T2 - Insulin and Low Carb Query

Hi
I am Type 2 (diagnosed in 2017 with initial A1C of 117). I was put on metformin and got serious about my low carb diet (I've been successful, when on it, with Atkins since 1984). A year later I had brought my A1C down to 55. For various reasons (including Covid) I didn't get regular appointments with my Diabetic Nurse, however, this didn't worry me as I considered myself controlled. Since original diagnosis I had lost 5 stone up until 2024, which is when I let things slide, so went back to the DN for help with an A1C of 104. I asked for, but was refused Ozempic, instead prescribed Forxiga (dapagliflozin - SGLT-2 inhibitor). Initially I felt awful for the first week I was on it but the Dr persuaded me to perservere as the side effects were only temporary. I did so and sure enough things settled down. Equally as important, I got my diet back in control and in three months brough my AIC down from 104 to 56.

2025 was extremely stressful and from November through February my diet (what diet!!) was out of control. Sometimes my Libre monitor (self funded) didn't have numbers on the scale to record my readings, simply just said "HI". Not to be rude, I'd say Hi back and continue eating Seriously though, the first week of March 2026 I gave myself the proverbial kick up the backside and reigned in my eating and within 10 days I was back in the green with an average over those previous 7 days of 7.9. However, since before Christmas I had been feeling not quite myself, tired all the time, would fall asleep at the drop of a hat, any time, anywhere, but still I kept active with work and day to day stuff. On 13 March, I couldn't even get out of bed. My husband told me that if I wasn't feeling better the next day, I needed to go to the Dr. I had an early night and before I knew it he was waking me up in the early hours telling me he was taking me to hospital. He didn't like the sound of my breathing and thought I was in heart failure. As soon as I was up I started to vomit and done so twice more on the way to the hospital.

Thankfully the emergency room was empty and the Triage Nurse asked me if I was diabetic as soon as she saw me. She said she could smell the ketones. By this time I was in and out of consciousness and I was told I had diabetic ketoacidosis. Unusual but not impossible for a T2. Interestingly, once I had been treated, the Dr told me the DKA was as a result of the Forxiga (apparently a well known side effect of SGLT-2 family) and an underlying infection. While my out of control eating had not helped (A1C of 125!!!!), it was not the main cause of the DKA.

The hospital took me off the Forxiga and replaced it with Insulin, long acting, 20 units twice a day. The Dr also said she would like me to lose more weight. No problem I thought. However, I have been religiously low carbing (between 0 and 25 grams of carb per day) and have been unable to get into ketosis (I normally do within 3 days of getting back on the diet). Not only that, I have put on 11 pounds. From what I am reading, Insulin stops fat burning, which is the whole foundation of a low carb diet. I have also restricted my calories (which is something I have never had to do when low carbing) to under 1,500 a day (I'm 5 foot 8 and weight 14 stone 12).

I have a phone appointment with the diabetic nurse next week and I am going to ask to come off the insulin and go back to controlling my diabetes with diet and metformin (which I've been on since 2017 when I was originally diagnosed). I just wondered if there is any advice anyone can give me or if anyone has been in the same situation with the insulin/diet issues?

At the moment my Libre is telling me that over 7, 14 and 30 days my average glucose is 7.1 and my 90 day reading is 9.1 (down from 19 on 16 March). I am also experiencing low readings through the night (alarms wake me below 3.7).

Thanks for listening.