Worried about ketoacidosis

[Winnie53]

That is very good news @miffli. I'm both relieved and happy for you.

Eric Westman, MD, an internist in the US who first learned about the keto diet from two of his patients in 1998, became curious about the diet and was invited by Dr. Atkins, who popularized the keto diet in the 1970's for weight loss, to spend time in his clinic to learn more about the diet and its effect on his patients.

Five years later, Dr. Atkins paid Duke University where Dr. Westman worked to study the low carb diet.

A number of studies were begun and later were completed with positive results. Sadly, in 2003, Dr. Atkins slipped on ice, hit his head, and died from his head injury a few weeks later.

Undeterred, Dr. Westman continued to study and learn about the keto diet from Dr. Atkins' nurse, Jackie, who worked with Dr. Atkinss patients on how to start and follow the diet for 30 years.

More recently, Dr. Westman started the HealClinics with Jackie's assistance.

In this lecture Dr. Westman reminded me that they start their patients on 20 carbs a day in the beginning, and around minute 17:00 shows "page 4" of the hand out Dr. Atkins and Dr. Westman uses to teach patients what to eat for that first month. (Virta Health starts their patients on 30 carbs a day)...

Dr. Westman also stated that only 30 to 50 percent of their patients get into ketosis eating more carbs initially. This may be helpful to @lcarter

 

[MillieT]

I have failed in that the last two days i took the jardiance because my sugars were on 17 and i felt awful, i think i feel even worse now with the worts headache and feeling sick, apart from that i'm ok, managing and have not failed on the low carb intake.

 

[Winnie53]

@miffli when we continue to feel worse, not better, sometimes it's helpful to make one change to see what happens.

In your case, your glucose levels were so elevated and you felt so awful, you did just that, you made one change: restarting your diabetes medication Jardiance. I might have chosen to do the same, had I gone from having normal glucose levels to high after stopping my medication. Don't know.

Now you know. You feel "even worse now with the [worst] headache and feeling sick".

miffli, you're going to feel poorly until those glucose levels start coming down. It's at these moments when I wish I had that magic wand to wave and make you all better...

Five years ago, it wasn't until I was on the keto diet for two to three weeks that I saw the beginnings of a downward trend in glucose levels. Am hoping you will too. But I know it's hard, really hard...

I'm a bit worried that you've resumed taking the Jardiance because doing so could land you in the hospital with ketoacidosis. What's your thinking on that?

I personally would choose to come off the Jardiance now, and give it another two to four weeks on the diet. At minimum, I'd let your doctor know if you continue on the Jardiance.

Another possibility would be to try a different diabetes medication, preferably one that doesn't increase insulin production or put you at risk for ketoacidosis.

My vote - (not that I have a vote in this, it's your decision) - would be to come off the Jardiance and give the keto diet a minimum of another two to four weeks.

Wondering also what would help you get through another two to three weeks of high glucose levels if you choose to stop the Jardiance?

 

[Winnie53]

@miffli after a bit of pacing and hand wringing, it seems I'm have more to say...

I am not anti-medication.

There are times when medication is necessary. Type 1 diabetes requires insulin, as does latent autoimmune diabetes in adults (LADA) eventually. Maturity onset of diabetes in the young (MODY) is another type of diabetes that may require medication and/or insulin eventually. But even in those cases, insulin and/or medication is not enough. Complications commonly follow those diagnoses without the additional intervention of the right diet and physical activity.

Type 2 diabetes is different - (outliers aside, and there are always a few for any condition) - use of medication or insulin does not stop or reverse the progression and worsening of diabetes. It appears to slow it down, but I don't know if it does or not. Does it lower glucose levels? Yes, initially, but more often than not, glucose levels begin to climb again, leading to dosage increases, addition of more medications, and ultimately the addition of insulin. Not always, but as I said, more times than not.

I have members of my diabetes group who were fine until they entered the third decade of their type 2 diabetes. It's difficult, but even then, while it's not always possible to reverse all the damage done, some damage can be reversed with the right diet and physical activity, and lab test results can be improved.

The good news is, the right diet and physical activity can and often does stop the progression, perhaps even reversing it in many cases. The sooner you get started, the better.

And let me tell you, when I started the LCHF/Keto diet five years ago, I had lived with type 2 diabetes, untreated, for ten years. Imagine how I felt in those early months on the keto diet when I heard multiple experts restate research that it is very difficult to reverse diabetes after 8 - 10 years. It was discouraging, and it stole away my hope.

But then, I'd remember that others here on this forum had reversed their diabetes so why not try for being a "statistical anomaly" or an "outlier"? What did I have to lose? Nothing. What did I have to gain? My health. If not now, when? Later? How much later? Would postponing giving it my best effort help my chances? Possibly, but probably not.

miffli, I know this is cliche... You fell off the horse, and it really hurt. It's up to you, but I'm hoping you get back on that "horse". Give the keto diet 4 weeks completely off the diabetes medication. I've had a few members running glucose levels much higher than yours during those first weeks, so know that you're not the only one.

If sticking with the keto diet off the diabetes medication means only checking your glucose levels once a day, two hours after eating a healthy keto style breakfast with adequate protein, fat, and fiber (from non-starchy, whole foods), for a week or more, do it. Figure out what you need to do to push through those 4 weeks, knowing that after that, it likely will get a lot easier for you. Go for it. Let us know how we can support you. We're here for you. I'm here only for you.

Edited to add: One of my favorite things to do now is show doctors my "before" and "after" lab results to see their reaction. It's...so...much...fun.

 

[MillieT]

Hello, not sure what horse i was on?!! lol. Anyway, I managed to get some test strips yesterday as have been without since last week, and have been really rough the last few days, i missed a gp appointment too but i was out cold, my sugar levels are still through the roof for me using my test strips, i just took a test a few moments ago, i have something to eat a couple of hours ago, an omelette with chorizo pieces in it and i'm still up to 17.8

I woke up yesterday and today on 19.5 and 19.8 respectively. the lowest i have been since yesterday is 15.6 so hence why i feel terrible i think. I tried urine test strips several times as you all said they are hit and miss, it showed low glucose but high ketones (purple) , everything else was on normal but being this high on my blood readings makes me worry ever so much, i don't feel right at all, like i'm running off of helium or something. @lcarter has been really poorly too and I'm hoping she makes it through ok, i worry because we both have had similar experiences so far with the keto diet. Thing is I have been doing it for well over 4 weeks now, weight loss, yes, just over half a stone since 2 weeks before Christmas, not sure whether that is good or bad.

I know i keep getting migraines from hell and nausea a lot and i am eating plenty of roughage, protein and fat ratio, last night i had a stir fry and i'm really not a great lover of frying anything but have been using an organic rapeseed oil '0' cholesterol just in case.( - that's another thing, I am absolutely committed to eating organic produce as have a really bad angst against Monsanto, i would not stand downwind of anything derived off them if i can help it.-mini rant over) I have just spent a small fortune on my garden beds this year, new raised ones, lined and organic soil/compost and organic/ heirloom seeds, so lots of nice stuff coming this year

I have only had a late lunch today and nothing more as just do not want to eat at all, i am however wondering if this is part of the problem only i am just not hungry like i was the first couple of weeks, i even walked over a mile today which surprised me, it did however take a while!

 

[HSSS]

I’m surprised the urine strips say low glucose with blood readings like those. At this point in your shoes I think I’d be back to the dr. Soon! High ketones and high blood glucose is nothing to be messed around with.

High teens after 4 weeks of very low carb, decent electrolytes and enough fat should not be leaving you feeling like this as a type 2 that is still producing (overproducing normally) insulin.

Maybe you are no longer making sufficient insulin or are in fact a very slow onset type 1 (LADA) and not a type 2 at all. I would be asking for antibody tests and c peptide to establish exactly what’s going on and how much 8nsulin you are producing and then apply the results to the way forward.

Hope you get some answers soon and feel better.

 

[MillieT]

Oh gosh, that worries me, with my anxiety i shall try the test strips again shortly, i wonder if this is why i feel so strange, i'm light headed, really nauseous, last night i was sick, i know my legs hurt especially my right one under my knee for some reason- i know, bizarre, tummy ache or at least unsettled, it's that yukky feeling where you feel light headed i can't stand. I am going ot ask for these tests asap, i am surprised they have never actually tested me for this. Thank you.

 

[HSSS]

Oh gosh, that worries me, with my anxiety i shall try the test strips again shortly, i wonder if this is why i feel so strange, i'm light headed, really nauseous, last night i was sick, i know my legs hurt especially my right one under my knee for some reason- i know, bizarre, tummy ache or at least unsettled, it's that yukky feeling where you feel light headed i can't stand. I am going ot ask for these tests asap, i am surprised they have never actually tested me for this. Thank you.

I’m not saying that’s what’s happening. I’m saying I’d want reassurance it wasn’t. Please don’t panic but also don’t ignore high bgl and high ketones. Just in case.

 

[ziggy_w]

Oh gosh, that worries me, with my anxiety i shall try the test strips again shortly, i wonder if this is why i feel so strange, i'm light headed, really nauseous, last night i was sick, i know my legs hurt especially my right one under my knee for some reason- i know, bizarre, tummy ache or at least unsettled, it's that yukky feeling where you feel light headed i can't stand. I am going ot ask for these tests asap, i am surprised they have never actually tested me for this. Thank you.

Hi @miffli,

I am no expert at this, (and of course wouldn't want to worry you unnecessarily), but if I were you I would this get looked into as soon as possible.

I agree with @HSSS -- High blood sugars, high ketones, feeling light-headed and nauseous, and being sick don't sound good at all. Can you make a phone call tonight to talk to a medical professional or go to the emergency entrance (A&E?) to get this checked out?

 

[Winnie53]

@miffli sorry to hear you're still feeling miserable.

It would be helpful if you could state what your ketone level is, number and units.

You posted a picture of your test strip previously, but the ketone test strips I use here are nothing like the ketone test strips you photographed and posted. I tried and tried to make sense of it at the time, but just didn't have enough information from the one photograph.

Glad to see you posting again.

 

[HSSS]

Let us know how you get on @miffli

 

[Brunneria]

I agree with @HSSS and @ziggy_w
You need to get medical advice on whether your current numbers are from being LADA and not T2. Or whether you now have a low insulin output, which means that even with low carb, you cannot produce sufficient insulin.
Ask for proper testing, or press to get copies of the results if those tests have already been run.
Ask for a referral to an expert on the subject.

In your situation I would be far more anxious about running high blood glucose for extended periods while not being correctly diagnosed, than I would be of achieving an accurate diagnosis and getting the appropriate treatment.

Good luck with getting a quick answer from your referral, and please keep us informed.
And have a hug.
This kind of unclear limbo is always very stressful, but once you get a clear answer and proper treatment, I am hoping that things will settle down.

 

[MillieT]

Sorry i did not reply last night, i was not very good and was trying to fathom out these urine test strips against my sugars... I have no idea what is going on, i realise some have said that the urine test strips give silly readings, well i checked them thre times last night after @HSSS's input and they have come back with fairly high glucose and zero ketones?!!! This is strange because I have not once gone off the keto diet, i check everything prior to eating it, i did want for something to eat last night and had some seafood.

This morning i was on amazingly 12.8 which is lower yet the test strips show something else. I have no had barely anything to eat today due to my stomach is cramping something horrid, i just took my sugars and they are on 8.8 - like wow, test strips show high, from last night until 4.30pm this is what they show.
The top three are at different intervals after speaking on here, are they dodgy test strips? all showing high glucose, very low if any ketones.

This morning:

And 4.30pm

 

[MillieT]

@Winnie53 this would mean i have to find and buy a ketone meter and i have seen some but they are really expensive, there are breath ones and blood ones.. I was using a Caresens blood meter but my old surgery changed me over to this Finetest Lite thing which half the time doesn't work. I'm going to ask to change back again, half these lancets are missing the needle too :|

 

[MillieT]

That last reading from 4.30pm shows high glucose and my test meter shows 8.8 which clearly is not as high as they were, i think these test strips are a bit naff maybe.

 

[HSSS]

well that all looks much better!

Of the two I’d be inclined to believe the blood glucose meter not the strips. It’s more accurate.

Urine ketone strips only show the wasted ketones. Not those that you use and are notoriously unreliable especially more than a few weeks in. As you become fat adapted you waste less and use more so do t show as much or at all on the strips. Also to add there’s more than one type of ketone and urine strips only measure one type. The blood ones measure a different one as do the breath ones!

 

[Winnie53]

@miffli I'm very confused too. More so now. Without a dependable way of testing your glucose levels and your ketone levels, you don't have the information you need.

I need to research what's available in England.

 

[Winnie53]

I don't know what monitors/meters to use in England to dependably and inexpensively monitor ketone and glucose levels separately, so asked here... https://www.diabetes.co.uk/forum/th...lucose-levels-in-england.171607/#post-2207068

Sorry to hear you missed your doctor appointment. Hope you've scheduled a new one.

 

[MillieT]

Back again, i'm up at this hour due to anxiety, i have felt terrible the last few days, i went 18 hours without eating becuse i simply wasn't hungry at all, i then had two eggs with two rashers of bacon, half a tomato around 2pm yesterday- first thing all day, and last night i had cauliflower cheese, i was gardening in the afternoon but was so out of breath i only managed 20 minutes sticking some bulbs in and had to come in, walkign somewhat like a penguin too, i just felt stiff all over. Checked my blood pressure and it was slightly up, i was anxious so checked it three times 145/87 139/103 130/94 so took a perindropril and hoped for the best.

I had cauliflower cheese for dinner with some chorizo pieces in it and 2 hours later and feeling terrible my sugar meter readings were 19.5 .. like how.. I started keto a couple of weeks before Christmas, it started to work and i lost a stone but i have stopped dead now and i'm sure i'm actually going up again and i am definitely not eating as much as i did before. I'm contemplating giving the diet up and seeking other help only getting an appointment with the diabetic nurse here is hard work, i have to speak to the doctors first so they can authorise me going if for goodness sakes, i can't have an appointment at the moment, they're running scared due to coronavirus so i get an phone appointment next Tuesday evening... i give up.. i'm sat here making my way through a couple of litres of spring water in a bid to get my sugars down :|

 

[MillieT]

oh, and tonight i have the worst stomach acid after that cauli cheese i have taken some lanzoprazole and it has not even touched me, i have acid reflux now too.. how utterly wonderful