DKA - Type 2

[LindsayCatt]

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

Yes. I've been using Implanon for years. My relapse started when when my GP wouldn't prescribe me Dapaglaflozin in June. I've had the implant in since December and felt fine until the Dapaglaflozin was stopped.

 

[LindsayCatt]

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.

Since I resumed taking my consultant level meds last Wednesday I've gradually been feeling better. Today is first day I feel relatively normal.
I'm concerned how ill I've been just removing the 5mg Dapaglaflozin x

 

[JoKalsbeek]

Yes. I've been using Implanon for years. My relapse started when when my GP wouldn't prescribe me Dapaglaflozin in June. I've had the implant in since December and felt fine until the Dapaglaflozin was stopped.

May be a stacking of the circumstances then.... May want to go over it all with your GP.

 

[LindsayCatt]

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.

Thanks!
Where's the best place to buy a meter?

 

[LindsayCatt]

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.

Thanks! I'm alarmed that no-one ever told me what any of these things look like, and what to do (go to hospital / see my GP).
All I know is that after a few days without Dapaglaflozin I felt iller, and iller until I was utterly on my knees. Exactly how I was prior to diagnosis.
Given I've changed my diet, and my HbA1c levels have been consistently low, at 40 to 42 for months, why would I feel so ill?
The emergency GP asked me if I knew what DKA was, and I didn't. She said I should have gone to hospital, I didn't know that either. Desmond doesn't cover this stuff.

 

[LindsayCatt]

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?

Hi,
Whilst I appreciate your reply. I'm here. Ask me the questions, not the ether.....

 

[LindsayCatt]

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

Yes, I completely reviewed my diet, and I've lost 2 stone, on purpose. I scratch cook all evening meals, and make healthier choices during the day.
My HbA1c was only 48 when I was diagnosed, but I was literally on my knees with it.... Exhaustion, having to have naps, and chronic daily headaches.
I have a 3 year old, so I'm home and busy all day. Unlike a lot of people who have struggled, I've stuck to plan and have continued to lose weight during lockdown.
I usually feel fantastic, and have more energy than I have done in years. Until the 5mg of Dapaglaflozin was removed.... I felt iller and iller until I was back on my knees last Wednesday...
Is it possible I have a greater sensitivity perhaps?
The emergency GP asked if I'd heard of DKA, I hadn't, and she said if anything like it happened again I should go to hospital to get checked out.
I'm concerned how quickly and how severely this happened.

 

[JoKalsbeek]

Yes, I completely reviewed my diet, and I've lost 2 stone, on purpose. I scratch cook all evening meals, and make healthier choices during the day.
My HbA1c was only 48 when I was diagnosed, but I was literally on my knees with it.... Exhaustion, having to have naps, and chronic daily headaches.
I have a 3 year old, so I'm home and busy all day. Unlike a lot of people who have struggled, I've stuck to plan and have continued to lose weight during lockdown.
I usually feel fantastic, and have more energy than I have done in years. Until the 5mg of Dapaglaflozin was removed.... I felt iller and iller until I was back on my knees last Wednesday...
Is it possible I have a greater sensitivity perhaps?
The emergency GP asked if I'd heard of DKA, I hadn't, and she said if anything like it happened again I should go to hospital to get checked out.
I'm concerned how quickly and how severely this happened.

DKA doesn't usually happen to T2's unless there's something else in the mix. I don't think there's any way of telling if that is what happened, but... I do think you need to get checked, get a C-peptide and GAD test done, and see whether you truly are a T2 and not a late onset T1. And do request the Daga back while you're getting this sorted... You shouldn't have to feel the way you are.

 

[LindsayCatt]

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

Oh, and I have the implant because I was diagnosed with ovarian endometriosis years ago. Anything that stops menstruation is a good thing.
I've also had abnormal cells and a loop excision of my cervix, so I won't have anything inserted below. I couldn't dilate in labour as my cervix was traumatized enough from the earlier surgery.
So CS, then implant put back in at 6 weeks. My sons 3.5 now, so not the implant.

 

[LindsayCatt]

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/

Thanks! I got all my numbers down to safe ranges (except my waist measurement!) by the time I went on my Desmond Course last year.
I can't over emphasise how awful i felt before i was diagnosed and started treatment, i was so ill, despite my HbA1c only being 48 at the time.
I have no idea what any of my readings were. I was at home for a telephone consult. She was a locum I think and I've never met her before. After I explained my symptoms she asked me if I'd ever heard of DKA, I hadn't, and said I should of gone to the hospital to have tests done. As far as I knew I just needed the 5mg Dapaglaflozin prescribing so hadn't gone anywhere.
Today is Monday and it's the first day I've felt relatively normal since I reported this episode to that GP, and started taking my original, consultant approved, levels of Metformin and Dapaglaflozin again.
Thanks for responding x

 

[JoKalsbeek]

Oh, and I have the implant because I was diagnosed with ovarian endometriosis years ago. Anything that stops menstruation is a good thing.
I've also had abnormal cells and a loop excision of my cervix, so I won't have anything inserted below. I couldn't dilate in labour as my cervix was traumatized enough from the earlier surgery.
So CS, then implant put back in at 6 weeks. My sons 3.5 now, so not the implant.

With my Depo Provera shots I don't get periods either (Haven't had one since 2005, thank heavens! Used to halfway bleed out, thanks to PCOS), but I don't know whether the shots would increase the chance of cervical cancer and the like... All in all though, there were a lot of changes all in one go and you're not feeling right because of them. Doc might be able to help.

 

[HSSS]

Hi,
Whilst I appreciate your reply. I'm here. Ask me the questions, not the ether.....

Really? Just because your name doesn’t preceded the comments doesn’t exclude you. Who else could answer? A lot of people don’t hit reply but just comment, otherwise the quote box takes up a huge amount of unnecessary room when it’s obvious who the comment is aimed at.