Still high BG , any suggestions?

[xirles]

Hi all,

Yes its the "wife again". My hubby has now benn very low carbing for almost 3 weeks and no improvement really in BG levels. Around 12.5 on waking, around 14 to 15 at lunchtime after bacon and egg or omelette for breakfast. Salad at lunchtime, stubbornly still around 12 - 13 before dinner of fish/ meat green "above ground veggies.
GP will " call him" to discuss in another 2 weeks ( earliest appointment!).
He is getting a bit down now, no energy, tired all the time and frankly feels hungry a lot of the time .
He isn't overweight and is obviously losing more weight from the strict diet. Dipped his urine and showing ketones as you would expect.
On glyclizide 40mgs one in the morning and metformin 850mgs twice daily.

 

[boggle]

Possibly not T2?
How many ketones?
What does he drink?
Any snacking on fruit?

Most people will feel tired switching to a low carb diet, it can take a while to become fat adapted.

 

[xirles]

Only drinks water ( sometimes sugar free flavoured). Has cut out fruit too.
It was the usual urine dip stick test and reading high end of ketones range on strip. It isn't just a ketone specific testing strip. Also measures protein, leukocytes etc.
Says he feels nauseous today. Went for a walk for an hour, BG now reading 12.8 and hasn't eaten for over 3 hours.
His breath doesn't smell of " pear drops" though.

 

[rman]

I would not wait for the GP appointment to be honest. I am not from the UK, but in my country there is a telemedicine service. Can you query with your local telemedicine service if available ? If not a trip to the emergency will not do anything bad, particularly since he is feeling nauseous. Such high figures cannot be sustained.

 

[HSSS]

I’m concerned when you say ketones are at the top of the strip test and that it’s where you’d expect. Even on full on keto top of the strip is not what I’d expect and it is worrying me. Can you put any numbers to what the strip is showing?

Where are the fats in his diet to keep him feeling full and prevent weight loss he doesn’t need? Is he eating enough or is he on starvation rations? Is he getting magnesium, potassium and sodium? Going low carb can rapidly decrease these essential electrolytes and leave you feeling terrible, but is easily solved.

Is there any way he could be cheating his diet without your knowledge maintains the high levels?

Not sure of his past but is there anything that suggests he could be type 1 not type 2? I’m assuming this is a fairly new diagnosis from the way this is worded Was he ever tested for insulin and antibodies?

 

[xirles]

Diagnosed type 2 some years ago. Last Hba1c was 62, that was about 6 weeks ago.
Felt unwell for about 3 weeks, ( previous post about beta blockers that are now discontinued by cardiologist. )
Blood glucose seemed to shoot up after starting bisoprolol but now think it may be a coincidence.
Reading above 1.6 on ketones strip, that is highest " colour".
I have called OOH service and fingers crossed will get a GP call back in a couple of hours!
Hubby doesn't want any " fuss" and none too pleased I have phoned them.

 

[xirles]

His sister was late onset type 1 diabetes initially treated as type 2. Despite my best efforts, it has fallen on deaf ears at our GP practice.

 

[JoKalsbeek]

His sister was late onset type 1 diabetes initially treated as type 2. Despite my best efforts, it has fallen on deaf ears at our GP practice.

Just call 111 and try to get the ball rolling by bypassing the GP. Say diagnosis is currently uncertain, but he has high blood sugars and ketones present, feeling unwell. That should get someone to take notice.

 

[xirles]

Just had out of hours GP call. Said John to go to A& E this evening. Hubby not keen, GP said he has to go!
Our son on his way to pick him up, ironically he finished work in Urgent Care A&E at another hospital about 2 hours ago! Let's hope he can get his dad seen before morning as A&E will be packed out.

 

[ert]

Just had out of hours GP call. Said John to go to A& E this evening. Hubby not keen, GP said he has to go!
Our son on his way to pick him up, ironically he finished work in Urgent Care A&E at another hospital about 2 hours ago! Let's hope he can get his dad seen before morning as A&E will be packed out.

As a diabetic with possible DKA, they should have someone check his blood sugars and ketones and blood pressure when he arrives before you wait to see a consultant.

 

[xirles]

Update from our son at A&E. Blood gases normal, waiting for more blood results. They don't think it is DKA.
Doctor said the "virtually no carb" diet not sustainable longer term as he has lost 8lbs in weight in 3 weeks and wasn't overweight to start with.
Hopefully someone will prescribe the correct medications and then he can eat a little more and feel much better.
Bloods also taken to check he doesn't have an underlying infection.
Feel at last someone is actually investigating!!

 

[HSSS]

Which shows that dr knows nothing about keto! But it’s good that dka is not the problem.

I do think that you may have been cutting everything out not just carbs possibly. If you cut carbs you must increase proteins/fats or else it becomes hunger city and starvation which are not sustain long term.

 

[xirles]

Back home now.
Letter for GP surgery requesting urgent medication review. Saw medical registrar before he left who actually approves of Keto diet. Said it is ok to continue long term but needs need a medication review.
You may be correct HSSS, need more fats, we just discussed that his diet may have been high protein but not really much else.
Thanks everyone for your advice. It really is very reassuring and helpful.

 

[HSSS]

Back home now.
Letter for GP surgery requesting urgent medication review. Saw medical registrar before he left who actually approves of Keto diet. Said it is ok to continue long term but needs need a medication review.
You may be correct HSSS, need more fats, we just discussed that his diet may have been high protein but not really much else.
Thanks everyone for your advice. It really is very reassuring and helpful.

Have a look here for some ideas, info and recipes (no need to pay anything for meal plans etc unless you want to) www.dietdoctor.com/keto or www.dietdoctor.com/low-carb

 

[ultradad]

I used a carnivor calaculator https://www.thecarnivoredietcoach.com/calculator.html to work out how much protien and fat i needed each day and have not felt hungry since i cut out carbs or felt unwell. Double cream in a coffee or tea is a quick way to get extra fats into your system (15mg for 2 tea spoons). Hope you feel better soon. I found 145 grams of fat and proteins a day work for me

 

[JoKalsbeek]

Back home now.
Letter for GP surgery requesting urgent medication review. Saw medical registrar before he left who actually approves of Keto diet. Said it is ok to continue long term but needs need a medication review.
You may be correct HSSS, need more fats, we just discussed that his diet may have been high protein but not really much else.
Thanks everyone for your advice. It really is very reassuring and helpful.

Glad he went, because DKA can be quite deadly, and it did sound like he was headed that way. Up the fats. They don't up glucose at all, but protein does, a bit. (Nowhere near as much as carbs would, but still).

Crazy questions, but has he been having headaches, muscle and joint aches, and fatigue? If so, he might want to take an electrolyte supplement as he could be low on those. Just thinking out loud.

 

[JoKalsbeek]

Yes its the "wife again".

By the way... It's the wife again, a lot of us would count ourselves lucky to have someone who got so involved and tried to educate themselves about our conditions. (My husband would, and did, but he wouldn't be able to come on here. His English is fine, but his medical English isn't.). Don't colour yourself a nuisance or anything. You're the best kind of spouse to have, and we're more than happy to help, if in any way we can.

Hugs,
Jo

 

[xirles]

Thanks again everyone. Your kind words are appreciated Jo. X

 

[xirles]

Update: This morning we saw " new" diabetes nurse who started last week at GP surgery . She spoke to us, checked his scarily high blood sugar readings from his device. Then said, " this looks like LADA to me" . AT LAST SOMEONE IS LISTENING.
She took blood for C- peptide and GAD, ordered urgent pancreatic scan and meds changing from tomorrow with strong possibility of starting insulin when she sees him with results next Wednesday.
He has lost 5kg in weight in less than 4 weeks hence the scan.

 

[danziger]

The new nurse sounds on the ball, thank goodness! I hope you get some answers soon.