I’m writing this to inform of what can happen . My husband ha type 2 diabetes and is insulin dependent. Just over a month ago I woke to find him what I thought was drunk. He rarely drank alcohol but I thouhjt he was behaving like I’d seen before. Anyway by the morning he hadn’t “sobered “ up like he normally did. So we (my sonwas with us)rang 111 for advice. As we were on the phone I could see his sugars rising as we were on the phone. Within half an hour of the start of the call there were paramedics at our house. He’s unconscious and unresponsive. I couldn’t go with him as I use a wheelchair. I just thought he’d be fine and I’d be arranging to get him home later that day. Within 2 hours of them taking him I got a phonecall, I was told I needed to get to the hospital asap because he was very poorly and they had to put him into an induced coma. When I arrived at the hospital I discovered he was struggling with oxygen levels, his blood pressure was all over the place and so we’re his glucose readings. I’d never heard of this before but he was in DKA which is diabetic ketoacidosis. This is where the body goes into ketosis and it can’t produce enough insulin to cope with the ketosis. The blood becomes acidic and starts to dry which then can have a massive effect on the brain, heart and lungs. He was on 100% oxygen and to make matters worse he’d aspirated into his lung- basic he’d been sick and breathed it in. They removed this from his lung and his oxygen improved slightly. He then inevitably came down with pneumonia. He was in a coma for 5 days and remained in icu for another 5 when he was then taken to an endocrine ward. Many of you will have seen an endocrinologist with your diabetes. He was in hospital for another week. When in a coma and you wake up you can be very confused and can have paranoia for a few days and then memory issues. My husband is still very weak and his brain function which wasn’t great due to fibromyalgia is still not great. He now has high blood pressure and we are struggling with his glucose levels. His DKA was caused by a very low carb diet. He’s my carer and made our meals and I lost count of the times I told him he needed carbs too. In his head he knew carbs turn to sugar so therefore he shouldn’t eat them! He was so wrong. Often his sugar levels were high. We were never told about ketones so when he appeared drunk he was in fact already in ketoacidosis and I didn’t check his sugar levels. To make it more difficult for me to see he’d had a drink that night which was a rarity. But he’d been I’ll for a while and we didn’t know. His ketones rose because of his diet, not taking his medication properly and the sugar in the alcohol tipped it over the edge. He hadn’t had much . His drunk symptoms were because of the raised ketones.There are drs who are surprised he survived. Now I monitor his diabetes which is so close to type 1 but he still produces the tiniest amount of insulin. He has a libra monitor on his arm which he qualified for in part due to memory issues caused by the fibromyalgia. I have an app that shows his levels to me. I make sure he eats at the right time and the right foods and he now drinks alcohol free which is also low sugar. I’m sharing this because we didn’t know about DKA. We weren’t told because he’s type 2. It is so important to keep ontop of your diet and monitoring and your medications as advised by your medical practitioner. If you haven’t been told about DKA don’t become paranoid just know what your levels are and keep them where they should be. It’s horrendous getting that call to go to the hospital because they weren’t sure he’d survive. Treat your diabetes with the respect it needs for you to remain healthy. You really don’t want to be where we are now .
DKA diabetic ketoacidosis in type 2 diabetes
- Thread starter squidge105
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Oldvatr
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Thank you for sharing your experiences, and i wish you and your huband a full and swift recovery from that episode. It is never pleasant to suffer DKA. It is sad that the advice was not given to you to prepare for this. I think you coped very well.
All insulin users need specific training for DKA, and all of us need to make ourselves aware of the symptoms and steps needed to avoid an episode.
i am a T2D and not an insulin user, but i was given a medication that is associated with euDKA which is a low bgl level variant of acidosis. it is supposed to be rare for T2D to get ketones to the point of acidosis, but low carbers and ketogenic dieters can have measurable levels of ketones in their blood and urine as a natural byproduct of the diet. Normally we clear the ketones through excretion, so they do not buld up and keto diets are normally safe. But someimes illnesss and medications can upset this, and the kidneys stop filtering the ketones out, and they build up in the blood to higher than usual levels, I had such an event when I had a slight illness, and luckiliy i had some weestix to hand, and measured a high level of ketones, In my case I hydrated and the problem resolved without mishap, but it was getting close to DKA which shocked me.
So I do not think the diet was a cause, but it does increase the risk. As you say, your husband may have also had a medication issue, which is a known trigger for DKA in insullin dependant people.
So all insulin users on a low carb diet need to be sure they have a robust level of monitoring and control while low carbing.
Other people using SGLT-2 meds, and also the DPP4 and Glutide meds may also have an elevated risk level since these also increase ketone levels, and also reduce pancreas output of insulin, These medications are not sweeties, and need to be used with care.
My advice, for what its worth, is to make sure you have access to some means of ketone measuring when using lowcarb diet while on one of these medications. It is a safety issue, but GP's do not yet recognise it as being likely and do not prescribe or advising ketone testing to non insulin users.
WeeStix can be purchased from the pharmacy or online, but be aware that they have a short lifespan (approx 6 months) from opening the jar. Some blood monitors can alao measure ketones, but the test strips are expensive, and again have a short shelf life.
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Hi @squidge105 and welcome to the forums. I'm so sorry your husband has had this happen, DKA is a very scary life threatening illness.
Here's what the NHS have to say
www.nhs.uk
If you don't make very much of your own insulin then you need to be aware of DKA as a risk going with high blood sugars, in any diet.... (Disclaimer, I am not a doctor or T2, but I am someone who produces no insulin of her own. If I stopped injecting insulin I would go into DKA). Diabetic clinics produce "sick day rules" for insulin users so as to advise them how to modify their dosing when sick, which is a time when blood sugars tend to go up.
It's great that your husband now has a libre monitor @squidge105 , as it will warn you if his levels stay persistently high. I hope he feels better soon.
T1s are warned about DKA (diabetic ketoacidosis) as something to be wary of when we have high blood sugar (for whatever reason), often sickness. We also get given blood testing meters so that we can check for blood ketones when this happens, though much cheaper urine testing strips can be used as well. My understanding, as a T1, is that it is caused by lack of insulin rather than a low carb diet. A reason low carb diets can confuse the matter is that ketones from dietary ketosis are difficult to distinguish from ketones from DKA, so a keto diet can make DKA harder to diagnose.
Here's what the NHS have to say
Diabetic ketoacidosis
Find out about diabetic ketoacidosis (DKA), including what the symptoms are, when to get medical help and how to prevent it.
www.nhs.uk
If you don't make very much of your own insulin then you need to be aware of DKA as a risk going with high blood sugars, in any diet.... (Disclaimer, I am not a doctor or T2, but I am someone who produces no insulin of her own. If I stopped injecting insulin I would go into DKA). Diabetic clinics produce "sick day rules" for insulin users so as to advise them how to modify their dosing when sick, which is a time when blood sugars tend to go up.
It's great that your husband now has a libre monitor @squidge105 , as it will warn you if his levels stay persistently high. I hope he feels better soon.
Hi and Thankyou all
I’d like to clarify my husband wasn’t on a keto diet . A libra only monitors glucose levels. He’s had the libra for months now. I’d had the discussion about him eating or not eating carbs before with him and the diabetic nurse and he just would not budge from the view that carbs turn to sugar which makes them bad. Obviously we know carbs are not bad and when you are an insulin dependent t1 or t2 carbs are an important part of the process of the body functioning.
As for the sick day rules we’d never been informed of these either. We knew that in sick days his sugars rose but we’d never been told how to deal with that. I’m in no way criticising his diabetic nurse because she is great and I’m able to email her about anything related to his diabetes.
My intention with this post is to inform folks about DKA and for whatever reason people have not been informed. I’m not a medic of any description I just know what we have been through.
Also it was the drs and nurses in icu who told us DKA for diabetics can be diet (what they are eating not as in a diet for weight loss) , medication -as in not being consistent with. Also ill health can be a factor. My hubby’s glucose always skyrocket when he’s unwell and even happened when in hospital once. Even then we were not told about DKA. I know exactly what it does and how it effects the body now, I’m almost expert at it. I just don’t want to see anyone else have to deal with this when it can be so easily dealt with. When keytones reach a certain level hospital is the only place you need to be at. It’s a very low level and I don’t have those numbers in front of me right now. You can’t sort it yourself. Look at the nhs website where I’m sure the info can be found.
All I know now is I’m exhausted, I have my own health issues in fact he is my carer as I’m disabled but I’m having to do my best to help him. Hopefully social services are sitting out extra hours for me to increase my care plan
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I’m so sorry you both went through this terrifying experience. It’s good to hear that there is light coming at the end of the tunnel. I applaud you wanting to help others avoid such a situation but there are some grey/confusing areas in what’s being said here in this thread.
I’d like to add this link that describes both ketosis and dka and importantly highlights the differences between them. https://www.diabetes.co.uk/in-depth/nutritional-ketosis-vs-dka/. It’s widely misunderstood and/or poorly explained in layman’s terms, even amongst by some medics judging by reports in here and many other places. And I’m sorry but whilst your practice nurse may be likeable and approachable not educating your husband about sick day rules, dka and hypos risks and avoidance when on insulin is a serious failing
DKA is typified by both high glucose and significant ketones, whereas nutritional ketosis instigated by low carb diets results in low glucose and lower but recordable level ketones (<3 in blood). Illness is a common trigger for DKA, as is missed insulin doses. Starvation and a few other rare conditions might instigate DKA too.
The biggest exception to the rule of high glucose is those taking certain type 2 medications (sglt-2’s most notably) whereby glucose doesn’t go as high as dka would normally exhibit, yet ketones build up much higher than a low carb diet alone would cause due to interactions with the medication. It’s called euglycemic DKA.
Lack of insulin is a key issue in DKA. Most accurately diagnosed type 2 still produce a decent amount, even if that’s not enough to overcome their huge insulin resistance and so need medicinal support to control resulting blood glucose levels. Sadly it’s rarely actually tested which would be very helpful for correct initial diagnosis and in the long term for any increasing risk of dka. So whilst this condition is usually seen in type 1, some long term type 2 whose pancreas has suffered from the disease over many years may also have very low levels and therefore in this respect have similar risks to a type 1. It sounds like your husband is in this latter category from your comments.
Low carb diets are not a cause of dka, though they may cause a delay in diagnosis or a confusion about what’s happening due to the presence of their expected low levels of ketones. The problem comes in not being able to clear ketones due to lack of insulin thus allowing them to build to high levels, not in having a low level of them in expected specific situations. Carbs do turn into blood glucose. Carbs are not essential for life, though do have some non essential yet useful functions. However if you are on insulin you do need the right dose to match the level of carbs you eat, an imbalance in either direction causes real and maybe even life threatening issues. More carbs - without sufficient insulin - is a common cause of dka. You seem to have been led to understand the cause of your husbands dka was from too few carbs. In an insulin user too few carbs for the insulin dose they took would cause a hypo not dka.
As you say in an insulin user not on a low carb diet any ketones are concerning as they may rise rapidly from the onset of DKA - and the reason the levels are set very low to take action. The guidance is issued with these assumptions - better to be over cautious than under cautious. And also why many insulin users avoid or are told to avoid low carb/ketosis.
However there are type 1 and insulin users that do low carb and are very aware of the potential for the confusion ketosis induced low levels of ketones can cause and also of the potential masking of a real dka as a result. They are vigilant in their awareness of ketones and bgl. They do it because low carb intake means lower glucose levels, meaning less insulin is required. Less insulin can be seen as desirable to minimise the risk of accidental hypos, keep levels more stable and reduce the potential for insulin resistance developing with high insulin doses. Hopefully this thread will have educated others in the need for ketone understanding.
I’d like to add this link that describes both ketosis and dka and importantly highlights the differences between them. https://www.diabetes.co.uk/in-depth/nutritional-ketosis-vs-dka/. It’s widely misunderstood and/or poorly explained in layman’s terms, even amongst by some medics judging by reports in here and many other places. And I’m sorry but whilst your practice nurse may be likeable and approachable not educating your husband about sick day rules, dka and hypos risks and avoidance when on insulin is a serious failing
DKA is typified by both high glucose and significant ketones, whereas nutritional ketosis instigated by low carb diets results in low glucose and lower but recordable level ketones (<3 in blood). Illness is a common trigger for DKA, as is missed insulin doses. Starvation and a few other rare conditions might instigate DKA too.
The biggest exception to the rule of high glucose is those taking certain type 2 medications (sglt-2’s most notably) whereby glucose doesn’t go as high as dka would normally exhibit, yet ketones build up much higher than a low carb diet alone would cause due to interactions with the medication. It’s called euglycemic DKA.
Lack of insulin is a key issue in DKA. Most accurately diagnosed type 2 still produce a decent amount, even if that’s not enough to overcome their huge insulin resistance and so need medicinal support to control resulting blood glucose levels. Sadly it’s rarely actually tested which would be very helpful for correct initial diagnosis and in the long term for any increasing risk of dka. So whilst this condition is usually seen in type 1, some long term type 2 whose pancreas has suffered from the disease over many years may also have very low levels and therefore in this respect have similar risks to a type 1. It sounds like your husband is in this latter category from your comments.
Low carb diets are not a cause of dka, though they may cause a delay in diagnosis or a confusion about what’s happening due to the presence of their expected low levels of ketones. The problem comes in not being able to clear ketones due to lack of insulin thus allowing them to build to high levels, not in having a low level of them in expected specific situations. Carbs do turn into blood glucose. Carbs are not essential for life, though do have some non essential yet useful functions. However if you are on insulin you do need the right dose to match the level of carbs you eat, an imbalance in either direction causes real and maybe even life threatening issues. More carbs - without sufficient insulin - is a common cause of dka. You seem to have been led to understand the cause of your husbands dka was from too few carbs. In an insulin user too few carbs for the insulin dose they took would cause a hypo not dka.
As you say in an insulin user not on a low carb diet any ketones are concerning as they may rise rapidly from the onset of DKA - and the reason the levels are set very low to take action. The guidance is issued with these assumptions - better to be over cautious than under cautious. And also why many insulin users avoid or are told to avoid low carb/ketosis.
However there are type 1 and insulin users that do low carb and are very aware of the potential for the confusion ketosis induced low levels of ketones can cause and also of the potential masking of a real dka as a result. They are vigilant in their awareness of ketones and bgl. They do it because low carb intake means lower glucose levels, meaning less insulin is required. Less insulin can be seen as desirable to minimise the risk of accidental hypos, keep levels more stable and reduce the potential for insulin resistance developing with high insulin doses. Hopefully this thread will have educated others in the need for ketone understanding.
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