Can doctors tell the difference between diabetes and starvation?

IIRC, they both can be very thin and have an acetone smell in their breath from Ketosis.

I’m curious about why you think diabetics would be starvation-thin.

My brother wasted away very quickly before some friends did an intervention and made him go to the doctor.

Type 1 diabetics are notoriously thin and have trouble thriving on the food they eat.

That’s only if they’re untreated.

It’s easy to tell, by testing the person’s blood sugar. A person in a state of starvation will probably have a low one, whereas an untreated diabetic will have one well into the hundreds, and possibly even over 1,000. :eek: Normal is about 70-120.

I lost 25 pounds in 2 weeks when I became a diabetic, then another 25 pounds a year or so when the pills stopped working for me. I started at 200 pounds, so not starvation-thin, but thinner than I’d been since college.

A diabetic who is in trouble due to too high a blood sugar is often mistaken as drunk. If they’re in trouble due to too low, they’re often unconscious or dead.

The mechanism in Type 1 diabetes isn’t exactly high blood sugar in and of itself, it’s a near-total lack of insulin to move the sugar around the body to serve as fuel. (Insulin doesn’t make sugar ‘go away’, though many people think it does. It moves it from place to place.) In the absence of insulin, blood sugar levels rise very quickly, and the body starts trying to compensate and feed its systems by burning muscle and fat. That’s why an untreated type 1 diabetic will lose weight so rapidly.
Type 2 diabetes - at least initially - isn’t about a lack of insulin production. It’s about insulin resistance, and metabolically, it’s a different disease. You don’t usually see the type of weight loss type 1 diabetics have in type 2.

They were speaking of someone untested, I presumed.

IINAD, but yes they can reasonably infer the difference. And test blood glucose levels in about 30 seconds to check for evidence of diabetes.

Even in America*, we do see different types of starvation. From the elderly who are not being cared for, to the addict who isn’t eating. Subjectively they appear different and come to the ED differently. Context informs your guess until more information (labs etc.) confirm things.

  • I know we have starvation in America but fortunately it is less common here than in many parts of the world.

Before I was diagnosed as a T1 diabetic, I was constantly craving & eating sugary snacks and losing a pound a week. It was great! I could eat like a pig, and was getting downright skinny!

… until I went to a doc, and my blood sugar was about 4x what it should be. Had I not caught it, I would be both skinny and dead.

With a very simple blood test, a doc, or even just a person with a glucose test kit, can tell the difference between diabetes and starvation. Nobody relies on how your breath smells.

People who deliberately don’t take their diabetes medication in order to lose weight are often considered to have “diabulimia”, which is not (yet) an official medical term, and it can be FATAL.

Diabetes is also identified by things like A1c level, anion gap, potassium level, and some other criteria.

That was my first thought too, a diabetic will have high blood sugar and a starving person would probably have a low one.

Would there be a situation where an untreated diabetic would have low blood sugar?

Specifically, from the bloodstream to those cells that need it to obtain energy. That’s why diabetics get such high blood sugar concentrations: sugar gets digested and moves to the blood normally, but it then doesn’t go out the way it should.

In theory, assuming a diabetic hasn’t gotten to the point of absolutely NO insulin, then a starving diabetic may also have a low blood sugar simply from lack of food. If I recall, highly calorie restricted diets used to be one method to “control” diabetes prior to the use of insulin. It wasn’t a cure and only delayed death, but it was what they had.

When my husband had cancer and wasn’t eating hardly at all his blood sugar dropped so low they stopped giving him diabetes medications. It went into “remission” of sorts due to having so few calories coming into his system and his blood sugar was “normal” or even below normal. When he felt well enough to eat, or when he was on TPN/intravenous nutrition, it went back up and he started requiring medications again.

Exercise can lower blood sugar without the use of insulin. The muscle cells use a different process to restore their glucose levels, so if one were to exercise heavily on an empty stomach, recovering from the exercise would lower the glucose level by a possibly dangerous amount.

How do muscle cells take up glucose without using insulin during exercise?

That’s a normal fasting blood sugar. A normal person will have higher glucose levels after eating.

They also no longer taste your urine to see if it’s sweet. The squeamish could put the sample near a beehive and watch the bees.

A starving person would not have sweet urine.

I’m surprised everyone here seems to know so much about diabetes here. It looks likes theres not much really left to discuss in this thread now.

Sure, the Doctor could just taste their urine and tell if they were Diabetic.

We don’t know that, but it’s an observable phenomena, and pretty @#$@# annoying to we diabetics at times. It’s part of the fun of T1 (and I’m guessing T2 as well but I’m not an expert in that) diabetes that you not only get to have to magically figure out how much insulin you need to cover basic daily needs and whatever food you happen to eat, but if you want to (gasp!) work out at all you have to take the very-real chance that you’ll go low during exercise.

I try as much as possible to time workouts during times where I don’t have a lot of extra insulin in me. Otherwise I end up having to stop and chow down some sugar in the middle of the workout. Not fun.