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Type 2 DKA recovery

Discussion in 'Ask A Question' started by toonarmy1000, Nov 5, 2017.

  1. toonarmy1000

    toonarmy1000 Type 2 · Active Member

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    hi guys, I came out of hospital 10 days ago after collapsing and ending up in a diabetic coma for 4 days. basically suffering from depression I wasn't looking after myself and drinking heavily leading to the spike in bm's and collapse. up till then really well controlled taking 1 gliclizide in the morning and 3 metformin breakfast lunch and tea (no higher than 9 before or after meals but regularly 7) in hospital went up to 25 so was being hit with insulin after being tested. my main question is I've been discharged to my doctors who quite frankly haven't been the greatest help. no dietary advise or anything even though I've asked. I've always been able to eat pretty much anything. I've now been on 2 x 80g gliclizide and 1 x 1g metformin morning and evening for a week now since coming out of hosotal and been told to monitor results and go back on 14th. got bm in morning down to about 12 but then increases after breakfast to about 15 and same teatime and at 10pm before bed. I was hoping for a bigger reduction but phoned surgery and they have said it could take a few weeks to settle down? is this correct please? I'm also worried this could end up with insulin so what is the largest dose of gliclizide you can take in a day? I've went from complete control with last hba1c of 54 to being in a right mess. I know it was my fault for not looking after myself but i know I'm lucky to be alive and this has really shook me up so determined it won't happen again. any help or advise greatly appreciated . thanks guys x Dave
     
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  2. wiflib

    wiflib Type 2 · Well-Known Member

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    Hi Dave.

    I can’t comment on insulin at all as I don’t need it but what sort of food do you eat?
     
  3. toonarmy1000

    toonarmy1000 Type 2 · Active Member

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    well in hospital they were giving me food with quite high carbs but obviously I've been experimenting cutting them down after reading advice on here? I've always more or less been able to eat anything really but concentrating my efforts now after this
     
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  4. novorapidboi26

    novorapidboi26 Type 1 · Well-Known Member

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    You probably should think about choosing your food a bit more wisely now though....

    If you have just started oral meds I would think that it will take some time for them to get to full working strength....

    Sounds like a horrible ordeal though.....were you drinking beer/lager by any chance....? if it was spirits without a full sugar mixer you would have went hypo maybe...
     
  5. toonarmy1000

    toonarmy1000 Type 2 · Active Member

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    no I was on gliclizide 80g and metformin 3 x day before I stopped taking them . strangely enough I thought that with the alcohol but was drinking spirits with zero sugar that's what confused me too?
    I have another appointment on 14th November and been told to monitor results until then and then they will look at my dosage. been told not to worry unlessregularly over 15 for now . been spot checking ketones when really high but coming out "lo" on meter which is good new anyway so not in any bother till i get on top of bm's. just shows you though going along quite happily with last hba1c about 55 and average bm 7-8 to a change in personal life eye off the ball and near death ! certainly a stern reminder!
     
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  6. leahkian

    leahkian · Well-Known Member

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    Dave when you go to your next appointment i assume it is at the hospital. The diabetes team at Newcastle are great speaking from personal point. I would tell them that you are not happy with the care your GP is giving you. You can ask to see someone about your diet and also ask if it would be possible to have contact with a DNS which i am you they will agree to. This may give you a better outlet when you have a problem. If you are depressed due to your diabetes they can sort out for you to see a mental health worker who works with the diabetic team. Hope this helps and do not tell anyone about this as i am a safc supporter and my mates will not be happy with me for helping the enemy!!!!!!!!
     
  7. toonarmy1000

    toonarmy1000 Type 2 · Active Member

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    hi thanks for the reply.
    I was discharged from hospital into the care of my gp. when originally diagnosed I was sent to trinity square gateshead diabetic centre and never been to Newcastle centre. my next appointment is with diabetic nurse on Tuesday 14th November at my gp who are going to look at my bm's for the last 10 days and look at altering my meds to get within range but I'm worried I'm getting to the max limits for tablet treatment. I will ask Tuesday about dietician as you suggest as in hospital every meal was loaded with carbs and cornflakes and toast was the preferred breakfast even though I queried it!. don't worry about upseting your fellow Sunderland fans because they will be proud of you helping me stay alive longer so I can keep suffering the pain of supporting the toon for 35 years ! lol
     
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  8. leahkian

    leahkian · Well-Known Member

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    If you get no joy on the 14th you can ask your GP to refer you the the diabetes center which is where the general used to be. If he will not which he should not do as you have a choice of where you want your treatment to be, you can get in touch with PALS and ask them to look in to your case.
     
  9. ringi

    ringi Type 2 · Well-Known Member

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    Was it DKA you had or a coma due to high BG without your blood having a low pH and very high ketoacidosis?

    I am asking as you can't get a DKA unless your body is making no (or very limited) insulin, it is very unlikely that someone with Type2 will go from being well controlled on gliclazide and metformin to producing no insulin of their own in a short time. Hence you may not be Type2, or it may not have been DKA.

    Ask your consultant about it as a lot of doctors will not be clear on the type of diabetic coma due to the emergency treatment being the same.

    (As they sent you home without insulin, I don't think it was DKA, as my textbook says anyone who has had a DKA should be on insulin for life.)
     
  10. toonarmy1000

    toonarmy1000 Type 2 · Active Member

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    It had DKA on my discharge note from hospital . my bloods still high (mid teens) example this morning 13.2 had breakfast porridge 23g carbs went up to 18.2 3 hrs later? I'm back to work Monday so hoping things will settle down once extra gliclizide kick in and I'm more active . hoping to avoid insulin but looking that way if they don't lower quickly. just had blood test this morning for hba1c which will be sky high so expecting bad news on Tuesday when I get results
     
  11. ringi

    ringi Type 2 · Well-Known Member

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    Replace the porridge with eggs and you will find your BG goes up much less.
     
  12. toonarmy1000

    toonarmy1000 Type 2 · Active Member

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    yeah been having scrambled egg and bacon but mistakenly cut nearly all carbs last few days but cut down too much and went back to having just 1 or 2 Brown wholemeal toast with them (advise from diabetic nurse this morning) . I've lost 1 half stone in hospital so I'm starving and need to build myself up but conscious of more I eat higher bloods but been told don't worry short term while they are sorting my meds out or onto injections. does this sound reasonable advice?
     
  13. Bluetit1802

    Bluetit1802 Type 2 · Oracle

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    I think you need to analyse your current diet very carefully.

    Can you give us a typical day's food? We may be able to spot things that might help.
     
  14. toonarmy1000

    toonarmy1000 Type 2 · Active Member

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    the problem ive got it is ive lost 1 and half stone in hospital and im really weak and always starving so im having to try and get my strength back but keep bloods down at the same time so i need to know what i can gorge on betqeen meals with a sensible amount of cbs?
    typically:

    breakfast : porridge oats/ sausage bacon scrambled eggs toast (wholemeal)
    lunch: salad with a touch dressing 4g carbs cooked chicken corned beef hard boiled egg. few crackers cheese slice of bread so about 23 carbs total.
    tea: mash mixed veg (microwave pouch) gravy . meat (beef or chicken). mixed fruit with a little portion of ice cream or double cream.
    snacks: very occasionally bag crisps
    before bed 5-6 wholemeal crackers with cheese . cooked meat . granny Smith's apple

    any advice is greatly appreciatwd

    cheers
     
  15. ringi

    ringi Type 2 · Well-Known Member

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    Eat lots of proteins
    Nuts and olives are good as snacks, so is cheese and pork crackling
    Add butter to your above ground veg so as to gain weight
    Use as much olive oil as you can, including in home made salad dressing.

    I would advoid all the bread, crackers and crisps as they will put your blood glocuse up.

    Apples have lots of carbs in them, but as the are unprocces and attached to fiber they are a lot less harmfore then the carbs in bread. Sweet potato is better then normal potatoes as they have less carbs and more fiber.

    You don't need to regain any fat you have lost, but you need to regain any muscle you lost, hence lots of protain. Resistance training will also help to rebuild your muscles.

    I will let someone else say what they think of your diabetic nurse advice to eat more carbs....
     
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  16. toonarmy1000

    toonarmy1000 Type 2 · Active Member

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    appreciate your advice thankyou
     
  17. toonarmy1000

    toonarmy1000 Type 2 · Active Member

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    just a follow up to this.
    I had a meal at 7pm last night only fresh soup with 1 slice wholemeal bread approx 40 carbs total. my bloods were 17 before meal and had 2 x gliclizide and 1 metformin and at 9.45pm were 17.3.
    tho morning it is still 15 and I don't understand because it's been dropping to about 11 in the morning?
    so in summary it hardly went up after my evening meal with 40g carbs when it normally does and hardly dropped when it normally does this morning?
     
  18. ringi

    ringi Type 2 · Well-Known Member

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    This is what I think is going on.

    The gliclizide results in your body creating more insulin.
    The 40g carbs are converted into blood glucose when you eat them.
    The insulin forces the glucose into your liver, where they are stored as glycogen and fat (hence carbs => fatty liver)
    Before you wake up in the morning, your body produces cortisol.
    Cortisol results in your liver converting the glycogen back into blood glucose.
    Normally someone's body will then produce more insulin, the results in the blood glucose being stored a glycogen in their muscles.
    This process does not work for us, due to our muscles having insulin resistance and our bodies no longer being able to produce very high levels of insulin.
    Hence increased blood glucose in the morning.

    The words in red are what you can change, so, for example, resistance training and HIIT makes our muscles respond a lot better to insulin.
     
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  19. NewTD2

    NewTD2 Type 2 · Well-Known Member

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    Hi Dave,

    I have had very similar experience to yours.

    I had Diabetic Ketoacidosis last 22 Sept 2017 and nearly died at the hospital. Diagnosed Type 2.

    Unfortunately I was discharged the next day and left alone completely without any help or advice from my GP or hospital for 6 weeks post discharge. How careless and irresponsible of some in the NHS!

    About 7 weeks later I received a call from the Diaberic Nurse to see me. She tested my blood glucose and tested very high at 11.8% and Ketones at 1.5! Any BG levels above 8% is considered dangerous.

    I was immediately put on once daily injections of 14 units of insulin and within just “one week” my blood glucose levels went down from 11.8% to between 5-6%.

    I trust God will help and cure me.

    Will have my A1c test mid December and hopefully when my blood glucose levels settle down, will start titrating insulin down and slowly taking metformin.

    Also been eating almost zero carb except for 1 slice of brown whole meal bread for lunch, a small piece of lean protein (chicken, fish) and plenty of steamed vegetables, salad. I’m losing weight and intend to do so.

    I strongly suggest to register with the low carb program - lots of valuable stuff how to manage diabetes!

    You just need to be disciplined, patient and determined and you’ll get there!

    Go low carb - high fat to bring your blood glucose levels down!

    Andrew
     
    #19 NewTD2, Nov 11, 2017 at 10:19 AM
    Last edited: Nov 11, 2017
  20. NewTD2

    NewTD2 Type 2 · Well-Known Member

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    Hi Dave,

    I would also recommend taking Magnesium, Potassium, Multi Vitamin, COD Liver Oil, Pomegranate extract (anti-Oxidant) supplements to boost your energy.

    Get rid of alcohol, snacks, biscuits, apples, starchy vegetables, saturated animal fats from your diet, instead add plenty of spinach, Cress, avocado, walnuts and healthy fats in your diet.

    Only have fruits and vegetables with low glycemic index / load.

    Also strongly encourage you to join the gym because low carb diet and exercise is the solution to fighting off this condition!

    Andrew
     
    #20 NewTD2, Nov 11, 2017 at 10:36 AM
    Last edited: Nov 11, 2017
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