Type 2 moved to insulin after dka

Debneld

Member
Messages
5
Type of diabetes
Type 2
Hi
I am 52 and have had type 2 diabetes for fifteen years treated with metformin and dapagliflozin. Three weeks ago I ended up in Hospital with severe dka. Since then I have been put on toujeo insulin.
My real question is I am due to return to work on Monday which involves a 45 min journey at 6:45 in the morning.
I cannot manage a full breakfast at this time, what would you think would be a good level for my blood sugars.
Also what do you keep as in car incase of hypo.
Thanks Deb
 

urbanracer

Expert
Retired Moderator
Messages
5,186
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
Not being able to eat as many chocolate digestives as I used to.
Hi
I am 52 and have had type 2 diabetes for fifteen years treated with metformin and dapagliflozin. Three weeks ago I ended up in Hospital with severe dka. Since then I have been put on toujeo insulin.
My real question is I am due to return to work on Monday which involves a 45 min journey at 6:45 in the morning.
I cannot manage a full breakfast at this time, what would you think would be a good level for my blood sugars.
Also what do you keep as in car incase of hypo.
Thanks Deb

Hi and welcome to the forums.

I keep a product called 'Glucojuice' with me most of the time. It comes in small canisters and contains 15g of carbohydrate which is about right for (my) hypo's. You could also try the small cans of fizzy drinks that are sold as cocktail mixers in most supermarkets and plain old orange juice.

Liquids are absorbed more readily than solids, but some people use jelly babies and there are also various brands of dextrose tablets on the market ( to me though, they're a bit like how I imagine eating chalk to be).

Have you been told that you need to notify DVLA if using insulin and driving?
 
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Jaylee

Oracle
Retired Moderator
Messages
18,214
Type of diabetes
Type 1
Treatment type
Insulin
Hi
I am 52 and have had type 2 diabetes for fifteen years treated with metformin and dapagliflozin. Three weeks ago I ended up in Hospital with severe dka. Since then I have been put on toujeo insulin.
My real question is I am due to return to work on Monday which involves a 45 min journey at 6:45 in the morning.
I cannot manage a full breakfast at this time, what would you think would be a good level for my blood sugars.
Also what do you keep as in car incase of hypo.
Thanks Deb

Hi,

Welcome to the forum.

Carry fast acting carbs with you always, especially as you are starting a new insulin regime.
Ideally 6Mmol as a "buffer zone" testing before getting behind the wheel.

They do say "5 to drive, 4 is the floor." (I've no ideas what levels you are trending with your basal at the moment. if you haven't been used to lower levels. You may feel out of sorts in the optimal range?)

I personally am happy in the mid 5s. but then my journeys are shorter. I don't do breakfast either.
In my experience certain journeys & driving conditions push my BGs up due to liver dump?

What time to you inject your Toujeo? & are you also prescribed a short acting insulin to cover meals too.?

Plan ahead with your morning routine prior to setting off for work. Just until you get comfortable with how the new meds are trending.

Best wishes.
 
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Debneld

Member
Messages
5
Type of diabetes
Type 2
Thank you for the replys
I am still in the sorting of dose as my fasting blood sugars are always high between 8 and 10. Until I get back to work and my eating times are more regulated they don't know if I will need meal time insulin. I suppose just wait and see.
 

KK123

Well-Known Member
Messages
3,967
Type of diabetes
Type 1
Treatment type
Insulin
Hi
I am 52 and have had type 2 diabetes for fifteen years treated with metformin and dapagliflozin. Three weeks ago I ended up in Hospital with severe dka. Since then I have been put on toujeo insulin.
My real question is I am due to return to work on Monday which involves a 45 min journey at 6:45 in the morning.
I cannot manage a full breakfast at this time, what would you think would be a good level for my blood sugars.
Also what do you keep as in car incase of hypo.
Thanks Deb

Hi there, gosh, that must have been frightening! We know that that type 2s CAN go into DKA but I can't recall seeing any posts on this site straight out of the horse's mouth. Would you mind telling us what happened and how it was caught in time etc?, it might help people to understand that you really cannot 100% categorise who will get what & when!

A 'good level' is very subjective because a level of 5 for some might be too low for others, who fall low fast for example. What are your usual readings during the day? x
 
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Debneld

Member
Messages
5
Type of diabetes
Type 2
I came home from work on the Friday feeling rough and fell asleep on sofa, woke a couple of hours later and went to bed.
Later that evening was sick but just went back to bed. All that night and through to Sunday morning just got up to drink water and wee husband did make me a couple of dioralyte drinks and had stopped taking meds.
I did do a lateral flow test on Saturday as I have to do them twice a week as work in Hospital.
Sunday morning told husband to book a pcr test as was feeling no better. Got up had shower and came down stairs my breathing was erratic so husband phoned ambulance.
They did ecg which showed tachycardia so they took me to hospital but no urgency.
When I got to hospital they put me in cubical ran tests I can't say how long after I was moved to High dependency unit they caught it just in time so although the ICU doctor came to see me I didn't need to go in. I was in hospital for 3 days.

My blood sugars weren't extremely high 10-11 I know the diabetic nurse used me as a training exercise for the nurses on ward as they had never seen it before.
They don't know why maybe underlying infection and the dapagliflozin which can be a risk factor.
I can honestly say that getting up to go for covid test probably saved me as I would have probably just stayed in bed until I slipped into a coma.
From all accounts the fast breathing is a sign of your body trying to get rid of ketones and the vomiting also you don't always need high blood sugars especially if you are on dapagliflozin.
Hope this helps someone but it is extremely rare.
 
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KK123

Well-Known Member
Messages
3,967
Type of diabetes
Type 1
Treatment type
Insulin
I came home from work on the Friday feeling rough and fell asleep on sofa, woke a couple of hours later and went to bed.
Later that evening was sick but just went back to bed. All that night and through to Sunday morning just got up to drink water and wee husband did make me a couple of dioralyte drinks and had stopped taking meds.
I did do a lateral flow test on Saturday as I have to do them twice a week as work in Hospital.
Sunday morning told husband to book a pcr test as was feeling no better. Got up had shower and came down stairs my breathing was erratic so husband phoned ambulance.
They did ecg which showed tachycardia so they took me to hospital but no urgency.
When I got to hospital they put me in cubical ran tests I can't say how long after I was moved to High dependency unit they caught it just in time so although the ICU doctor came to see me I didn't need to go in. I was in hospital for 3 days.

My blood sugars weren't extremely high 10-11 I know the diabetic nurse used me as a training exercise for the nurses on ward as they had never seen it before.
They don't know why maybe underlying infection and the dapagliflozin which can be a risk factor.
I can honestly say that getting up to go for covid test probably saved me as I would have probably just stayed in bed until I slipped into a coma.
From all accounts the fast breathing is a sign of your body trying to get rid of ketones and the vomiting also you don't always need high blood sugars especially if you are on dapagliflozin.
Hope this helps someone but it is extremely rare.

Thank you SO much for posting!
 
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ert

Well-Known Member
Messages
2,588
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
diabetes
fasting
I came home from work on the Friday feeling rough and fell asleep on sofa, woke a couple of hours later and went to bed.
Later that evening was sick but just went back to bed. All that night and through to Sunday morning just got up to drink water and wee husband did make me a couple of dioralyte drinks and had stopped taking meds.
I did do a lateral flow test on Saturday as I have to do them twice a week as work in Hospital.
Sunday morning told husband to book a pcr test as was feeling no better. Got up had shower and came down stairs my breathing was erratic so husband phoned ambulance.
They did ecg which showed tachycardia so they took me to hospital but no urgency.
When I got to hospital they put me in cubical ran tests I can't say how long after I was moved to High dependency unit they caught it just in time so although the ICU doctor came to see me I didn't need to go in. I was in hospital for 3 days.

My blood sugars weren't extremely high 10-11 I know the diabetic nurse used me as a training exercise for the nurses on ward as they had never seen it before.
They don't know why maybe underlying infection and the dapagliflozin which can be a risk factor.
I can honestly say that getting up to go for covid test probably saved me as I would have probably just stayed in bed until I slipped into a coma.
From all accounts the fast breathing is a sign of your body trying to get rid of ketones and the vomiting also you don't always need high blood sugars especially if you are on dapagliflozin.
Hope this helps someone but it is extremely rare.
I'm sorry you have had been so unwell. I hope you are feeling recovered soon. Did they tell you how high your ketones were?
 

UK T1

Well-Known Member
Messages
334
Type of diabetes
Type 1
Treatment type
Insulin
I came home from work on the Friday feeling rough and fell asleep on sofa, woke a couple of hours later and went to bed.
Later that evening was sick but just went back to bed. All that night and through to Sunday morning just got up to drink water and wee husband did make me a couple of dioralyte drinks and had stopped taking meds.
I did do a lateral flow test on Saturday as I have to do them twice a week as work in Hospital.
Sunday morning told husband to book a pcr test as was feeling no better. Got up had shower and came down stairs my breathing was erratic so husband phoned ambulance.
They did ecg which showed tachycardia so they took me to hospital but no urgency.
When I got to hospital they put me in cubical ran tests I can't say how long after I was moved to High dependency unit they caught it just in time so although the ICU doctor came to see me I didn't need to go in. I was in hospital for 3 days.

My blood sugars weren't extremely high 10-11 I know the diabetic nurse used me as a training exercise for the nurses on ward as they had never seen it before.
They don't know why maybe underlying infection and the dapagliflozin which can be a risk factor.
I can honestly say that getting up to go for covid test probably saved me as I would have probably just stayed in bed until I slipped into a coma.
From all accounts the fast breathing is a sign of your body trying to get rid of ketones and the vomiting also you don't always need high blood sugars especially if you are on dapagliflozin.
Hope this helps someone but it is extremely rare.
Hope you're feeling much better now! Sounds very similar to when I was diagnosed type 1 with DKA - also breathing problems, sickness, tired, in the end couldn't walk had to be carried into the hospital.
So important to know it can happen to type 2 too, and glad you noticed it in time!

I don't know if these apply to you now you're on insulin? As a type 1 we have to inform the DVLA and have a 3 year review of our driving license. We also have to test blood glucose levels before driving and then every 2hrs during long journeys, otherwise our insurance is void. I have dextro tablets in the glove compartment as they can withstand the hot/cold temps of the car better, but otherwise cartons of juice in my bag. Hope that helps a little and you're feeling a lot better now.
 

Debneld

Member
Messages
5
Type of diabetes
Type 2
I'm sorry you have had been so unwell. I hope you are feeling recovered soon. Did they tell you how high your ketones were?
I looked at my chart once I felt better and they recorded levels of 7+ after about 24hrs the nurse told me I was doing well and they had gone down to 2.6.
 

Debneld

Member
Messages
5
Type of diabetes
Type 2
Thank you everyone for your kind replies I have informed DVLA and am carrying apple juice cartons but have been advised to carry a long acting carb item I thought about a cereal bar but is this the best thing?
 

bulkbiker

BANNED
Messages
19,576
Type of diabetes
Type 2
Treatment type
Diet only
Hi
I am 52 and have had type 2 diabetes for fifteen years treated with metformin and dapagliflozin. Three weeks ago I ended up in Hospital with severe dka. Since then I have been put on toujeo insulin.
My real question is I am due to return to work on Monday which involves a 45 min journey at 6:45 in the morning.
I cannot manage a full breakfast at this time, what would you think would be a good level for my blood sugars.
Also what do you keep as in car incase of hypo.
Thanks Deb

You medication was likely the cause of the DKA (in case none of your medics old you)

https://www.gov.uk/drug-safety-upda...n-empagliflozin-risk-of-diabetic-ketoacidosis

You'd do well to try to come off the insulin by changing what you eat to an ultra low carb diet.
 

Oldvatr

Expert
Messages
8,470
Type of diabetes
Type 2
Treatment type
Tablets (oral)
I came home from work on the Friday feeling rough and fell asleep on sofa, woke a couple of hours later and went to bed.
Later that evening was sick but just went back to bed. All that night and through to Sunday morning just got up to drink water and wee husband did make me a couple of dioralyte drinks and had stopped taking meds.
I did do a lateral flow test on Saturday as I have to do them twice a week as work in Hospital.
Sunday morning told husband to book a pcr test as was feeling no better. Got up had shower and came down stairs my breathing was erratic so husband phoned ambulance.
They did ecg which showed tachycardia so they took me to hospital but no urgency.
When I got to hospital they put me in cubical ran tests I can't say how long after I was moved to High dependency unit they caught it just in time so although the ICU doctor came to see me I didn't need to go in. I was in hospital for 3 days.

My blood sugars weren't extremely high 10-11 I know the diabetic nurse used me as a training exercise for the nurses on ward as they had never seen it before.
They don't know why maybe underlying infection and the dapagliflozin which can be a risk factor.
I can honestly say that getting up to go for covid test probably saved me as I would have probably just stayed in bed until I slipped into a coma.
From all accounts the fast breathing is a sign of your body trying to get rid of ketones and the vomiting also you don't always need high blood sugars especially if you are on dapagliflozin.
Hope this helps someone but it is extremely rare.

Since you were using Dapagliflozin at the time, may I suggest you read up about how this med can induce DKA at moderate levels of blood glucose? You should also request a test to determine if insulin insufficieny is actually present i.e. do you really need insulin treatment?

Discussed it here in the past
https://www.diabetes.co.uk/forum/th...-on-the-risk-of-diabetic-ketoacidosis.104325/
 

Sarah69

Well-Known Member
Messages
1,441
Type of diabetes
Type 2
Treatment type
Insulin
Dislikes
Anything healthy!
I came home from work on the Friday feeling rough and fell asleep on sofa, woke a couple of hours later and went to bed.
Later that evening was sick but just went back to bed. All that night and through to Sunday morning just got up to drink water and wee husband did make me a couple of dioralyte drinks and had stopped taking meds.
I did do a lateral flow test on Saturday as I have to do them twice a week as work in Hospital.
Sunday morning told husband to book a pcr test as was feeling no better. Got up had shower and came down stairs my breathing was erratic so husband phoned ambulance.
They did ecg which showed tachycardia so they took me to hospital but no urgency.
When I got to hospital they put me in cubical ran tests I can't say how long after I was moved to High dependency unit they caught it just in time so although the ICU doctor came to see me I didn't need to go in. I was in hospital for 3 days.

My blood sugars weren't extremely high 10-11 I know the diabetic nurse used me as a training exercise for the nurses on ward as they had never seen it before.
They don't know why maybe underlying infection and the dapagliflozin which can be a risk factor.
I can honestly say that getting up to go for covid test probably saved me as I would have probably just stayed in bed until I slipped into a coma.
From all accounts the fast breathing is a sign of your body trying to get rid of ketones and the vomiting also you don't always need high blood sugars especially if you are on dapagliflozin.
Hope this helps someone but it is extremely rare.
Hi, I didn’t know that about the breathing being a sign of getting rid of ketones. I had DkA once, I was sick every half an hour I couldn’t even keep water down. My son called me an ambulance as I had the fast breathing and the paramedic said I was having a panic attack! After going to hospital and they did tests they said it was DKA, I’d never heard of it before. I was in and out of hospital for two weeks and took me around a month to recover from it!