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Euglycemic DKA - twice in 4 months

MissTam

Member
Messages
8
Hi, I'm new here & in need of a chat to wrap my head around this and hopefully connect with others who've experienced this or can lend some clarity.

A bit of context: Diagnosed T2 4 years ago. Was diet controlled + metformin for under a year before BG suddenly went out of control. Have since been on pretty much every class of diabetes meds, they'd work for a few months then revert back to BG up to high teens (14-20) despite maintaining a sugar-free healthy diet.

4 months ago - was put on SGLT2 meds (Forxiga) & within 4 days I was in ICU with euglycemic DKA. Apparently a rare reaction to Forxiga, although there seems to be increasing reports of cases. They suspected I'm T1/LADA but GAD antibodies were negative. They're still not sure about what type of diabetes I am, MODY has been suggested but the hospital doesn't do genetic testing and it's too expensive to be done privately.

Following that, they put me on Trulicity injections. My BG came down fast (from 19 to ~ 8) but had constant extreme nausea & fatigue. After 4 weeks, my BG levels shot back up & felt progressively sicker (but hoping it was a glitch & the Trulicy would kick back in) until a month later I saw my Diabetes Nurse Educator. She called the hospital, I was re-admitted and started insulin.

Now - I've been on basal/bolus insulin for almost 8 weeks. I've been really diligent (with the help of Libre sensors) about trying to get tight control of my BG, working out carb/insulin ratios etc and being precise about nutrition and dosing. The last few weeks I thought I was doing great (at last!), with BG 4-8 (mostly 5/6). I started feeling off the last week but figured my body wasn't used to BG now being in the 4's & 5's and would take some time to get used to. Then I had abdominal pains, felt disoriented.. even though my BG was 6, I checked my ketones - high. This was after lunch. Back to ICU & another Euglycemic DKA. What the hell!

I've only been home a few days & still feeling a bit fragile, scared and confused. They could not find a cause for this DKA, despite blood tests, xrays, ultrasounds etc. There's talk of possible autoimmune diseases. I'm at a loss to make sense of it or how I can prevent another one.
The hospital dietician confirmed that even though I'm "on the lower side of carbs" (along the lines of Dr. Bernstein's protocol) it's not low enough to cause it. I don't drink alcohol, haven't been fasting, haven't skipped insulin.

I'm all over the place! Has anyone experienced this after stopping Forxiga? I can't help but wonder if there was damage done to make me more prone to e-dka or if there's just something really wrong with me.
Any advice or ideas or support would be greatly appreciated, I feel like no one around me has any idea what I'm going through.

Thanks





 
I may be way off base here as I only know of this from various posts in here, but could it be reactive hypoglycaemia?
Tagging @Lamont D who I think posts about it a lot... I may have the wrong name
Its the wide swings from high to low that reminded me
 
I may be way off base here as I only know of this from various posts in here, but could it be reactive hypoglycaemia?
Tagging @Lamont D who I think posts about it a lot... I may have the wrong name
Its the wide swings from high to low that reminded me

Thanks for replying. The swing from higher to lower (not hypos) only happens when starting a new med, Trulicity was the most dramatic drop.

I’ve only had 1 hypo overnight when I started using insulin, adjusted basal dose & it’s been ok since.

The last few weeks on insulin have been really stable, in range with no wide swings
 
Hi @MissTam , and welcome to the forum!

Sounds like you've been having a very rough time!
Just to make sure, are you on insulin only for your diabetes now or are you still taking other medications with it?

Thanks for the welcome!
Yea it’s been pretty rough. I’m on insulin only now (as far as diabetes meds go).
I was on metformin as well as Trulicity & stopped both when starting insulin
 
Thanks for the welcome!
Yea it’s been pretty rough. I’m on insulin only now (as far as diabetes meds go).

I'm so sorry you're suffering like this. I had no idea you could even get a DKA at lower bgs, it must be really scary. Hopefully your doctors will identify a cause but on the plus side at least you now know the symptoms and can test for ketones often enough to catch it before it requires ICU?

Lots of virtual hugs.
 
I'm so sorry you're suffering like this. I had no idea you could even get a DKA at lower bgs, it must be really scary. Hopefully your doctors will identify a cause but on the plus side at least you now know the symptoms and can test for ketones often enough to catch it before it requires ICU?

Lots of virtual hugs.

Thanks for that. Yea I used to think you had to be insulin dependent with very high BG & skipped insulin for dka.. now I know none of that applies in certain cases.
I’m testing for ketones (still a bit high) but I wasn’t given any instructions by Drs of what to do when ketones are rising.
All I have is a follow up appointment in 2 weeks, hopefully with some answers as to what’s going on.
I don’t know how to tamper ketone production with insulin without causing a hypo (as my BG are finally coming down after they pumped me with glucose IV & high carb food in hospital) ... it’s all so confusing
 
I’m testing for ketones (still a bit high) but I wasn’t given any instructions by Drs of what to do when ketones are rising.

I'd be tempted to ring 111 and ask for advice.
 
I'd be tempted to ring 111 and ask for advice.
Thanks. I managed today to find a T1 sick day protocol pamphlet online with instructions for adjusting insulin according to ketone levels. The only thing is it's made for BGs being over 11.
So I'll need to be a bit more careful but I'm relieved to have some specific info
 
So I'll need to be a bit more careful but I'm relieved to have some specific info

Honestly, in your position I'd ask my team (GP and/or hospital) and ask for advice specific to my circumstances. The sick day rules assume the DKA risk goes away when your bg drops....
 
Having done a bit of reading, it is not RH.
But having wide fluctuations is the reason why you feel awful.

It is another condition which needs to be sorted and controlled.
Hope they find a solution, keep battling, those like us with weird rare conditions need to keep hassling the doctors.
Stay safe.
 
Honestly, in your position I'd ask my team (GP and/or hospital) and ask for advice specific to my circumstances. The sick day rules assume the DKA risk goes away when your bg drops....

That’s a good point. I’m dealing with the public health system here & the hospital Drs couldn’t give me any advice. I had a great diabetes nurse educator but I don’t have any care plan visits left. I might try contact her anyway
 
Having done a bit of reading, it is not RH.
But having wide fluctuations is the reason why you feel awful.

It is another condition which needs to be sorted and controlled.
Hope they find a solution, keep battling, those like us with weird rare conditions need to keep hassling the doctors.
Stay safe.

Thanks for your support, I’m not sure I’ve got much battle left in me
 
Thanks for your support, I’m not sure I’ve got much battle left in me
Hi, I know what you are going through, I was really ill for over a decade because my surgery and the ever revolving GPs, didn't know or trained to recognise the symptoms or read the blood tests, I was misdiagnosed and told to eat the very thing that if I hadn't been referred, was slowly killing me. It was certainly a struggle and I battled and battled, till if I had known better you could see that I'm not diabetic.
I really didn't have a clue? I do now!
And because it's food that causes the condition, I still keep my food diary going.
Don't give up, don't let the b.s. get you down.
 
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