Worried about ketoacidosis

Resurgam

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Usually eating low carb will - for a lucky type two, put them into normal numbers in just days - you really need to be speaking to someone who will take notice of what you are experiencing and act on it. Those numbers must show that there is something that needs to be addressed - it might well mean more tests but it needs to be sorted.
 

Winnie53

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A question I have is what is the process for patients whose needs are not being met by their primary care doctor in England? Are there any organizations that can facilitate the process with the patient, particularly when the patient is so unwell?
 

MillieT

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Losing the will here, i got my call, he seems to think that because of other ailments then the perindopril is not likely to be the blame for my shortness of breath and severe itchiness, he said it is probably the Lymphoa, however, so far i have been given the all clear and am supposedly in 100% remission.. and I have had these issues since taking the silly tablet.

He also said that it was not really something he could help and discuss over the phone and to make an appointment.. rewind 8 hours, everyone who is under the surgery received a text message to say Do not under any circumstances go into the surgery, make a phone appointment in light of the Coronavirus... Okay, well i reminded him of the text message and he said, just book an appointment for when is possible...

So, in the meantime what on earth am i supposed to do, someone please tell me i am over reacting with my sugar levels and ketones @ 2.5mmol, if i am then i apologise but it really makes you feel strange and ill that's for sure. The only good thing was that he said he would try me on something else instead of the perindopril... and what about everything else? he was speaking as if he had lots of other phone appontments so had to kind of rush off.. as such i'm not sure what to do next.

Thank you all for staying with me and helping where you can, i really do appreciate it.
 
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Winnie53

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miffli, I'm so sorry to hear this. This is sounding so circular. I share your frustration. He's saying you can't be having side effects from the medication, that it must be the lymphoma even though you are in complete remission. And he won't make changes to your prescription until you schedule an in-person appointment.

Has an appointment been scheduled to review all your lab test results? Do you know when they'll be completed and available?

I don't understand.

Does anyone in England know what options are available to miffli under these circumstances? Is there any process or advocacy available to her?
 
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Winnie53

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Miffli, did he or someone else provide your lymphoma care? If he thinks your lymphoma is no longer in remission, why aren't any steps being taken to address that?

Perhaps a referral to both an oncologist and endocrinologist is needed at this point. I don't understand.
 

Brunneria

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@miffli

Every nhs patient has the right to a second opinion.
Contact your surgery and ask politely (it is really a demand, but no need to be difficult about it) ask for a referral to the nearest diabetes clinic.

say that you feel you are a complex case and need specialist care and that you are no longer willing to experience constant high blood glucose and feeling so ill.

You need this fully investigated.
 

VivD

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bigoted and selfish people, this Government, grey cold windy days
I found your above response helpful as an insulin user I don't aim to get my bloods below 6 as I can start to react by 5 so this worries me more than being a bit high but I can see that I need to make that gradual change. My HA1C averages around 8% which is high but they are not too unhappy as I maintain it. I need to get over my fear have been trying to keep between 6 and 7 but doing it slowly.
 

Winnie53

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@VivD I see you've been here off and on for a few years now. Glad you're here. Glad you've set a goal of getting your glucose levels down. I encourage you to become curious as to what's possible and to learn how to get there with the generous help of the many forum members here.

There's a doctor in the US who has a slightly different take on protein, fat, and carb macros. His name is Ted Naiman, MD. He began using the low carb diet both personally and with his patients 20 years ago, so he has a lot of clinical experience. I've been listening to these recent interviews with him repeatedly. Perhaps you'll find them equally of interest. :)



After five years of educating myself and others I'm realizing that continuing to learn how to cook for my diabetes is where my focus needs to be now, both for myself and others. But to do this effectively, there's no getting around monitoring fasting glucose, pre-meal, and post-meal glucose levels. Without that feedback, I'm unable to improve my glucose levels. If you choose to do the same, pay cash for the cheapest glucose test strips you can find and the meter. And use it. The one thing you have is the gift of time because you're retired (though I well understand it's easier to prioritize fun activities and the needs of others over your own). Having worked as a teacher, I imagine you've dedicated your entire life to the service of others. :)
 

DCUKMod

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@VivD - I'm wondering if you would like a thread of your own for support on your journey? @miffli has a bit of an ongoing story here, and I don't think you'll get as man you responses sharing her thread as your input could be missed by many.

If you'd like a thread of your own, just let any Mod know.
 

MillieT

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Messages
264
Type of diabetes
Type 2
Treatment type
Other
Does anyone know what low sodium actually means, not being thick but i am taking supplements, twice daily and now my second lot of blood tests have come back too low, i have yet to find out what the original test results were, i asked for C Peptide etc and nobody has said anything so i'm none the wiser. Thye have made another phone appointment for me but due to being so busy that is not until a week on Thursday.

Sorry for this and i'm embarrassed with regards my ongoing story, it was not meant to be like this at all and it's not meant to be all about me, i am just left in the dark and have nobody else to talk to, i am really sorry if i come over this way, i also realise many of you are in the same or similar situations, i ready the carb free thread and see so many being successful and others in remission, i guess i just wish to be like them.:bigtears:

These are the ones i'm taking now

https://www.myvitamins.com/vitamins...ml?autocomplete=correction&variation=11698495
 

Ellenor2000

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Messages
91
hi, I'm now over 2 weeks into doing this carb free diet, like i have said i have lost weight, my sugars are way down to what they were, i'm hitting 4's and 6's which i never did for over a year, trouble is i am on empagliflozin and after speaking somewhere else here on the forum and i'm told that this should not be taken when on a keto diet... now, i do have quite a few dizzy spells, i feel nauseous but never actually sick, i do go to the loo like i lost count how many times a day but then i also drink a couple of litres of fresh water every day too, i keep getting this nasty acid like tummy ache and have had diarrhea yesterday but only the one day and though it could be some form of cleansing due to the diet.

Anyway, these dizzy spells, the hot flushes and i do get very thirsty are symptoms of the KA but my sugars are not high at all, today i woke up on 5 exactly and after breakfast i went to 6.2, i have one of these urine testing kits (EconoTest) and it shows i have lots of ketones as i expected from the diet- but this test strip also says that i have high glucose and this is where i'm getting confused, how can i have high glucose when my sugars are low and sorry to seem thick- i get dreadful brain fog since radiotherapy. I have to admit, i feel thinner but also quite rotten, i have been really irritable too or more than usual.

I am due to see my nurse next week too so shall be mentioning all of this but due to my horrendous anxiety I kind of need some advice to try and at least settle down a bit, i have paced up and down, washed the same washing 3 times today and just don't know what to do with myself.




View attachment 37550 .
Gliflozins make your kidneys waste out glucose at a lower blood sugar than they usually do (5 or 7 instead of 10 or 14). As a side effect, they lower insulin, and if insulin gets too low, ketosis runs unchecked and you get ketoacidosis
 

Goonergal

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Retired Moderator
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Type 2
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Diet only
Gliflozins make your kidneys waste out glucose at a lower blood sugar than they usually do (5 or 7 instead of 10 or 14). As a side effect, they lower insulin, and if insulin gets too low, ketosis runs unchecked and you get ketoacidosis

Just to be clear, Ketosis and ketoacidosis are two separate conditions, one does not lead to the other. Ketoacidosis (DKA) does occur when insulin levels are low, but in circumstances when blood sugars are also high. The following article provides more detail: https://www.diabetes.co.uk/diabetes-complications/diabetic-ketoacidosis.html
 

MillieT

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Messages
264
Type of diabetes
Type 2
Treatment type
Other
Gliflozins make your kidneys waste out glucose at a lower blood sugar than they usually do (5 or 7 instead of 10 or 14). As a side effect, they lower insulin, and if insulin gets too low, ketosis runs unchecked and you get ketoacidosis

@Ellenor2000 I'm not on anything now, that was the first couple of weeks in December, the thread has evolved a lot since then and @Goonergal i do know this regards the difference, somewhere on this forum i stated i was in hospital with dka some 2 years ago prior to having Lymphoma, i asked the question above ' does anybody know' regards sodium because i thought i did and have been taking electrolytes daily, i'm just wondering if anyone can expand on the low sodium thing.
 
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ziggy_w

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Messages
3,019
Type of diabetes
Type 2
Treatment type
Diet only
@Ellenor2000 I'm not on anything now, that was the first couple of weeks in December, the thread has evolved a lot since then and @Goonergal i do know this regards the difference, somewhere on this forum i stated i was in hospital with dka some 2 years ago prior to having Lymphoma, i asked the question above ' does anybody know' regards sodium because i thought i did and have been taking electrolytes daily, i'm just wondering if anyone can expand on the low sodium thing.

Hi @miffli,

So sorry about the experience you are having with high blood sugars, worries, and apparently very cavalier attitude of your GP. It'd definitely be nice to get some answers. I really feel for you.

As to your ketone levels of 2.5 mmol, this does seem to be commensurate with eating very low carb and also eating very little. Personally, my ketones also seem to be very high when not eating much (and also exercising a lot).

In my view, I would find the higher blood sugar levels more of a concern -- especially considering you're only consuming very few carbs. I tend to agree with @Brunneria. Could your GP possibly refer you to a specialist -- a diabetes clinic or an endocrinologists to look for the root cause?

As to low sodium (and mind you I am not an expert on this), doesn't this just seem to indicate that you're not having enough salt. Eating low carb and subsequent lower insulin causes your kidneys to retain less water and with this less salt. Thus, many recommend to up your salt intake when low carbing. I would be curious what other's take on this is.
 
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Graham1960

Newbie
Messages
2
Type of diabetes
Type 2
hi, I'm now over 2 weeks into doing this carb free diet, like i have said i have lost weight, my sugars are way down to what they were, i'm hitting 4's and 6's which i never did for over a year, trouble is i am on empagliflozin and after speaking somewhere else here on the forum and i'm told that this should not be taken when on a keto diet... now, i do have quite a few dizzy spells, i feel nauseous but never actually sick, i do go to the loo like i lost count how many times a day but then i also drink a couple of litres of fresh water every day too, i keep getting this nasty acid like tummy ache and have had diarrhea yesterday but only the one day and though it could be some form of cleansing due to the diet.

Anyway, these dizzy spells, the hot flushes and i do get very thirsty are symptoms of the KA but my sugars are not high at all, today i woke up on 5 exactly and after breakfast i went to 6.2, i have one of these urine testing kits (EconoTest) and it shows i have lots of ketones as i expected from the diet- but this test strip also says that i have high glucose and this is where i'm getting confused, how can i have high glucose when my sugars are low and sorry to seem thick- i get dreadful brain fog since radiotherapy. I have to admit, i feel thinner but also quite rotten, i have been really irritable too or more than usual.

I am due to see my nurse next week too so shall be mentioning all of this but due to my horrendous anxiety I kind of need some advice to try and at least settle down a bit, i have paced up and down, washed the same washing 3 times today and just don't know what to do with myself.




View attachment 37550 .
 

Winnie53

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Miffli I wonder...can you get a copy of your lab test results? I personally wouldn't want to wait yet another week for them.
 

MillieT

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264
Type of diabetes
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Hi @miffli,

So sorry about the experience you are having with high blood sugars, worries, and apparently very cavalier attitude of your GP. It'd definitely be nice to get some answers. I really feel for you.

As to your ketone levels of 2.5 mmol, this does seem to be commensurate with eating very low carb and also eating very little. Personally, my ketones also seem to be very high when not eating much (and also exercising a lot).

In my view, I would find the higher blood sugar levels more of a concern -- especially considering you're only consuming more carbs. I tend to agree with @Brunneria. Could your GP possibly refer you to a specialist -- a diabetes clinic or an endocrinologists to look for the root cause?

As to low sodium (and mind you I am not an expert on this), doesn't this just seem to indicate that you're not having enough salt. Eating low carb and subsequent lower insulin causes your kidneys to retain less water and with this less salt. Thus, many recommend to up your salt intake when low carbing. I would be curious what other's take on this is.

Hi @ziggy_w
it is true that i am not eating much at all though i do have a breakfast most days and an evening meal, i'm not actually excercising a lot though some days i walk a couple of miles, but the last week or so i have spent a lot of time in bed due to exhaustion. an example of today, i was up at 6.30am, i did actually have breakfast about 10am though was a small bowl of tonights dinner- please don't judge me, it has to be a first in my life.

I have made a slow cooker stew or hotpot with one whole shredded sweetheart cabbage, four spring onions, 1lb of minced lamb, half a dozen jalepeno slices, a small red bell pepper, one dessert spoon of tomato puree and one fresh tomato with hot smoked paprkia powder, a good teaspoon of Himilayan Pink salt and spring water.... this is just to show you the sort of thing i eat some days..(it actually tastes divine) does this sound too carby?

After doing my chores I had two sticks of celery dipping in salt, I went back to sleep at around 1.30pm and got up an hour ago... my sugars right now are 15 mmol. Surely you cannot have dawn Phenomenon every time you go to sleep and awake again?

I drink a lot of water and i do go to the loo a lot, i am having the electrolytes plus which have 200mg of sodium per tablet twice daily and i think i have enough salt in cooking and what have you, next stop is licking a salt block yukk.

@Winnie53 all i can do is call them and ask, i'm surprised they have not actually mentioned anything else apart from the low sodium twice.
 

Winnie53

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Miffli, in the US, they will not release lab test results until the doctor reviews them. But that's done typically within 24 hours, so delay is minimal.

Also, in the US, once the doctor signs off on the lab test results, I can take my driver's license to the lab and get a free print out of all lab test results that I then review with Dr. Google.

Don't know how this works in England. Perhaps someone here on the forum knows.
 

Ellenor2000

Well-Known Member
Messages
91
@Ellenor2000 I'm not on anything now, that was the first couple of weeks in December, the thread has evolved a lot since then and @Goonergal i do know this regards the difference, somewhere on this forum i stated i was in hospital with dka some 2 years ago prior to having Lymphoma, i asked the question above ' does anybody know' regards sodium because i thought i did and have been taking electrolytes daily, i'm just wondering if anyone can expand on the low sodium thing.
Have you been assessed for anti-beta cell/anti-insulin type antibodies?
 
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