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Dapagliflozin and ketones

M

MarthaD

Well-Known Member
Messages
50
Location
Edinburgh
Type of diabetes
LADA
Treatment type
Insulin
Hi. I've just started dapagliflozin and have slightly elevated ketones (1.1). Wondering if anyone knows if this is to be expected? I'm being monitored for latent type 1. Glucose levels are good. Thanks.
 
Hi there - any more context - why are you being monitored for Type 1 if your glucose levels are good? can you give us any more details?
 
Sorry, I was clear as mud. I might have LADA. Slim and losing weight. Have had worsening glucose for some time, even when on full dose of Metformin. I don't eat a carby diet, but not low carb either. Latest hba1c is 65mmol/l. My cpeptide isn't low enough yet for insulin. The addition of dapagliflozin has brought my glucose levels into mostly normal range, but have slightly elevated ketones, so I'm wondering if that's normal. This is only day 5 of dapagliflozin.
 
I would be very weary of ketones on a flozin.
Do you have reason to expect ketones because of your diet? Do you eat low carb? Have you fasted or eaten fewer carbs than you usually eat today?

The thing with flozins is that it's possible to develop DKA without the high blood glucose to go with it.
For T1's the advice is to test for ketones to rule out DKA when they have prolonged highs of over 14 or so. But if you don't get the highs you can easily forget that DKA is a possibility if you don't feel well.

www.gov.uk

SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis

Test for raised ketones in patients with ketoacidosis symptoms, even if plasma glucose levels are near-normal.
www.gov.uk www.gov.uk
MarthaD said:
My cpeptide isn't low enough yet for insulin.
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As far as I know, there are no T1/LADA guidelines on how low C-peptide should be before starting insulin, usually this decision is guided by blood glucose. There are some who believe that starting insulin early may even help the body produce its own insulin for a bit longer.
But this is about T1, not T2, and you're not sure what type you have yet.
MarthaD said:
The addition of dapagliflozin has brought my glucose levels into mostly normal range, but have slightly elevated ketones, so I'm wondering if that's normal.
Click to expand...
I would contact your HCP with this question, and I would read up on symptoms of DKA as well.
 
Thanks, @Antje77, very helpful. I don't follow a low-carb diet as such, but I'm careful about what I consume and try to limit my carb intake. My endo gave me a prescription for ketone test strips and told me I'd only need to test over 13. Sounds like I need to reconsider that. I think I'll periodically test until I feel more comfortable on the flozin. Back to 0.7 now, so I'll see what happens. Will contact diabetes clinic if they rise again.
 
MarthaD said:
Thanks, @Antje77, very helpful. I don't follow a low-carb diet as such, but I'm careful about what I consume and try to limit my carb intake. My endo gave me a prescription for ketone test strips and told me I'd only need to test over 13. Sounds like I need to reconsider that. I think I'll periodically test until I feel more comfortable on the flozin. Back to 0.7 now, so I'll see what happens. Will contact diabetes clinic if they rise again.
Click to expand...
Makes sense to me. :)
 
My cardiologist wanted to put me on this…. My diabetes team gave me loads of warning that I could get ketones at normal bg levels as the extra sugar just gets pee’d out.

However the raised jetties could be that you are not producing enough insulin OR it could be that you tested after having a low carb meals so it’s normal dietary keytones..

So you need to monitor that those levels don’t rise a level of about is normal for diet keytones.. or that the number is better after a normal meal
 
Thanks for the insight. Spoke to diabetes team. They said to continue to monitor and see if it settles. Meanwhile, get myself to A&E if it goes over 1.5. It's currently fluctuating between 0.7 and 1.2.
 
I’m not a consultant or DSN, and I’m type 1, but…
My consultant will not prescribe “flozins” for patients as they are known to raise ketones at normal glucose levels.
For me, 0.7 would still be high ketones yet that’s the low end that’s being experienced here. I think I would go back and discuss their suitability and the effects with the prescriber. My evidence is obviously just anecdotal but the prescriber should have the information and knowledge at their fingertips.
 
etmsreec said:
I’m not a consultant or DSN, and I’m type 1, but…
My consultant will not prescribe “flozins” for patients as they are known to raise ketones at normal glucose levels.
For me, 0.7 would still be high ketones yet that’s the low end that’s being experienced here. I think I would go back and discuss their suitability and the effects with the prescriber. My evidence is obviously just anecdotal but the prescriber should have the information and knowledge at their fingertips.
Click to expand...

More importantly they are for T2’s only

They should not be prescribed to any form of T1 including lada.. they are not licensed for this use, although they can be prescribed off licensed it should be done with great care
 
searley said:
More importantly they are for T2’s only

They should not be prescribed to any form of T1 including lada.. they are not licensed for this use, although they can be prescribed off licensed it should be done with great care
Click to expand...
Thanks. I've done some reading since, and I'm now questioning why the consultant prescribed them. Doesn't seem to have been a very informed decision. Although he prescribed a ketone meter at the same time, so I'm presuming he must know there are risks.
 
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