Possible LADA - do I need to worry about DKA?

[AndyMc]

Hi, I self-diagnosed high blood sugar about 8 years ago after a period of steadily losing weight.

I was able to get my blood sugar under control by switching to a low-carb diet, but over the years my levels have been gradually increasing. I've made my diet stricter (it's very extreme now, probably < 20g of carbs per day), and added more exercise, but in the last few months my readings are high-ish all the time - mostly in the 10 to 12 range.

So I went to a GP, got an HBA1C and it has confirmed my readings - HBA1C is 64. I suspect some form of type 1 / LADA.

I'm now waiting for an initial appointment with a diabetes nurse, which is two weeks away. In the meantime I'm slightly concerned about DKA. Assuming my pancreas is producing very little insulin, does my long-time low carb diet make DKA more or less likely? I'm struggling to find anything online that helps me answer that.

Thanks

 

[Deleted member 527103]

If you are concerned you could purchase some ketostix from your pharmacy.
DKA is only a concern if your blood sugar levels are high. I assume from your self-diagnosis" you have a meter so just keep an eye on your levels.

 

[Antje77]

If you are concerned you could purchase some ketostix from your pharmacy.

When eating less than 20 grams carbs a day, you're likely in ketosis so ketostix will show ketones. This doesn't mean you're in DKA.
Usually, T1's aren't at risk from ketoacidosis until their BG is at least over 13 for a prolonged time, and usually it doesn't happen until glucose levels are higher than that.

A low carb diet doesn't make DKA more or less likely, the only issue with it is that a quick test for ketones won't tell you anything because you're in ketosis anyway.

 

[AndyMc]

Usually, T1's aren't at risk from ketoacidosis until their BG is at least over 13 for a prolonged time, and usually it doesn't happen until glucose levels are higher than that.

A low carb diet doesn't make DKA more or less likely, the only issue with it is that a quick test for ketones won't tell you anything because you're in ketosis anyway.

Thank you, this is very helpful. I will just keep a careful eye on my blood sugar levels but otherwise carry on as normal.

 

[searley]

For me whilst producing some insulin I did not get dka as my body was getting energy from what little insulin I had... also in the early stages you can get ever increasing BG even though you can be producing a substantial amount of insulin just not enough to maintain a low bg.. again in this scenario dka is unlikely as your body is still getting energy from food

However for the cost of a pack of ketostix it does not hurt to do a few checks whilst you wait for some official results etc

 

[EllieM]

Thank you, this is very helpful. I will just keep a careful eye on my blood sugar levels but otherwise carry on as normal.

I'd have a look at the other symptoms of LADA as described in this NHS article as well,
https://www.nhs.uk/conditions/diabetic-ketoacidosis/
where they say you shoud be checking ketones if you are over 11mmol/L

 

[Antje77]

Checking for ketones when on a keto diet won't tell you anything because you will have dietary ketones.
So you can only go by symptoms (read the link @EllieM posted!) and keeping a very close eye on your blood glucose.

 

[jonathan183]

Dehydration and high blood glucose are the key things to watch out for. I have been on a low carb diet since before starting on insulin and have had over 6mmol/l ketones with no ill effects both before and after starting on insulin (usually in the 0.5 to 4mmol/l range). I'd suggest you stick with low carb until you get to see the specialist - but explain you are very low carb otherwise they will have a fit when they see ketone levels.

 

[AndyMc]

Just a small update in case anyone else is in a similar position.

I had a call with a Diabetes nurse and as expected she wanted me to try Metformin as a first step. To my surprise this brought my blood sugar readings down significantly within a couple of days (with just a starter dosage of 500mg). I'm consistently getting 8s and 9s where before I was getting 11s and 12s, over the last 10 days. Not ideal but a significant improvement.

Not sure how long the effect will last, but feels like this is a good enough to postpone pushing for insulin for now.