Low carb flu?

Hi @Cragwood , and welcome to the forums.

You're taking Forxiga and insulin, have you read the PIL that came with your medication?



here is the link to the on-line PIL.
http://xpil.medicines.org.uk/ViewPil.aspx?DocID=27191

Please speak to your doctor if you're having problems.

Obvious suspects are a contrindication from the new med, or low carb flu. But until you look into it further, no one can really say.

The following little article lists a few things people often do when they switch to low carb
https://authoritynutrition.com/5-most-common-low-carb-mistakes/

Of them all, at this time of year, the not enough salt and the not enough to drink are the most likely suspects.
You can test this out yourself, really easily, and see if it applies to you.

Make yourself a big mug of broth (stock cube in water) or bovril. Drink it, wait and see if you feel better.

You can also add salt to food.

If you start to get cramps, esp in hot weather, then you need to look at salt, potassium and magnesium supplements. Apparently something more than half Americans are magnesium deficient, so I can't imagine that the UK is far behind.
http://articles.mercola.com/sites/articles/archive/2013/12/08/magnesium-health-benefits.aspx

Cragwood said:

Hi and thanks for the replies

I did read the PIL and I spoke to both the doctor and the pharmacist when I experienced the sudden drop in blood sugars. I have been monitoring my blood sugars and dropping my insulin every day to stop having hypos.

I'm interested whether other people on this board experienced low carb flu when they started out? How long did it last?

The salt, magnesium and potassium thing is something I'll try straight away!

Thanks for the advice
Jo

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My wife and I both started the LCHF diet a few months ago - our first weekend, we went shopping and could barely walk or think one day. We stopped and got boiled eggs and a latte from EAT and soon felt much better. We've not had a low since.

You will be like a pin cushion when you come out as I was in hospital with DKA last year and I was in for 3 days and stuck on a drip for a day that will have insulin in it and then you will be going to a ward soon and you can soon feel better than you did and you will be able to eat some breakfast and other meals before they let you go as they will be watching you to make sure you don't go back to the way you were and check your ketones via needle until they are gone and then you are able to go home

@Cragwood and @Jordi77, I didn't know it was possible for type 2's to develop DKA. What an eye opener. Keep us posted. I hope you're soon feeling much better.

Oh dear! So sorry to hear this.

Hope you feel better soon.

Cragwood said:

Thanks, still here on a drip. It's a reaction to the Forxiga tablets

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Relieved. Thank you for sharing this. I need to learn more about this drug. What you described is frightening. So, so glad you went to the hospital.

Cragwood said:

Thanks, still here on a drip. It's a reaction to the Forxiga tablets

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@Cragwood, how are you doing now?

@Cragwood, thanks for the update. Glad you're home now. It's good you're taking this slow and giving your body the time it needs to recover.

I'm so saddened this happened to you. Been there myself. A bad reaction to medication is a real confidence shaker.

I, like you, suffered harm due to a medication many years ago. Four years would pass before I would understand what happened to me and before I'd finally get the appropriate care I needed, thanks to a different doctor.

I think I was 29 years old at the time. A year earlier, I had been formally diagnosed with AD/HD, depression, and anxiety. I was reasonably stable but decided it might be worth giving medication a try. After taking my history, the doctor prescribed for me an anti-depressant called desipramine because he thought it would be helpful for all three conditions. Not long after that I began exhibiting hypomanic symptoms. And then, following that, I was diagnosed with bipolar II disorder, and continued under this doctor's care for 4 years.

Luckily for me, a change of circumstances forced me to find a new doctor. After taking my history and reviewing my medical records and personal journals, my new doctor informed me that desipramine is known to cause hypomanic symptoms in normal people and that he wanted to take me off all medication, which I believe took two to three months.

After I completed that process, I felt so much better. I was told that I could never take desipramine again, nor could I take any antidepressant again (which was fine with me. ) I was also told that if I didn't have another hypomanic episode in 5 years time, I would be fine. That was 25 years ago. I'm still fine.

The advice you received to not take Forxiga makes sense to me. The advice to never use the low carb diet again does not.

I have three suggestions for you: 1) do work with your treatment team to get your blood glucose levels back under control with medication and insulin, 2) follow the advice they've given you regarding rest, physical activity, and diet (which I hope will be healthy, whole foods, not processed) and 3) when you're ready, begin asking questions:

- Do you want to try the diet again after your blood glucose levels are stable again? If yes, then I'd ask...

- Is there anyone in your area who is experienced in using the low carbohydrate diet with type 1 and type 2 diabetics?

- Could you begin seeing them?

- Why specifically does your treatment team believe the LCHF diet harmed you? Why do they believe you can never use the LCHF diet again?

If after you're recovered and have gotten your confidence back, you do decide this year or next year that you'd like to try the diet again, a good place to start is the with Dr. Richard K. Bernstein, MD, who pioneered the use of the low carbohydrate diet decades ago. His book is Dr. Berstein's Diabetes Solution, 4th Edition (2011). You can read his inspiring story here...

http://www.diabetes-book.com/bernstein-life-with-diabetes/

What I've learned from my experiences is to always question. And if the answers don't make sense to you, do your own research and consider getting additional professional opinions.

Glad you're back with us again. Take all the time you need to sort this all out. Know that you have our support.

Cragwood said:

Hi Winnie, that's really interesting, thank you. My understanding of the LCHF diet is that your body needs to make the switch from using carbs as fuel to using fats and proteins. For some reason my body was unable to do that. Mark's Daily Apple describes it as being due to "a sliding scale of genetic variations". It might be part of my genetics, it might just be that I have been diabetic for so long. Either way I have no intention of every going into DKA ever again, I wouldn't wish it on my worst enemy xx


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Strictly speaking, you are describing a ketogenic diet, rather than a low carb diet.
Low carbing starts at anything under 130-150 g carbs a day, while 'running exclusively on fat' (ketogenic) is usually anywhere from less than 20 up to 50g carbs. It depends on the person. And there is a huge amount of personal flexibility and tailoring than can be done. No need for extreme keto, for anyone, if they don't want it!

I completely agree with Winnie, and respectfully submit that those instructions about 'never lchfing ever again' may stem from ignorance about the difference between nutritional ketosis and ketoacidosis.

It would be a great pity if your diabetes team's ignorance denied you the opportunity of (in the future, when you have recovered from your recent drug reaction) stabilising your blood glucose by using Bernstein's idea that lowering carbs, reduces insulin doses, and automatically reduces the risk, highs, lows and instability that come with high carb eating.

Gosh, I'm on Forxiga and didn't know about this. I've been on it for about 5 months now and don't appear to have any side effects. Hope things are better for you now Jo?

I've been type 2 for 12 years and suffered from chronic diahorrea for most of that with Metformin and then Glucophage. I was originally told it was IBS and I should work out what triggers it. Docs not really interested. It was only when I went to him with a lot of travelling planned and told him it was completely out of control and he had to give me something or I couldn't travel, that he suggested stopping the Glucophage. Within 12 hours I was back to normal! Stunning.

However I have had to go on to Insulin (small price to pay) and diabetic nurse also continued Glicazide and Forxiga. I don't appear to have any side effects, but I am low carbing. Down to one Glicazide from 4 and 1 Forxiga each day with my Lantus basal.

Should I be worried about DKA? Should I be testing for ketones, if so how do I do this?

Thanks


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Cragwood said:

Hi Winnie, that's really interesting, thank you. My understanding of the LCHF diet is that your body needs to make the switch from using carbs as fuel to using fats and proteins. For some reason my body was unable to do that. Mark's Daily Apple describes it as being due to "a sliding scale of genetic variations". It might be part of my genetics, it might just be that I have been diabetic for so long. Either way I have no intention of every going into DKA ever again, I wouldn't wish it on my worst enemy xx


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Yes, as Brunneria pointed out, there's a lot of confusion about the LCHF diet (up to 150 carbs/day) and LCKD (up to 50 carbs/day). I'm relieved that you understand you can still eat below 150 carbs/day.

Researchers Volek and Phinney acknowledge that the ketogenic diet doesn't work for all diabetics, but beyond that I don't know much. In general, I thought they were referring to the lipid panel worsening rather than improving over time, nothing like what happened to you.

I'm perplexed as to how eating less carbs in the 50 to 150 carb range would raise blood glucose levels and be destabilizing. I would think the opposite would be happening, that you'd be at higher risk for hypos.

DKA is outside of my understanding because I'm a type 2 and have always been able to easily explain my high blood glucose levels - (it usually involves a muffin made with almond flour that has been sweetened with sugar).

I'm trying to think of anything helpful that I can share...

Well, perhaps this, because not sure Bernstein discussed this or not, and I loaned my book to a friend so can't check...

On the LCHF diet, we're restricting carbs and protein. If you go to this thread - http://www.diabetes.co.uk/forum/threads/lchf-issues.102455/ - and find post #19, I provide information on how to calculate daily protein intake. For me, one egg in the morning and 2 ounces chicken for lunch and 2-3 ounces of meat, poultry or fish for dinner meets without exceeding my protein limit for the day.

@Cragwood I'm still shaken up by what happened to you. I hope as you sort this out you'll keep us informed as to what you're learning and discovering. Hoping, hoping you'll be able to find an eating strategy that works for you. I would be interested in corresponding privately with you anytime. I really want to understand...

http://eatingacademy.com/nutrition/is-ketosis-dangerous

http://ketopia.com/ketosis-fear-uncertainty-and-doubt/

http://www.dietdoctor.com/low-carb-diet-pill-good-idea

Wow, I'm still stumped. Everything I've read so far says diabetic ketoacidosis cannot occur if your pancreas is still producing insulin but then I read this on Diet Doctor - (click on third link) - and it sent chills up my spine...

"Forxiga blocks the reabsorption of glucose in the kidneys. This leads to the excretion of glucose – up to 70 g per day may leak out into the urine for people with diabetes (less for people with normal blood sugar).

So the result may be the same as if you had eaten 70 g less carbohydrate that day. This results in lower levels of the hormone insulin."

Based on that, I'm not sure Forxiga combines well with the low carbohydrate ketogenic diet.