DKA in type 2

[Absxx]

Good morning I was recently in hospital with DKA and sepsis it really knocked me for 6. Has anyone else experienced DKA in type 2?

 

[Oldvatr]

I used to think my bg; meter was being friendly when it said "HI" to me when I tested. Then I got a new meter and it shouted KETONES at me, and I thought it was being very clever, I did not suffer DKA and felt fine, but GP had a hissy fit and threatened insulin. I am lucky since I am clearly still producing insulin so did not suffer the acid buildup, If you got DKA then it suggests that something interfered with your ability to produce insulin, and over a period of time.

Did you have some other infection or reaction going on at the time? Do you have a kidney issue? Some medications can induce pancreatitis, so it may need a change. DKA in a T2D does need a proper investigation and a watchful eye. Maybe get some urine test strips to check for ketones, or get access to a meter that measures the blood levels of ketones.

There may be a simple explanation, but get it checked since DKA proper is a significant risk.

 

[Absxx]

I had a dental abscess which went into my sinuses then got a virus on top of that (not Covid) I didn’t know I had to stop the empagliflozin which caused the DKA along with the infections

 

[Oldvatr]

That would probably explain it. These meds are strongly associated with DKA events but not sepsis - that was probably the abscess. Not common, but can occur with lowish blood sugars around 10 mmol/l (ish) even in healthy people.

 

[Absxx]

Been given a blood testing kit that does ketones as well as my recent hba1c was 51 and I’m well controlled on metformin empagliflozin and semaglutide so they were surprised I went into DKA. Thanks for all the comments xx

 

[62Karen]

I found out I was diabetic after going to a&e with abdominal pain, was in dka and had sepsis, his was March 2020, although everyone is undecided which type I have still, thanks to covid I can’t get all tests I need, I’m on insulin at the moment

 

[Andydragon]

Been given a blood testing kit that does ketones as well as my recent hba1c was 51 and I’m well controlled on metformin empagliflozin and semaglutide so they were surprised I went into DKA. Thanks for all the comments xx

Hmm…
They really shouldn’t have been surprised given one of the drugs (empagliflozen) you were on has DKA as known, but rare side effect

https://www.gov.uk/drug-safety-upda...d-advice-on-the-risk-of-diabetic-ketoacidosis

I was specifically sent a warning about DKA when I was on Dapagliflozin

edit: noticed @Oldvatr did point that out, but this adds the link. I had assumed as my surgery had warned people, so would have all.

 

[DisFanJen]

I had a DKA in late Jan, funnily enough 2 weeks after being moved to empagliflozen.

Was put on insulin (NovoRapid and Lantus), and have just been pulled off the NovoRapid as my numbers are now nice and low.

Currently re-adjusting to work with just Metformin and Lantus so a little high right now, but still in reasonable numbers (6.8 at dinner).

Changed my lifestyle radically (healthy food, exercise, lost 5 1/2 stone), but you can turn it around and get back off of bolas insulin.

 

[bellapodus]

I took Empagliflozin for 4 days then felt ill. By the 5th day, I was rushed to hospital with DKA and ketones of 8.5. I'm now on insulin (Lantus and NovoRapid) which seem to be working fabulously

 

[KateS14]

Hi Abssx.

I ended up in hospital a couple of months ago in DKA as a result of a runaway infection. Didn't even know I was diabetic - that was diagnosed in the hospital (confirmed T2). Scary experience, and has made me a little bit paranoid about infections and ketones since... Although at least I know what's going on now and what to look out for.

 

[Colliewobbles]

I used to think my bg; meter was being friendly when it said "HI" to me when I tested. Then I got a new meter and it shouted KETONES at me, and I thought it was being very clever, I did not suffer DKA and felt fine, but GP had a hissy fit and threatened insulin. I am lucky since I am clearly still producing insulin so did not suffer the acid buildup, If you got DKA then it suggests that something interfered with your ability to produce insulin, and over a period of time.

Did you have some other infection or reaction going on at the time? Do you have a kidney issue? Some medications can induce pancreatitis, so it may need a change. DKA in a T2D does need a proper investigation and a watchful eye. Maybe get some urine test strips to check for ketones, or get access to a meter that measures the blood levels of ketones.

There may be a simple explanation, but get it checked since DKA proper is a significant risk.

 

[Colliewobbles]

That is what i thought when it said hi, thought how polite and it was over 40 lol

 

[zerocarbisbest]

just a quick random question did you take exogenous ketones? Did u drink ketones?

 

[Oldvatr]

just a quick random question did you take exogenous ketones? Did u drink ketones?

Dietary ketones from ketogenic diet or exogenous ketone supplements usually give readings below 4 mmol/l. DKA readings will be significantly higher.

 

[zerocarbisbest]

Dietary ketones from ketogenic diet or exogenous ketone supplements usually give readings below 4 mmol/l. DKA readings will be significantly higher.

I just remembered someone saying that when ketones are present naturally (fasting), the sugar level will be low, but if u drink ketones with high sugar in the blood not a nice mix, but I did not know there was a 4mmol cap, regardless of how much you take?

 

[Oldvatr]

I just remembered someone saying that when ketones are present naturally (fasting), the sugar level will be low, but if u drink ketones with high sugar in the blood not a nice mix, but I did not know there was a 4mmol cap, regardless of how much you take?

Diabetic ketoacidosis does indeed have the hallmark of high ketones+ high glucose. The Gliflozin meds though can themselves cause DKA with low blood sugar levels which makes them so dangerous, Most HCP's are trained to recognize the normal DKA, but most are not trained to check for a gliflozin induced one. I am on Dapagliflozin, which is the strongest of the family, and my GP refuused to give me ketone strips, and the heart consultant who put me on the Forxiga for my heart refused to believe me when I said it was a known side effect. He said it only occurred in T1D not T2's like me. I bought some wee sticks.

The NHS actually has a 3.0 mmol/l cap, but it does seem possible to get nutritional levels up to 4 and still be safe (apparently fasting can take the levels up to 5 and still be safe). DKA levels tend to be between 7.0 and outer space. However DUK ( the other lot) say any level over 3 is considered an emergency requiring hospital treatment. I note that they do not support ketogenic diets, or fasting, and also do not include gliflozins as a possible source of DKA. But apparently having a period can cause DKA ( but that is outside of my experience)

 

[zerocarbisbest]

Diabetic ketoacidosis does indeed have the hallmark of high ketones+ low glucose. The Gliflozin meds though can themselves cause DKA with low blood sugar levels which makes them so dangerous, Most HCP's are trained to recognize the normal DKA, but most are not trained to check for a gliflozin induced one. I am on Dapagliflozin, which is the strongest of the family, and my GP refuused to give me ketone strips, and the heart consultant who put me on the Forxiga for my heart refused to believe me when I said it was a known side effect. He said it only occurred in T1D not T2's like me. I bought some wee sticks.

The NHS actually has a 3.0 mmol/l cap, but it does seem possible to get nutritional levels up to 4 and still be safe (apparently fasting can take the levels up to 5 and still be safe). DKA levels tend to be between 7.0 and outer space. However DUK ( the other lot) say any level over 3 is considered an emergency requiring hospital treatment. I note that they do not support ketogenic diets, or fasting, and also do not include gliflozins as a possible source of DKA. But apparently having a period can cause DKA ( but that is outside of my experience)

thx.

 

[Kiwigal]

I'm Type 2 and it has been over a year since I was diagnosed.

I had my first DKA last month, but at the time I didn't realized I was going thru DKA but my glucose level were over 12.9 mmol when I checked my glucose level as it felt high for 5 hours + esp I was working at my job. As I had symptoms of nauseous, acetone breath, short fast breathing, thirst etc.

(I didn't have ketones monitor or ketones urine strip at the time but now I do as my Diabetes Educator told me to get ketones monitor and gave me sick days treatment plan to follow.)

My GP send an referral to Diabetes Clinic at local hospital as my Diabetes Educator recommends me to go introduction to insulin... for 4 x shots a day on insulin.

Only diabetes medication I'm on at the moment is Ozempic injection once a week, esp there is shortages of Ozempic and Trulicity in Australia.

 

[Oldvatr]

I'm Type 2 and it has been over a year since I was diagnosed.

I had my first DKA last month, but at the time I didn't realized I was going thru DKA but my glucose level were over 12.9 mmol when I checked my glucose level as it felt high for 5 hours + esp I was working at my job. As I had symptoms of nauseous, acetone breath, short fast breathing, thirst etc.

(I didn't have ketones monitor or ketones urine strip at the time but now I do as my Diabetes Educator told me to get ketones monitor and gave me sick days treatment plan to follow.)

My GP send an referral to Diabetes Clinic at local hospital as my Diabetes Educator recommends me to go introduction to insulin... for 4 x shots a day on insulin.

Only diabetes medication I'm on at the moment is Ozempic injection once a week, esp there is shortages of Ozempic and Trulicity in Australia.

I have corrected an error in my post that you quoted. DKA is normally associated with ketones and High glucose, (not low) The Gliflozin case is different in that it occurs at low and medium levels. Your report of 12,9 is more akin to the gliflozin level rather than the normal insulin deficient DKA.

I am curious because Ozempic is not associated with DKA like the Glifozin med, but you having that experience with sub-20 bgl levels is unusual. In UK we have a yellow card system for reporting side effects of medications back to the authorities for investigation, and your case may be one that they should follow up. Normally DKA diagnosis is when bgl readings are above 20 mmol/l.

As a T2D on orals, I used to clock readings above 32 mmol/l daily, but did not have ketones, and never had a DKA admission. I am still on orals, but using diet to control now and rarely see a reading above 7 nowadays. My trouble was Insulin Resistance which my diet has seen off.

 

[Kiwigal]

I have corrected an error in my post that you quoted. DKA is normally associated with ketones and High glucose, (not low) The Gliflozin case is different in that it occurs at low and medium levels. Your report of 12,9 is more akin to the gliflozin level rather than the normal insulin deficient DKA.

I am curious because Ozempic is not associated with DKA like the Glifozin med, but you having that experience with sub-20 bgl levels is unusual. In UK we have a yellow card system for reporting side effects of medications back to the authorities for investigation, and your case may be one that they should follow up. Normally DKA diagnosis is when bgl readings are above 20 mmol/l.

As a T2D on orals, I used to clock readings above 32 mmol/l daily, but did not have ketones, and never had a DKA admission. I am still on orals, but using diet to control now and rarely see a reading above 7 nowadays. My trouble was Insulin Resistance which my diet has seen off.

Yes I do find it is very unusal to get DKA on 12.9mmol on Ozempic.

I got told by GP if I do get DKA again and over 15 mmol and unwell, go straight to hospital to get insulin treatment.

Looking on my diabetes educator's sick days plan for Type 2... over 10 mmol high glucose. And explained each levels of ketones what to do and when go to hospital urgent.

As my med is only Ozempic which is once a week pen injection, for orals I was on before starting Ozempic - metformin - both regular and XR I cannot tolerate it and Trajenta didn't work.

I'm on low carbs foods - 30 grams carbs per meals, and 15 grams for snack and exercises as well.

Will see what Diabetes Clinic comes up with finding right treatments that will works for me. Esp a lot of Oral medications for Type 2 has narrowed down for me.

But I'm staying positive.