diagnosis may give you better access to these helpful tools.
What can you do to ensure you're correctly diagnosed?
Lab work and referrals to medical specialists (like an endocrinologist) can help you explore your type 2 diabetes diagnosis. If you've struggled with your blood sugar levels or needed insulin within 3 years of diagnosis, you may be more likely to have a different form of diabetes. Experiencing chronic pancreatitis or other pancreas issues could point to a different form of diabetes.2,3,4
Have you ever been to a medical appointment and felt likeyour healthcare teamwas speaking a whole different language? If so, you're not alone. There are so many medical terms used to describe everything from diagnoses to medications.
I thought I'd provide a guide to bring together "layman's" terms and medical jargon into one neat package. Below, you will find medical terms that are most associated with insulin treatment as it related to type 2 diabetes care.1
Complicated words associated with insulin injection
Prandial: The timing that coordinates with meals. Prandial is usually used to describe the timing for blood sugar checks or insulin doses.
Injection rotation*: Changing your insulin injection sites to different areas of your body with each dose. Injection rotation is essential as it helps insulin absorb well and lowers lipodystrophy risk. Other terms used to describe injection rotation include:
Site rotation
Changing sites
Moving injection sites
Shot rotation
Injection pattern
*Some folks can misinterpret what rotation means. Rotation does NOT mean you rotate your needle once it's in your skin.
Lipodystrophy: Skin changes that happen at insulin injection sites. Skin changes can include excess fat tissue building up under the skin or fat tissue shrinking away from under the skin. Additional terms used to describe lipodystrophy include:
Scar tissue
Fat lip
"Lipo"
Skin dimple
Skin divot
Prime: A technique used to fill an insulin pen needle full of insulin before injection. The prime approach also checks that the pen needle is in working order before your injection. Prime can be called need check, fill, or prep.
Terms associated with insulin dosing
Basal/Bolus: A way to describe an insulin dosing pattern that most closely matches your body's natural patterns. This can also be called multiple-daily injections (MDI).
Basal: A way to describe insulin that replaces your body's 24-hour insulin needs. Basal insulin is delivered continuously from an insulin pump, or with 1-2 injections a day. Other descriptions for basal are:
Ultra-long-acting insulin
Long-acting insulin
Once-a-day insulin
"Night-time" insulin
Food bolus: A way to describe how insulin is used to replace your body's needs at meals. Bolus insulin is delivered on-demand from an insulin pump or with injections at each of your meals. Additional descriptions for food bolus include:
Rapid-acting insulin or fast-acting insulin
Meal-time insulin or food insulin
Prandial insulin
Regular insulin
Insulin to carb ratio or carb ratio
Set dose or base dose
Correction bolus: A way to describe how insulin is used to lower a high blood sugar level. Bolus insulin is delivered on-demand from an insulin pump, or with injections. More descriptions for correction bolus are:
Rapid-acting insulin or fast-acting insulin
Correction insulin
Regular insulin
Extra insulin dose
Sliding scale
Correction dose
Insulin sensitivity factor
Insulin to carb ratio (ICR)*: The number of units of insulin that should be given for a certain amount of carbohydrate. It allows flexibility in meal sizes because insulin dosing is based on how much one eats. An example is 1:15 or 1 unit of rapid-acting insulin for every 15 grams of carbohydrate. Other terms for insulin to carb ratio include:
Meal-time insulin
Food insulin
Carb ratio
*ICRs can be prescribed as 1 unit per gram of carb or 1 unit per carb choice. This can make a big difference in your insulin dose, so make sure you clearly understand your prescription.
Insulin sensitivity factor (ISF): The amount of 1 unit of insulin that is expected to lower your blood sugars to a healthy range. ISF can be calculated based on how much insulin you take daily. The insulin sensitivity factor is also described as a correction factor.
There are precious few things to be optimistic about when one is depressed, so you must be thinking I'm cuckoo. Well, allow me to explain. The way I see it, nihilism is a school of thought which believes that life is meaningless. Needless to say, that's a depressing point of view. Optimistic nihilism is, therefore, a brighter outlook than mere nihilism as it proposes that since life is meaningless, we are free to give it whatever meaning we choose.
Why Optimistic Nihilism Can Help Depression
Why does an attitude of optimistic nihilism help someone with depression? I believe there are two reasons behind this: one, depression not only makes one lose interest in goals and hobbies, but it can also make that person experience an existential crisis. Speaking from personal experience, an existential crisis occurs when you question the meaning and purpose of your life.
The duration, intensity, and recurrence of the crisis vary from person to person, but the result is typically the same: despair, depression, anxiety, and stress. This is because many of us are not living life on our own terms, or we are setting unrealistic expectations owing to social conditioning. Existential crises make depression worse, and depression worsens existential crises. This is a vicious cycle that can be broken when one rejects rigid social norms regarding what makes your existence meaningful.
Constantly Redefine Your Purpose
To keep depression at bay, it is important to find purpose in the things that matter to you. This is where optimistic nihilism can help you. Watch the video below to get an idea of how I incorporate this philosophy in my life.
Seeking Professional Help for Optimistic Nihilism
Optimistic nihilism seems easy to execute in theory, but in reality, it can be quite challenging. I have found myself gravitating towards full-blown nihilism at times. In fact, as recently as two days back, I was tempted to shave off my eyebrows. I was tweezing my eyebrows and suddenly got the urge to get rid of them, because everything is pointless, right? I stopped myself in the nick of time somehow.
Of course, this was a low-stakes situation, but you can imagine how it can escalate to something life-threatening. It's easy to remove the optimism from nihilism. Plus, optimistic nihilism is not a cure for depression, it's not a replacement for therapy, and it's definitely not a stand-in for psychiatric medication. If you find yourself depressed and/or suicidal, please consult a mental health professional.
It’s surprising how quicklydepression's ups and downscan get you. It’s almost as if, you’re going along feeling pretty good and then WHAM, depression slams into you and says,“Now, now… you have chronic depression, remember? You’re not allowed to feel too good.” That’s the depression roller coaster.
The Depression Roller Coaster Gives No Advance Warning
I’ve been feeling pretty good lately so imagine my surprise and confusion when after a light, afternoon nap, I woke up feeling acutely negative and sad and I could feel the depression on me like a mound of heavy dirt. Clinically, it’s not supposed to happen that way, I suppose. It's like a roller coaster sometimes. Up one hour, down the next. But I know the darkness of depression all too well so when I’m in it, I know I’m in it.
I knew enough to be honest with my husband about it; no sense in trying to candy-coat it. He knows me too well anyway. I explained that I was confused by this sudden drop and that I’d be better off alone in my room where I hoped it would pass. He was probably hoping the same thing. Lord only knows what the poor man feels when I’m at the start of a downhill drop.
I also knew that in order to prevent this chemical spill (of the brain) from drowning me in its ooze, I had to practice my CBT (cognitive behavioral therapy).
What to Do When the Depression Roller Coaster Drops
All you can do when the major depression roller coaster plummets you to the ground is to take care of yourself and practice your cognitive behavioral therapy skills.
It was the evening already so I:
Took a calming shower – stopped to appreciate how lucky I am to have hot water (gratitude)
Got into bed under the warm covers – felt the soft flannel sheets envelope me and reminded myself that I am not drowning in ooze (positive reinforcement)
Watched distraction television – sitcoms can work wonders if you let them (trying to focus on something other than my thoughts)
The next day, I:
Slept in – but not too late (there is a fine line between extra rest and too much rest)
Stayed home from work – did some work from home (which was a real challenge but I felt good after it was done)
Ate good, wholesome foods (even though I really, REALLY wanted junk food)
Got some exercise – walked the dog (she kept looking at me in that “you know you need it more than I do” way of hers when she senses my depression)
Watched more television – in the fetal position (accepting the pain as a part of who I am)
I started to feel better.
Testing the Roller Coaster of Depression's Resolve
The day after that I went back to work, the depression having lifted somewhat – enough for me to at least test the ride to see if I was on my way back up. Thankfully, I was though who knows how long it will be before I hit the peak again, then sail screaming down the other side.
Regardless of how long I have battled depression, it still surprises me how it can just appear out of nowhere and knock me off my feet. It’s a few days later now and while I still don’t feel as good as I did before this roller coaster of depression began, I can at least function almost normally . . . and go on.
Over a year ago, you welcomed me to the Coping with Depression blog. Since then, I have had the opportunity to write specifically about postpartum depression and how it impacted my life. As I write this final post, my hope is that you've found help and encouragement through reading about my experiences with postpartum depression.
Why I Am Grateful
I want to thank HealthyPlace for the opportunity to write, grow, and reflect through this blog. Many mothers suffer postpartum depression in silence, shame, or solitude. It should not be so. The Coping with Depression blog offers human connection through open communication, empathy, and education. HealthyPlace is where people can say, "Really? Me, too! It's nice to know I'm not the only one."
This connection happens between people of all backgrounds and beliefs because mental illness does not know ethnic, socioeconomic, or cultural boundaries.
I also want to thank you, readers, for being here. You are the reason I wrote each month.
Postpartum depression was not something I wanted. It's not something I always handled well. But I learned valuable lessons from it that have helped me draw closer to my husband and children. As a result of postpartum depression, I became more patient, emotionally responsive, and humble. I don't take a good relationship with my children for granted. And while I would never wish mental illness on either of my children, I know that if they were to experience it, I would be better prepared to support them. For that, I am filled with gratitude.
Looking Forward
While I am moving on to pursue other opportunities, I will still be around to root for you and connect with you. If you are going through postpartum depression, know that you are not alone. You have an army of women who have been through it and come out stronger on the other side. Postpartum depression is not weakness or failure; it's an illness that can make you a better parent in the long run. Seek treatment, give yourself grace, and take it one day at a time. There are easier days ahead. I wish you nothing but the very best, dear friends.
Below are 15 tips for managing thesymptoms of an RA flare-upat home. These suggestions are meant to be used in addition to the treatment plan recommended by your physician.
Reducing RA joint pain and swelling
The most notable sign of an RA flare is increased inflammation in the joints, which causes pain and swelling. Your joints may feel especially stiff and achy in the morning, when you’re getting out of bed. To reduce joint symptoms:
1. Review your medication routine
RA medications can lose some of their effectiveness if they are not taken on schedule. If you have a history of forgetting to take your medication on time, create reminders, such as a repeating alarm on your phone.
A splint can support a painful joint and minimize movements that put stress on it. For example, a wrist splint will allow you to use your hands but prevent wrist movements that may cause joint strain and lead to long-term damage.
3. Avoid inflammatory foods
Certain foods, such as sugary sodas and foods fried in oil, may increase inflammation and make joint symptoms worse. Trade them in for fruits, vegetables, and other plant-based, high-fiber foods.
Most people with RA can safely take an over-the-counter medication, such as acetaminophen or ibuprofen, to control a temporary flare in joint pain. If you are unsure about how these drugs will mix with your other medications, or if you need to take them daily for more than a couple of weeks, talk to your physician or pharmacist.
Ease joint stiffness with heat therapy, which will help warm up and lubricate joints. You can use wet heat, like a hot shower, or dry heat, like a heating pad or heat patch. Avoid temperatures that can burn or irritate the skin and limit the application time to 15 to 20 minutes a few times a day.
Decrease joint inflammation with cold therapy, which can ease inflammatory pain and slow down the production of joint fluid that exacerbates joint swelling. Cold therapy may be especially helpful after activity. Always put a cloth between your skin and an ice- or cold-pack, and limit the application time to 15 to 20 minutes a few times a day.
Some people prefer using just heat therapy or cold therapy, while others alternate between the two throughout the day. Try both to decide which approach works best for you.
Many people who have rheumatoid arthritis report fatigue as a symptom. You may feel fatigued even if you spend a lot of time in bed. To minimize the effects of RA fatigue during a flare:
7. Make changes to your bedtime routine
To improve sleep quality, establish a good sleep routine. This routine may include going to bed at the same time every night, avoiding screen time before bed, eliminating sources of disruptive noise, and sleeping on comfortable, supportive bedding.
8. Consider getting tested for sleep apnea
In addition to making changes to your sleep routine, you may also want to talk to your doctor about getting tested for sleep apnea, a sleeping disorder that can affect your breathing. Sleep apnea can leave you feeling exhausted even after a full night’s sleep. People with RA are more likely to have sleep apnea.1,2 This difference seems to exist even when a flare is over and inflammation levels are low.3
9. Use your energy more efficiently
During an RA flare, don’t waste energy on activities that aren’t necessary or helping you get well. For example, sit down while brushing your teeth or doing your hair. If your finger joints hurt, wear clothing that’s easy to get on and off. Ask family members and friends for help with specific chores and errands.
Making meals takes time and energy. Prepare or buy a few meals to keep in the freezer in case of a flare. Alternatively, consider ordering out or subscribing to a healthy meal service. (Just make sure to stay away from inflammatory foods.)
11. Exercise regularly
While it may sound counter-intuitive, research shows that people who have RA report lower levels of fatigue when they get regular exercise.4-6 Experts typically recommend engaging in low-impact exercise, such as walking, tai chi, swimming, or water therapy.
RA fatigue can persist even after a flare is over, so consider using these tips year-round.
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Easing stress or anxiety
People who have rheumatoid arthritis tend to have higher levels of stress and anxiety. These feelings can trigger the release of stress hormones that increase inflammation. They can also cause muscle tension, which may worsen joint pain. To ease stress and anxiety:
12. Use tried-and-true relaxation techniques
Meditation, deep breathing exercises, and other relaxation techniques can reduce the release of stress hormones that make both anxiety and RA inflammation worse.
13. Say no more often
It’s okay to say no to social invitations, requests for volunteering, and extra assignments at work. By saying no today, you are conserving your energy and helping ensure that you’ll be healthier in the long run.
14. Unplug and focus on what you can do
Rather than get frustrated thinking about your RA and the things that you cannot do, enjoy the things that you can do, such as watching a movie, reading a book, calling a loved one on the phone, or—if you’re able—taking a walk outdoors.
15. Resist negative thoughts
When you feel an RA flare coming on, try to resist negative thoughts about the flare itself or what others think about it. Remind yourself that rheumatoid arthritis has its ups and downs and flare-ups sometimes happen.
Through trial and error, you can identify the self-care tips that work best for you. If the symptoms of your RA flare-up are unusual or severe—or they’re not responding to your self-care treatments—make an appointment to see your rheumatologist. Your overall treatment plan may need adjusting.
RA inflammation affects more than joints. Thesigns and symptoms of RAand conditions related to it may be felt all over the body, including in the ears, eyes, skin, lungs, and heart. Below is a description of 9 unusual symptoms that may be related to your rheumatoid arthritis.
Rheumatoid arthritis is an autoimmune disease that causes painful swelling, stiffness, and deformities of the joints. Watch:Rheumatoid Arthritis Overview Video
1. Hearing problems
Researchers have found that hearing loss and tinnitus (constant ringing, buzzing, or whistling in the ears) can be linked to rheumatoid arthritis. Hearing problems typically show up in older people who have had rheumatoid arthritis for many years.
Experts suggest many ways RA may contribute to hearing problems:
Rheumatoid arthritis inflammation may damage the tiny joints in the ear.1
Drugs that reduce RA symptoms, including aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs)2 and hydroxychloroquine3, may occasionally bring on tinnitus and/or hearing loss.
Other disease processes may affect the auditory nerves or cochlear hair cells in the ear that are necessary for hearing.1
Some hearing problems are treatable—for example, stopping the use of NSAIDs may reverse symptoms—while others may be permanent. Even when changes to hearing are permanent, steps may be taken to stop or slow down future hearing loss.
Research suggests a significant connection between rheumatoid arthritis and sleep apnea4,5, which causes breathing to repeatedly stop and start during sleep. Symptoms include loud snoring and interruptions in breathing and/or gasping for breath while sleeping.
Sleep apnea can also cause headaches and contribute to chronic fatigue because the body takes in less oxygen at night.
Sleep apnea can be diagnosed and treated. Treatment typically includes using a continuous positive airway pressure (CPAP) machine or another treatment device to increase oxygen intake while sleeping.
3. Skin rash
When RA inflammation affects the blood vessels (Rheumatoid Vasculitis / Vasculitis), it can cause a variety of problems, including skin rashes. These rashes may appear as clusters of dark red or purple bumps, hives, or irregularly shaped raised pink patches on the skin. On darker skin, changes in skin color may be less noticeable.
Rashes related to vasculitis can occur anywhere but are most common on the lower legs. Sometimes these rashes are itchy, painful, or burning.
In addition, biologics medications used to treat RA increase the risk of rashes and other skin problems6, such as skin infections.
If you have a persistent rash that has lasted for more than 2 weeks, is painful, or looks infected, it’s advisable to contact your physician. Medical treatment is recommended for any rash that is persistent, severe, or accompanies symptoms of vasculitis in other areas of the body, such as the lungs, heart, kidneys, or eyes.
4. Trouble breathing, chronic cough, or chest pains
The lungs are commonly affected by rheumatoid arthritis, especially if the RA is long-standing and has not been well-managed.
Shortness of breath accompanied by a chronic cough, fatigue, and/or weakness may be a sign of scarring caused by chronic inflammation of the lungs. Shortness of breath accompanied by fever and/or chest pain when breathing may be a sign of fluid build-up around the lungs (pleural effusion). Both lung scarring and pleural effusion can be serious conditions, and medical attention is recommended.
5. Sudden, temporary numbness in the fingers or toes
Rheumatoid arthritis increases the risk for Raynaud Syndrome, also known as Raynaud Phenomenon or Raynaud disease. This condition causes one or more fingers or toes to lose blood circulation. The affected area will feel numb and appear paler, white, or blueish. There is typically a distinct border between this area and normal-colored tissue.
Raynaud Syndrome can be triggered by cold exposure, emotions, and certain medications.7 An episode may last minutes or hours. A warm compress, bath, or shower may encourage blood flow. If symptoms do not resolve then medical intervention may be necessary to prevent tissue damage.
6. Gum disease
Rheumatoid arthritis is associated with gum inflammation (gingivitis) and gum disease (periodontitis).8,9 Both of these conditions are linked to worsening RA symptoms10 and can lead to gum damage and tooth loss.
Regular dental checkups and good oral hygiene at home may help improve oral health as well as ease rheumatoid arthritis symptoms, such as joint tenderness and swelling.11,12,13
7. Increased fat-to-lean mass ratio
People who have RA tend to have a higher fat-to-lean mass ratio than people who do not have RA.14,15 This difference tends to hold true even for people whose weights are within normal range. Experts are not sure why.
Strengthening exercises can help counteract the loss of muscle. If applicable, losing excess weight may decrease rheumatoid arthritis disease activity and therefore reduce symptoms.16 The combination of building muscles and losing excess weight will support joint health and may reduce RA symptoms.
8. Red eyes
While nearly everyone experiences temporarily irritated, red eyes occasionally, eye redness that is recurring, persistent, and/or severe may be a sign of a medical condition related to RA. Eye conditions may be temporary or life-long and typically cause other symptoms, such as eye pain, sensitivity to light, watering, or irritation.
Signs and symptoms of eye problems, including any changes in vision, should be immediately reported to a health care practitioner.
9. Numbness or tingling
A damaged or pinched nerve can cause numbness and tingling in the hands, feet, or other areas of the body. Rheumatoid arthritis may contribute to nerve injury in a few ways:
Swollen joint tissues cause a nerve to be pinched (for example, carpal tunnel syndrome can result from swollen joints in the wrist)
Vasculitis related to RA affects blood flow and causes nerve damage
Certain RA medications may also cause side effects of numbness and tingling sensations
While not necessarily painful, it’s best to report sensations of numbness and tingling to a physician. Addressing the cause may help prevent nerve problems from becoming worse or chronic.
New and unusual symptoms are not always related to rheumatoid arthritis. Contact your doctor to identify the possible cause of unfamiliar symptoms and discuss treatment strategies.
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