Welcome back to Ask D'Mine -- the web's most quirky yet informative diabetes Q & A column, hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil's exploring the term "Type 3," and he's taking a look into the toilet bowl for us -- errr, so to speak, as he explores urine issues with diabetes. Never a dull moment here at the 'Mine!

{Got your own questions? Email us at AskDMine@diabetesmine.com}


Jim, type 2 from Michigan, writes: In your column published on Friday March 29, you refer to a Type 3 in Texas looking for low to no cost supplies. Was that a typo? Or am I not understanding the definition of Type 3 correctly? I thought it had something to do with Alzheimer's?

Wil@Ask D'Mine answers: Damn fine question, Jim. There's no shortage of confusion around type 3 diabetes lately because there are at least three candidates in the running for the title. First, second, and third, let me be clear that "type 3" is not not not an official designation for any disease at this time.


OK, here's the deal. Back in 2005 or so, dLife proposed the label of type 3 as a designation for the sugar-normal Friends and Family of anyone with diabetes. It was, I think, an important way of recognizing that diabetes doesn't just affect the patient: it affects the whole family. I like to joke that type 3 is the only contagious form of diabetes: you get it by kissing a type 1 or type 2.

In the diabetes community at large and in the online community in particular, type 3 always refers to a non-diabetic loved one. That said, "type awesome" is making headway recently as an alternative, largely due to the media coverage around the discovery that Alzheimer's disease may be triggered by deficient insulin in the brain. This, in turn, has led some researchers to call for Alzheimer's to be renamed type 3 diabetes. (As if we didn't have enough trouble with people confusing the two types of diabetes we have now.)

Which researcher I should kick in the shin for suggesting this isn't clear, but it could be Owen Dyer, who proposed it in the headline of a piece in the National Review of Medicine back in December of 2005; which I must point out, was at least a half a year after dLife started using the term. "We" got there first, so by all civilized law we should get to keep it.

That said, as any quick Google search of the term will show you, a growing number of researchers in the Alzheimer's community are now using the type 3 label. Also, doctors Suzanne M. De la Monte and Jack R. Wands even jointly called for the tWhats In a Nameerm to be officially adopted in a piece written in the Journal of Diabetes Science and Technology back in 2008.

But wait. There's more.

There are other groups of diabetics clamoring for the title of type 3, most notably the folks that deal with gestational diabetes. Others, too, have proposed that type 2s who don't take insulin should retain the title type 2, while those who need insulin should be promoted to type 3s. For a time LADA was kicked around as a contender for the type 3 label, then the (also unofficial) title of type 1.5 gained popularity before fading from the scene. Most LADAs just consider themselves type 1s now, as do their docs.

Meanwhile, to make matters more confusing, still other people have been advocating for calling insulin-resistant type 1s "type 3s," as such folks show hallmarks of both disease processes: the autoimmune-generated insulin deficiency that is the underlying factor behind type 1, combined with the heavy insulin resistance that's the primary driver of type 2. Yes, you can have both types of diabetes at the same time! I guess the thinking here for what to call these super diabetics is 1+2 = 3...

Damn. Type 3 is the most popular girl at the ball; everyone wants to dance with her!

But, to date, type 3 remains an unofficial, unsanctioned, and unauthorized term. It's not even clear who would have the authority to officialize it, sanction it, or authorize it. And to make things yet more complicated, some in our tribe want to get rid of the type 1 and type 2 classifications altogether. And if that were to happen, type 3 might end up being the only numerical type of diabetes left... for whoever wins the title. Then I guess "1" won't be the loneliest number, after all.

Anyway, Jim, until such (highly unlikely) time as "type 3" is officially co-opted as the new label for an old disease, I'm sticking to my guns will continue to use it the way I first heard it: as an honorary type of diabetes. A title that recognizes, incudes, and honors our sugar-normal loved ones; those amazing people who—by fate or by choice—signed up for diabetes along with us; the fabulous people who put up with all the shit the diabetes causes, but unlike us, have almost no control over it.

Surely, this kind of diabetes is the worst kind to have.


Joseph, type 2 from New York, writes: I'm new to blogs. Age 73. Type 2. Diagnosed about 10 years ago. Control with diet and exercise. Am impatient to learn how this condition works. Question of moment: Why do I smell ketones in my urine when my reading is 124, low for me? Had big meal with too sugary dessert. So, how does this condition cause such symptoms?

Wil@Ask D'Mine answers: Frankly, it shouldn't. Well, it shouldn't in your circumstances anyway. Ketones come from high blood sugars, not low, and the big meal and sugary desert are obviously not to blame, as your blood sugar is pretty damn good.

But to answer your question, diabetes doesn't cause ketones, high blood sugar does. Well, high sugar and low insulin. In a nutshell, your body needs insulin to move sugar from the blood to your trillions of hard-working and hungry cells. Keeping it simple for today, just know that if your cells don't get the food they need, they turn into cannibals. All across the jungle of your body, big iron pots are dragged from thatched roof huts and fires are kindled to melt your body's fat down into food. The smoke from these cooking fires is ketones, and they are dangerous in large quantities.

But I have to wonder, are you 100% sure you are smelling ketones in your urine in the first place? While, in theoUrine Samplery, you can smell ketones in urine, you generally don't because in diabetes ketones are accompanied by high levels of glucose, and the sweet smell of all that sugar in the urine generally overwhelms the ketone's faint nail-polish-in-the-urine smell.

There are two problems here: There are a whole lot of things that can make your pee smell "off;" and the English language is poorly equipped to describe odd odors. That said, welcome to Professor Wil's Urine 101 (hey, somebody has to teach the class).

Normal urine smells like... like... Well, like pee, because that's what it is. That said, the "normal" urine scent is variable, but light. In many people, the first pee of the day smells a bit stronger. But beyond that, the smell of your urine is important information, as abnormal odors are often a head's up that something downstairs isn't working right.

Now, this is absolutely one of those cases where instead of listening to "Doctor Wil," you must talk to your doctor, but here are a few common odor and cause combinations—just to give you an idea about how much you can learn by peeing.

If you're dehydrated, urine is more concentrated and has a stronger "ammonia" smell. If you smell a foul, pungent, or strong odor it could be the signal of an infection. There's a lot of pipes connected down there, so infections of the urinary tract itself, the bladder, or the kidneys can all create these smells. Oh, and If you're a guy, it's even possible to get a prostrate infection that can throw off the smell of your urine.

A malt-like smell could herald the aptly-named Oat House Syndrome... What? Oh. Sorry, my mistake, it's called Oasthouse Syndrome. Of course, if you are female, this same smell could be a "garden variety" yeast infection.

A musty or "hose-like" smell may be a warning of impending liver failure.

A caramel-like smell in your urine, no shit, can be caused by the unlikely-named Maple Syrup Urine Disease (MSUD), an honest-to-God genetic disorder that can actually lead to brain damage if untreated. And speaking of shit, well, yes, if your urine smells like shit, you could have a fistula—a hole in the wall of the tissue between your bowel and your urinary tract, allowing the mixing of materials between the two waste systems.

What? Your pee smells like sulfur? I bet you ate asparagus last night. The smells will pass as soon as the rest of the asparagus does. So not all oddball urine smells are things you need to worry about. Some meds and vitamins can throw off the smell of your pee, too.

Yikes! All this pee-talk is making me need to go...

See you all next week!



This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.


Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.