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Type 2 B.s suddenly 30+, and now 4.1... I'm now a guinea pig... Any thoughts..?

Arnstein_Bjone

Member
Messages
8
Which units to use here..? (30 / 4.1 mmol /L = 540 / 74 mg / dl. )

I am 61 year old. Overweight (+ 30-40 kg).
I was diagnosed with diabetes 2 in 2013. It was well controlled up to Sept. 29.th (HbA1c =4.9) with just Metformin 850 mg x 2.

I also take medications for high BP and heart arrhythmia, with excellent result.
The same goes for my bloodfats (using statins)

2 days later (Oct. 1st) I measure b.g. "hi" (> 30).
It stays hi (18-25) the following days. My GP prescribe Janunia (in addition to Metformin). No noticable effect. She stops it after 1 week.

GP: "Have you got LADA ..?" "No" :
Anti-gad = 0.01 (normal = <0.09))
1A2A = 0.04 (normal = <0.11)
C-peptide is normal.

GP prescribe Insulatard (insulin, pen), with quite small doses since I live and work alone from home:
8 IU / 4 IE morning / night.
B.g. is still hi (14-18).
Dosage increased to 8/6 IE ... then 12/6 ... B.g drops to 10-15.

Specialist nurse Increase the isnulin to 12/10 IE + increase the Metformin from 2 x 850 mg to 2 x 1000 mg...AND 10 mg Jardiance.
Imidiate result: B.g. drops to 7-9.

I deceide to also change my diet, without consulting anyone, from "normal fat / normal protein / moderate carbs to a ketonic diet (high fat / low protein / very low carbs (<20 g/day).
B.g. drops to 4.1 - 5.7 !!!
β-Ketone: 2.8 mmol / L . Which means I'm in ketosis ..?
Am I challinging death..? (Risk of going into ketoacidoses?)

These b.g.-numbers is very encouraging, but also a bit scary ...I keep some chocolate handy.. everywhere.
I have never seen/experienced hypoglycemia, but hope I will recognize the symptoms early enough ..?

I ate one half hamburger bun this afternoon, and the meat, in a business meeting at Burger King.
β-Ketone drops to 1.1 mmol/L. Out of ketosis so quickly ..?)

I have tried to reach both my spesialst nurse and my GP this Friday afternoon, with no luck, to ask them if I ...:
1) .. should reduce the insulin dosage..and switch from 10 mg Jardiance to 25 mg
2) ... stop the ketogenic diet?
I have an appointment with my GP in a week, but I'm very eager to get some thoughts about this now.

Jardiance is not giving me any of the reported/possible side effects they warn about, so I hope I can increase the dosage to 25 mg, which I already have got the presiption for. It seems to be a fantastic medicine for me...?
I'll assume I have to reduce the inslulin quite a bit if/when I start taking 25 mg Jardiance, maybe to zero...?

And, maybe reduce the dosage of metformin too...?

Encouraged by these low BG-numbers, I got up on my training bike this afternoon
 
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ketoacidosis happens when your BG is high, when you eat low carb you go into ketosis - which just means fat burning, and your BG is low.
I found it quite difficult to restart ketosis after over a year on a high carb cholesterol lowering diet, but it did take less than two weeks. It is usually easy to control weight - just by controlling carbs, something which came as quite a shock after failing on all diets but Atkins. I was only diagnosed with type 2 last month, but I have been low carbing for decades, probably keeping me prediabetic for a long time. I have decided to cut down taking statins - in three weeks my tinnitus has increased so much that I can't use the phone, which is rather a disaster as I have only a small pension and need to get work to live, but most of that is gained by phone calls. As you have a BG meter if you take your guidance from that, you will at least be able to show the medics the readings and argue your case if there are any repercussions - I can only take Metformin when I know I don't have to go out of the house, it doesn't suit me at all, but I am recording when and if I take it, and the consequences, just so the doctor can understand the problem. Sometimes low carb can result in constipation, which just doesn't happen when done with Metformin.
 
It is against the forum rules to make recommendations regarding someone's medication (i.e. we can't recommend changing dosage or stopping a med), but can provide our personal experiences. So with that in mind, here's what the Diet Doctor says about starting a LCHF diet while on diabetes meds:

https://www.dietdoctor.com/low-carb/with-diabetes-medications

Being on a ketogenic diet and having ketones in your blood is a very different thing than ketoacidosis and you needn't worry about your diet casing ketoacidosis: http://www.healthline.com/health/ketosis-vs-ketoacidosis
 
As the dietdoctor says, talk to your physician for advice.
 

"we can't recommend changing dosage!"
Of course not. I shouldn't have asked my questions like I did.

I have followed the Diet Doctor for several years. He is like my "guru", but I couldn't find any answers to my concerns. Thank you for the ketoacidosis link. I will read up on that. I have a LOT to learn about all this...
 
Perhaps we need more info.

If you have followed the dietdoctor for years, but still became diabetic 3 years ago, then something else changed recently, is there anything else happening?
 
Arnstein_Bjone said:
I first start to follow the diet Doctor in 2010 (www.kostdoktorn.se then) for diet tips.
Click to expand...

Following the Dietdoctor in 2010
Diagnosed type 2 2013
A change in your BG in 2016?

Perhaps a different approach is needed now?
But I believe in the HCP's so maybe others may be able to offer different advice.
 
Hi, blood ketones of 1.1 is still in ketosis which is anything between .5 and about 3 or 4. A hamburger bun, however, is enough to throw me out of ketosis for a couple of days. As others have said, no one on here can tell you to change or adjust your meds. A ketogenic diet is probably one of the best tools out there for weight loss and blood sugar control but as you are taking medication you will need to work with your doctor as far as dosages go. Ketoacidosis happens when your blood sugars are very high and your ketones are also very high, like 10 or more. This is very dangerous and is not the same thing as ketosis. It is also not very common in a T2. A BG of 4.1 to 5.7 is right in the sweet spot and totally normal.
 
douglas99 said:
Following the Dietdoctor in 2010
Diagnosed type 2 2013
A change in your BG in 2016?

Perhaps a different approach is needed now?
But I believe in the HCP's so maybe others may be able to offer different advice.
Click to expand...

In the initial post, I describe very detailed what happend (around oct. 1st). No one knows what happened yet.

Changing to a ketogenic diet is a different approach, wouldn't you say..?

My BG has since been between 4.2 and 5.9. The β-Ketone level is now 2.1 mmol/L. Last insulin injections was last night. BG between 4.7-6.1 (average 5.3)

What is HCP..? Searched the forum and the web but couldn't find anything.
 
Health Care Professional...
 
I believe you need to see an endocrinologist!
I don't usually comment on insulin T2s, because I have no experience of it.
The reason I say this is because of all the different results you are getting. You clearly don't have control despite lowering your blood glucose levels. There is some reason why you are getting different results.
It could be many things, that is giving you these results and you need tests to diagnose your symptoms.
However, being in ketosis will get your bloods near normal levels, but the unexpected readings, I have no idea!
Would you know if you were in hypoglycaemic episodes?
I didn't!
Since your body is still probably adjusting itself to a ketogenic diet, your hypo awareness maybe very hard to distinguish from other symptoms!
Do you keep a food diary, as that will tell you so much! Do you record your readings, before eating and two hours after? As this for a T2, will give you a better idea what is going on!
 
donnellysdogs said:
Health Care Professional...
Click to expand...

As I wrote, I have an appointment with my GP on Friday. In the situation I am now, she wants to see me every 2-3 weeks.
I'm also seeing this specialist nurse at the hospital, but since they both seems a bit confused about what is going on, I thought the members of this group had some thoughts. "Thought" is all I asked for.
 

This is a typical situation when the dsn and GPs don't understand what is happening, I have had the merry go round with doctors, dsns and an endocrinologist who didn't have the knowledge of unusual metabolic conditions.
They are not trained to notice, to diagnose conditions, if something is not within their spectrum of understanding!
As in my previous post, you need tests, only an endocrinologist can order specific tests regarding metabolic conditions. You have T2, but something else is going on.
Only tests can get to the bottom of the cause and of course treatment.
I'm sorry I don't have answers, so can only advise!
 
With normal, good levels and showing low ketones and eating a diet designed for ketosis.. whats the prob here? Have I missed something?
 

I have noted your advice about seeing an endocrinologist. That may be a good idea.

I wouldn't say I'm getting a lot of different results. The BG and HbA1c was quite stable between 2013 until now (oct. 1st), where it suddenly spiked to 30+. (I didn't measure BG at that time) Since then the insulin got it down som units, and Jardiance got it further down...but ketogenic diet got it down to ideal levels

I didn't take insulin this morning (12 IE) or tonight (10 IE), and the BG was now 4.8. It has been 4.2-5.9 since I started keto diet on Thursday.
I keep a diary about the BG, with comments, but 'm not keeping a food diary. I belive I have good control on the fatintake (ca 100 g/day), protein (<70 g/day) and carbs (<20 g/day).
 
If notntesting blood at time of 30+ and now ok... I just dont fathom out your concerns now.. more likebwhy weret you testing when 30+ and where did that 30+ result come from if you werent testing?
 
donnellysdogs said:
With normal, good levels and showing low ketones and eating a diet designed for ketosis.. whats the prob here? Have I missed something?
Click to expand...

The problem is that I was very eager to find out what to do with the medications, now that the keto-diet has got the BG down to 4.2 -5.9. I couldn't reach my GP or my special diabetes-nurse at the hospital on Friday.

I have read a lot about keto-diet and ketoacidosis this weekend, and was reassured that ketoacidosis was almost imposible for me to reach, especially as long I now check the blod ketones often. (now it is around 2.2 mmol/L).

So, I didn't take my insulin this morning (12 IE) and tonight (10 IE), and the was now 4.8.

Next "experiment" will be to stop taking the metformin, but I wait until I have seen me GP on friday.

According to the Diet Doctor, many people stop all diabetes medications, or alt least insulin, after just 4-7 days after switching to keto-diet.
 
If I were you I would try to get a fasting c-peptide test done to find out what your own natural insulin levels are doing. Being on exogenous insulin will not affect this test. It is easier to make informed decisions if you have all the information.
 
 
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