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DKA - Type 2

LindsayCatt

Member
Messages
14
Yesterday I crashed. Big time. After my fab results last month (holding steady at 40), my GP thought it was a good idea to reduce my meds again (after halving my Metformin at Christmas from 1g x 2 to 500mg x 2 within a week of me seeing my Endo Consultant who said to stay on the same dose, she then removed my 5mg of Dapaglaflozin completely 3 weeks ago).
My 3 y/o had to wake me up 3 times before lunch after I fell asleep on the sofa. This was after a solid 8 hour nights sleep.
I had to ring and get my husband out of work and come home as I wasn't fit enough to look after my own son. I booked an emergency telephone appointment with my clinic for 5pm. I then went back to bed for 3 hours I was so tired.
The GP I spoke to has re-prescribed me the full doses of the meds my consultant advised me to take at Christmas, as she could see no justification in the correspondence to my GP recommending that course of action.... the drugs my GP has reduced twice this year is apparently just to "see how I get on" because my HbA1c has stayed at 40 for ages, and I've lost 2 stone. According to the GP I spoke to I could have had DKA, and needed hospitalization, yesterday.
Although I know my GP means well, I strongly suspect the moral of the story is that Consultants are Consultants for a reason.
Any advice for going forward would be much appreciated. Thank you x
 
Hi @LindsayCatt ,

Welcome to the forum.

Do you have your own blood rest meter?

Moving forward, it may help as a backup with regards to what's happening with your management when a doc changes your med dosage..
 
It'd help if we knew what you're doing now. We know your medication, but was that the only thing keeping you at a HbA1c of 40? Did you do anything else? Diet? Exercise? What do your daily meals/snacks/drinks look like on average? And good point from @Jaylee , do you have a meter? (Considering this, if you do not, you might want to consider a CareSens Dual or similar, as it can read both regular strips and ketone strips. You could also go for a cheaper meter besides that, which only does blood sugars. Or rather, a meter that takes cheaper strips, as you'll probably be testing a lot in the next few weeks.).

You need to know what your blood sugars are up to, and whether there have been, or are, any drastic changes in them anywhere. DKA doesn't often happen to T2's, though it is not unheard of. But then it usually involves some kind of other medication like a steroid or sever infection or something. If the doc really thinks you went into DKA-territory, you might want to request C-peptide and GAD testing. See whether you weren't just in a honeymoon period while you're actually LADA/T1. Not to scare you, but you don't want this happening again. Just covering the bases.

Good luck,
Jo
PS: Some stuff on diet that might be of interest if you truly are a T2: https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html
 
I'm sorry you haven't been well and you're finding it frustrating getting support from consultants. Your Hba1c below 42 is classified as normal, so you're doing amazingly well.

I don't understand how a GP could say someone 'probably' had DKA - it makes you critically ill as DKA is where your blood pH changes, and is life-threatening. Is this what you had rather than abnormal blood ketones? They treat DKA with insulin.

As new type 1, I walked into A & E after my blood ketones were over 5 mmol/L and rising, and I couldn't get my blood sugars below 15 mmol/L. But I wasn't in DKA and my blood pH wasn't tested. I just needed insulin from then on as my c-peptide supported absolute insulin deficiency at 0.078 nmol/L. My ketones cleared after the nurses gave me my first insulin injection. I've been on insulin ever since.

In type 2's DKA is usually triggered by prolonged uncontrolled blood sugar (which doesn't sound like you), missing doses of medicines, or a severe illness or infection. And other causes listed here:
https://www.nhs.uk/conditions/diabetic-ketoacidosis/
 
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I don't fully understand this? Is there any reason why you would be under a consultant for T2 diabetes or is it for another condition? The result is that you appear to have two medics managing your diabetes which is not good. A GP shouldn't really be guessing DKA and it could possibly have just been a bad hypo?
 

Hi,

I'm less likely to shout "fire" on a hypo.. Or anything without a meter to consolidate what was happening at the time.

I'm hazarding a guess lowered medication dosage from the OP's GP earlier this year could have elevated the BG levels.?
The telephone consultation with a different GP in attendance (thankfully) reversing the decision of the first GP had another "idea.."
The OP had a reasonable recorded lab A1c, prior to the advent of med dose reduction.

@LindsayCatt , a meter; whether your HCPs recommend you need one or not will help them (whether they like it or not.) help you.
Use of a meter regarding any numbers can also at least help us give experienced feedback, even though we cannot diagnose.

Hope this helps.
 
Do you know your actual readings? Blood glucose? Ketones?
I would be concerned that healthcare professional told you that you could have diabetic ketoacidosis without ensuring that you had proper testing and treatment.

you (and your doc!) may find this link helpful:
https://medlineplus.gov/ency/article/000304.htm
and please chase your doc into providing you with a test meter and sufficient strips, both for blood glucose and ketones, so that you are never left wondering about ‘ifs and maybes’ again.

oh, and welcome to the forum @LindsayCatt
 
Very unlikely to be DKA as they need inslin to control and if not controlled you will be in ICU. I am not convinced that the GP you spoke to on the phone for the emergency appointment know enough to be trusted. I think you need to speak to your consultant.

There is some information missing, or something unrelated to normal types of diabetes as I cant' see a diabetes related reason for you to crush with the drug you say you are on.
 
Agreed, a staggering number of adult T1s are initially misdiagnosed as T2.

ringi said:
There is some information missing, or something unrelated to normal types of diabetes as I cant' see a diabetes related reason for you to crush with the drug you say you are on.
Click to expand...
Unless she is a misdiagnosed LADA, in which case diet could have kept her insulin needs at bay until insulin production got too low. Having said that, I don't see how you can just "recover" from a DKA without insulin, so something's off there.

Also, if she was on daplaglaflozin she should have been given a glucose meter then (@LindsayCatt did you run out of strips?), as I'm pretty sure that this is a requirement for hypo inducing drugs (assuming you are in the UK).

Feels like some medical incompetence/ignorance is going on here. We all know that many GPs are clueless about diabetes. And giving someone a phone diagnosis like that without any access or request for medical tests (blood sugars, ketones etc) seems crazy.

Is the weight loss desired, because though excess weight can be lost as a result of controlling T2, it can also be a sign of T1/LADA.

Moving forward, as others have said, you need a meter, both for blood sugar and ketones, so you can work out what is happening if you crash again. I'd also be urging you to request a specialist endo appointment again, but that will be a lot more useful if you have the result of blood tests to indicate how your system is coping. And the doctor who thought you might be DKA should be asked to do GAD and c-peptide tests if he/she really thinks that that was the case....

Good luck.
 
Far too much guesswork going on here.

The emergency gp talking about potentially fatal dka without acting to check it??? Ignorance of the condition or negligence by not acting?

No meter from consultant or gp whilst on hypo potential meds? No meter reading or checking to see what was happening at the time in question or what is happening I gotta since meds were reduced?

I’m surprised a consultant is even involved with a type 2 to be honest, unless there’s some additional issues. Reducing metformin wouldn’t usually make a significant difference, certainly nothing Dka inducing as it’s a mild drug that doesn’t actively reduce glucose levels, merely prevent liver dumping. Removing dapagalaflozin might make more difference though, dka still unlikely but possible.

How long has hb1ac been around 40? from where? Anything else managing levels apart from meds? Was the weight loss intentional and over how long? Any particular diet? It is often perfectly possible to reduce meds in type 2 if those meds have been made redundant by other lifestyle changes such as going low carb but usually drs need to know this is the case before reducing them.

what preceded the “episode”? Fasting? A heavy carb meal? Any particular reason to suspect it was or wasn’t diabetes related?
 
EllieM said:
Also, if she was on daplaglaflozin she should have been given a glucose meter
Click to expand...

A BG meter is not standard for people on daplaglaflozin (a SGLT-2i) as on it own or combined with Metformin it does not create a risk of hypos.
 
ringi said:
A BG meter is not standard for people on daplaglaflozin (a SGLT-2i) as on it own or combined with Metformin it does not create a risk of hypos.
Click to expand...

Fair enough, the google article I read said that it could induce hypos, but I'm guessing that must be in conjunction with other drugs?
 
EllieM said:
Fair enough, the google article I read said that it could induce hypos, but I'm guessing that must be in conjunction with other drugs?
Click to expand...

Anything that reduces BG can make hypos more likely if someone is taking a drug thst increases inslin levels.
 

I was under a consultant because I have an adrenal adenoma which had been classified as benign and non functional after 3 years of testing. I had been discharged literally 12 months before I found out I was T2 diabetic last June.
The symptoms of my diabetes were chronic, prolonged headaches, and extreme exhaustion... my HbA1c was only 48 when I was diagnosed, however, my symptoms hadn't been addressed by my practice on 2 previous visits, despite my worsening condition. By the time I was diagnosed I was very ill.
That's why I saw a consultant initially, because there was a possibility that my tumour had become active, leading to diabetes. However after stress testing the tumour using corticosteroids it was determined that it was down to heredity, exacerbated by a long term use of Mirtazapine, and some weight gain after my last pregnancy at 43; I'm 46 now. However, as my tumour was none active, I'd lost well over a stone in 6 months, and my HbA1c has come down and maintained at 40 after my initial diagnosis, I was discharged at Christmas.
I hope that helps clear that up.
 
Jaylee said:
Hi @LindsayCatt ,

Welcome to the forum.

Do you have your own blood rest meter?

Moving forward, it may help as a backup with regards to what's happening with your management when a doc changes your med dosage..
Click to expand...

Hi,
No I don't have a blood test meter I'm afraid. I was diagnosed last year. I've attended a Desmond Course and done my own reading.
As my HbA1c went to 40 almost immediately after diagnosis, treatment and diet changes, I've never bothered as the nurses running our course said we didn't need one. My diabetes nurse hasn't mentioned it either.
 
Hi again. Thanks for the clarification and obviously a complex history before the event.
 
 
Hi @LindsayCatt ,

Sounds like a bit of a perfect storm. Have you had that particular implant before? Because there are some contra-indications for diabetics. Worsening insulin resistance, glucose intolerance... Though I think your response might've been a bit extreme, it is something that needs to be looked at, something to mull over. (I do fine on a hormone shot myself every 10 to 13 weeks. The pill wasn't doing enough to keep my migraines in check, and the IUD was rejected by my body after being a good solution for about 8 years). A few things changed, which would explain why things got bad so fast: bad response to the implant, and a bunch of reductions that would have cushioned that particular blow, possibly. Also, feeling ill and tired/overly sleepy etc, are side effects of the implanon as well... I'm not sure you went into DKA, as more likely than not, you wouldn't be talking to us right now if that was what happened. I think you're just responding very, very badly to the implant. And you wouldn't be the first. Friend of mine is perfectly healthy and she had to have that thing removed within a week, things got so rotten. http://www.hpra.ie/img/uploaded/swedocuments/295ebb71-ceb0-43cb-8b79-b4809c827c40.pdf Have a read, it might be eye-opening. (I can't find anything on diabetes right off, but it was there in the Dutch leaflet. We're kinda thorough.) And yeah, sometimes things cause a reaction even if it'd been fine in the previous years. My uterus was perfectly happy with an IUD, until it most decidedly wasn't. Took the docs 6 months to figure out I was having contractions around a rather spiky thing in my body.

Hope this helps,
Jo
 
 
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