DKA in type 2

The patient information for Semaglutide (Ozempic) has the following
"
This medicine may increase your heart rate while you are at rest. Check with your doctor right away if you have fast or pounding heart beat.

Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your antidiabetic medicine, overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual.

Symptoms of high blood sugar include blurred vision, drowsiness, dry mouth, flushed, dry skin, fruit-like breath odor, increased urination (frequency and amount), ketones in the urine, loss of appetite, stomachache, nausea or vomiting, tiredness, trouble breathing (rapid and deep), unconsciousness, or unusual thirst.
If symptoms of high blood sugar occur, check your blood sugar level and then call your doctor for instructions.

"
It does not define what a high sugar level is. but the med does have this as a known set of effects, which is surprising since the med is prescribed to diabetics.

I have found evidence that Semaglutide has been associated with severe DKA events requiring emergency treatment, The DKA was confirmed in this case, but it seems that the patient was also taking a gliflozin med as well. Since the Semaglutide had been recently added, and the known fact that the gliflozins do themselves cause DKA then the incidence of the event was ascribed as anothe gliflozin case, but it had been noted that the semaglutide addition within the week prior to the event had possibly triggered the event. It does seem to be rare, but ketones and palpitations do seem to be common side effects. Maybe what you experienced was not quite the full monty.

https://journal.chestnet.org/article/S0012-3692(21)02354-0/fulltext

This drug has recently been approved in the UK as a general anti obesity treatment so is no longer restricted for diabetes users only.

I have been pondering over why the instructions for Ozempic list ketones as being common. Some recent research has discovered thst alpha cells in the pancreas have another previously unknown pathway to control metabolism. They discovered that the alpha cells have an emergency response to the condition of high glucose with high insulin, and this triggers the pathway to the beta cells to force more insulin out of them. It is actually the pathway that activates fat burning, which is why this med is used for weight loss and why you get ketones. So your dose of Ozempic will stimulate ketosis without requiring carb restriction.

I can understand how keto diets work with low glucose levels since that comes from evolution. But forcing it when there is lots of glucose sloshing around seems to be a bit dodgy.

If the clearance of ketones is impaired, then this will lead to DKA. The presence of high levels of glucose may well be forcing your kidneys to work overtime removing excess, and they may not be so efficient at clearing ketones, which is why ketones come out in the breath and sweat instead. This is similar to what csn happen in the T1D form of DKA except that in that case insulin is not available, so it is just glucose and ketones fighting for the same exits.

Suggests that your problem may have been dehydration related. Especially if vomiting occurred.

Oldvatr said:

I have been pondering over why the instructions for Ozempic list ketones as being common. Some recent research has discovered thst alpha cells in the pancreas have another previously unknown pathway to control metabolism. They discovered that the alpha cells have an emergency response to the condition of high glucose with high insulin, and this triggers the pathway to the beta cells to force more insulin out of them. It is actually the pathway that activates fat burning, which is why this med is used for weight loss and why you get ketones. So your dose of Ozempic will stimulate ketosis without requiring carb restriction.

I can understand how keto diets work with low glucose levels since that comes from evolution. But forcing it when there is lots of glucose sloshing around seems to be a bit dodgy.

If the clearance of ketones is impaired, then this will lead to DKA. The presence of high levels of glucose may well be forcing your kidneys to work overtime removing excess, and they may not be so efficient at clearing ketones, which is why ketones come out in the breath and sweat instead. This is similar to what csn happen in the T1D form of DKA except that in that case insulin is not available, so it is just glucose and ketones fighting for the same exits.

Suggests that your problem may have been dehydration related. Especially if vomiting occurred.

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Just lucky I wasn't vomiting but I forgot to mention I did had abdominal pain too.

I was drinking two bottles of water at work (refilled up my water bottle.) Esp it is winter here as well.

I'm not on very very low "Keto diet".

That morning I had fast of 8.9mmol when I woke up 5am.

Only thing I can think of I had 3rd covid booster vaccine (wasn't keen to get it - but it was mandatory at the time.) I had bad reactions to every covid vaccines shots and cannot get medical exemption for it.

Esp I have been on Ozempic since March this year... and my 3rd covid shot was in late May - previous 2 covid shots was way before Feb.

Kiwigal said:

Just lucky I wasn't vomiting but I forgot to mention I did had abdominal pain too.

I was drinking two bottles of water at work (refilled up my water bottle.) Esp it is winter here as well.
I'm not on very very low "Keto diet".

That morning I had fast of 8.9mmol when I woke up 5am.

Only thing I can think of I had 3rd covid booster vaccine (wasn't keen to get it - but it was mandatory at the time.) I had bad reactions to every covid vaccines shots and cannot get medical exemption for it.

Esp I have been on Ozempic since March this year... and my 3rd covid shot was in late May - previous 2 covid shots was way before Feb.

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I am wondering if your abdominal pain was an indication of acute pancreatitis? That is a reported side effect that can make a rare occurence with this medication.

Oldvatr said:

I am wondering if your abdominal pain was an indication of acute pancreatitis? That is a reported side effect that can make a rare occurence with this medication.

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I had a look of acute pancreatitis symptoms... I had no high fever temps on that day.

Glad to hear that. May I possibly ask a favour?
Here in the UK we have a Yellow Card system where doctors and patients can report any adverse or unusual reactions to medications. DKA in Type 2 is thankfully rare, and euglycemic version is even rarer. In the USA they have the FDA who oversee medications, and they can raise warnings if they see a significant problem. I tend to use the FDA website often since it is more up to date than the UK and they seem more proactive. The FDA.gov website does have a portal for anyone to report on it. I have not used it personally, but I have used yellow cards. I get an impression that the Ozempic is known to trigger fat burning, but they do not have any DKA warning. Perhaps it should?
https://www.fda.gov/drugs/questions...event-reporting-system-faers-public-dashboard

Thank you, I have reported to TGA (Therapeutic Goods Administration) Adverse Event Management System (Australia) for this Ozempic "DKA" in Type 2.

It is quite very unusual. But yes it do need DKA and or Euglycemic DKA warning incase any Diabetics who use Ozempic is in risk of getting DKA.

I guess on that day my own body insulin stopped to work temporarily. (I will ask Diabetes Clinic to do C-peptide if my own insulin has dropped down.)

I think it not yet very common for Ozempic side effects to cause DKA esp it seems very rare trigger.

I do wonder if I was go on Trulicity... it is possible to get similar DKA trigger?!? At the moment both Ozempic and Trulicity are on shortages in Australia and shortage date for Ozempic is pushed to end of December 2022.

Hence my diabetes educator is recommended me to go on insulin shots.

Kiwigal said:

Thank you, I have reported to TGA (Therapeutic Goods Administration) Adverse Event Management System (Australia) for this Ozempic "DKA" in Type 2.

It is quite very unusual. But yes it do need DKA and or Euglycemic DKA warning incase any Diabetics who use Ozempic is in risk of getting DKA.

I guess on that day my own body insulin stopped to work temporarily. (I will ask Diabetes Clinic to do C-peptide if my own insulin has dropped down.)

I think it not yet very common for Ozempic side effects to cause DKA esp it seems very rare trigger.

I do wonder if I was go on Trulicity... it is possible to get similar DKA trigger?!? At the moment both Ozempic and Trulicity are on shortages in Australia and shortage date for Ozempic is pushed to end of December 2022.

Hence my diabetes educator is recommended me to go on insulin shots.

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Thank you. I think Trulicity is very similar to Ozempic, but needs a different dose. It does seem to be an easier med based on forum comments. Seems ther is a general shortage of Ozempic here in the UK as well.

Absxx said:

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?

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Yes I had 6 times and hospitalized in each. Last one 2019 December it was 9.5. I was vomiting terribly, very heavy breathing, I could walk, I was very weak and veryyy thirsty. They didn’t have equipment to check ketones. Once checked they put me at ICU for the night and stayed a week in the hospital. It was terrible. It happened because I didn’t take insulin for two days and ate chunk food.

Absxx said:

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?

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Hi yes i also was admitted in hospital for 12 days it took quite a while to get it under control with lots of different amounts of insulin.Originally they thought I was type 1 but after tests they found me to be type 2.Over time I have managed to decrease my insulin purely by changing some things in my diet,I do like sweets so I but diabetic sweets now you dont have to miss out on things just be very mindful of what you eat.I hope you start feeling better soon.