How long to dka?

[TheBigNewt]

Sodium-glucose transporter (SGLT) 2 inhibitors reduces how much glucose the kidneys reabsorb, so hence removing glucose from the body. Their usage is becoming more common in Type2, and are in the process of being approved for Type1. They can keep BG low even when insulin is VERY low, hence the risk of DKA not being detected.

So what good things are they supposed to do for us?

 

[ringi]

So what good things are they supposed to do for us?

They reduce BG without increasing insulin levels, remember in Type2 the insulin level is already often very high, and a lot of the complications are due to the very high insulin level. In Type2 the RCTs have shown that they reduce the risk of cardiovascular disease, unlike most other BG lowing drugs, that increase the risk.

A recent RCTs has shown them to also improve BG control in Type1, without increasing the risk of DKA, but clearly if the doctor who is providing treatment does not consider DKA to be an option due to the low BG.......

 

[TheBigNewt]

Is Victoza (liraglutide)one of those? It doesn't say it is on their ad, but I've seen it advertised on TV to lower blood sugars and risk of heart dz in type 2.

 

[ringi]

Is Victoza (liraglutide)one of those? It doesn't say it is on their ad, but I've seen it advertised on TV to lower blood sugars and risk of heart dz in type 2.

No it is a glucagon-like peptide-1 receptor agonist, so it stimulates insulin secretion but only when BG is high. (A lot of new drugs for Type2 have come onto the market in the last five years.)

 

[DCUKMod]

@ringi and @TheBigNewt - Could we please keep this thread on-topic for the OP. If you'd like to develop your current discussion, please take it to another thread, or PM.

Thanks.

 

[scotteric]

Wrong. Ketones don't CAUSE DKA, lack of insulin causes a metabolic derangement that RESULTS in ketone body production and resultant acidemia which IS called DKA. And of course lack of insulin starts with hyperglycemia.

You're right, I shouldn't have used the word cause. I understand keytones are the symptom, not the cause.

 

[h4kr]

Ok.. so I’m gonna start taking my lantus. Maybe really small doses of fiasp too. I think suddenly getting ill out here is gonna be really tricky. At least I can deal with the lows!
My levels are all over the place..

 

[NoKindOfSusie]

I'd say a few days at least. @catapillar says she got there in about 48 hrs off her pump, but says she spills ketones normally on her ultra low carb diet. But I don't think those diets lead to any acidosis, at least I sure hope they don't for their sakes. The other thing is you get more and more acidotic as time goes on. You can compensate for it to a degree by blowing off CO2 but that card gets played pretty early and runs out. And then you die. I think in the days before insulin known diabetics (they could measure blood sugar) could last like weeks before they died but I'm not 1000% sure of that.

I don't know how you guys can just sit there talking about this stuff. This is the stuff that does my head in, that I'm constantly a few days from just being dead. Maybe you guys are used to having that hanging over you, I'm not, it just sits in your brain going oh by the way, you're basically dying all the time. And yes then you think what does happen if I just stop taking it, is it worse than decades of this.

 

[Seacrow]

I'd say a few days at least. @catapillar says she got there in about 48 hrs off her pump, but says she spills ketones normally on her ultra low carb diet. But I don't think those diets lead to any acidosis, at least I sure hope they don't for their sakes. The other thing is you get more and more acidotic as time goes on. You can compensate for it to a degree by blowing off CO2 but that card gets played pretty early and runs out. And then you die. I think in the days before insulin known diabetics (they could measure blood sugar) could last like weeks before they died but I'm not 1000% sure of that.

During one of my mental health episodes I stopped insulin for just over three days with no ketoacidosis. Wasn't eating food either though, so that'd be a factor.

I saw a documentary on pre-insulin treatment. They could keep young kids going for two or three years, on a diet of water, green vegetables and a measured amount of potato. There were pictures of wards with limp children unable to move out of their beds, slowly going blind and losing toes and fingers. Absolutely horrific. The parents were desperately hoping there'd be a treatment invented before their child went comatose.

 

[ickihun]

Thanks, @TheBigNewt for explaining it.

As Sodium-glucose transporter (SGLT) 2 inhibitors are now being approved for Type1, it will be interesting to see how many cases of DKA there are with normal BG readings....

I'm dead against it. Personally.
Just anything to save money. Type1s need insulin. Full stop. I can see the need for metformin in some but not canagliflozin family drugs. A very complicated drug which looks simple. Dangerous. @Indy51 doesn't like them either.
Not a wise med for type 1 especially.

 

[ann34+]

That's really interesting. As a long term T1 (since 1970) I've never had DKA (was diagnosed very early by T1 mum and have never been completely without insulin though I might misjudge doses). How long do you think I would have before falling unconscious if I stopped insulin altogether? (Obviously not an experiment I'm going to try!).

it would depend - if you had a virus or an infection, very possibly very little time at all. pre diagnosis i had had all the diabetic symptoms for more than a couple of years, but they were not picked up by GP, i just had iron tests for tiredness, and thrush meds given etc, but one mild ear infection led to near death in less than a day, so i would advise always taking insulin once diagnosed. later, after days in intensive care, i was told i still had some insulin, (it seemed to have been just enough to enable me to survive, but not enough to cope with any infection)

 

[EllieM]

Ok.. so I’m gonna start taking my lantus. Maybe really small doses of fiasp too. I think suddenly getting ill out here is gonna be really tricky. At least I can deal with the lows!
My levels are all over the place..

As others have said, you are/were probabaly in your honeymoon period so you don't need much insulin, but going without altogether is likely to bring you to seriously ill prediagnosis levels at some point, even if not immediately.

Just another quick heads up. Freestyle libre is a totally awesome device but you should occasionally check against a traditional blood testing meter, as some sensors can be very in accurate and it can be inaccurate for some people.

 

[h4kr]

Ok.. so a few doses and I’m fixed. I actually feel better too(thought it was jet lag and hangover.. maybe not).
Lesson learned.. don’t experiment with not taking insulin and travelling half way round the world!

 

[db89]

Glad you're feeling better. Someone will probably correct me but it's possible to my layman's brain that you still had some long acting hanging around to take the pressure off your beta cells - combined with your honeymoon period - that gave you the flattish results you were getting at first. They do say when changing Lantus doses it can take a few days to see the effect of the change.