Type 2 Worried! DKA

[Nicel]

Today I’m starting a low carb diet. My blood sugar has been awful. I’m on trulicity 0.75 and Jardinance 10mg

I’ve just tried out a keto urine strip and it’s showing ketones as 1.5mmol. My blood sugar is 8.4mmol.

I’m very poorly with long covid and fatigue at the moment.

Is the ketone and blood sugar ok or should I be alarmed. I thought I’d have no ketones as only has breakfast without carbs this morning. I’m T2. I had v high blood sugar in covid and I’m wondering if my pancreas has been compromised

Thanks

 

[ajbod]

That shows you are in Ketosis, burning fat. It is only a problem with much higher levels of Ketones alongside much higher Glucose levels. Provided your sugar and Ketone levels don't climb a lot higher, you are in a very good place. Had your Pancreas been damaged, your sugar levels would be a lot higher. as a type 2 like myself, DKA is virtually impossible.

 

[Nicel]

Ok thank you

 

[Hopeful34]

@Nicel is only starting a low carb diet today @abjod so won't be burning fat. Jardiance can cause DKA as a serious side effect.

 

[ajbod]

My understanding is as long as Ketone levels don't hit about 3 then there is not actually a problem, hence the reason i said provided the levels don't rise a lot higher, although 3 is not high, it is double the current level of 1.5.

 

[Nicel]

My understanding is as long as Ketone levels don't hit about 3 then there is not actually a problem, hence the reason i said provided the levels don't rise a lot higher, although 3 is not high, it is double the current level of 1.5.

Thank you

 

[KennyA]

Today I’m starting a low carb diet. My blood sugar has been awful. I’m on trulicity 0.75 and Jardinance 10mg

I’ve just tried out a keto urine strip and it’s showing ketones as 1.5mmol. My blood sugar is 8.4mmol.

I’m very poorly with long covid and fatigue at the moment.

Is the ketone and blood sugar ok or should I be alarmed. I thought I’d have no ketones as only has breakfast without carbs this morning. I’m T2. I had v high blood sugar in covid and I’m wondering if my pancreas has been compromised

Thanks

If you've only just started low-carb I'd be very surprised if you're fat-adapted and producing ketones in less than a day. I have been in (mainly) and out of ketosis for the last three and a half years and it usually takes at least three days to restart.

Of themselves the ketone levels you're reporting are not particularly high - I'd normally expect to be somewhere between 1.5-and 4 mmol/l.

However empagliflozin has Diabetic Ketoacidosis listed as a possible side effect and I think you should get some proper advice - try 111 as the first option?

Side effects of empagliflozin

NHS medicines information on side effects of empagliflozin and what you can do to cope.

www.nhs.uk

 

[Oldvatr]

If you've only just started low-carb I'd be very surprised if you're fat-adapted and producing ketones in less than a day. I have been in (mainly) and out of ketosis for the last three and a half years and it usually takes at least three days to restart.

Of themselves the ketone levels you're reporting are not particularly high - I'd normally expect to be somewhere between 1.5-and 4 mmol/l.

However empagliflozin has Diabetic Ketoacidosis listed as a possible side effect and I think you should get some proper advice - try 111 as the first option?

Side effects of empagliflozin

NHS medicines information on side effects of empagliflozin and what you can do to cope.

www.nhs.uk

I am on Dapagliflozin which is a brother med to Jardiance. I had an episode where my ketones on my wee stix was at 3.9 one minute, and rose to 8 a half an hour later, and I felt definitely out of sorts. The levels dropped after that so it was not DKA, but my glucose was only 6.2 mmol/l so it was not dietary ketosis either. This family of meds can suddenly react to something (illness, dehydration, fasting or whatever) and those taking one of those meds need to get wee sticks to monitor if they feel off colour. You need to overhydrate to flush the ketones out.

you have an additional risk of DKA with Trulicity, since there is also a small risk of DKA from that family of meds too.

 

[HSSS]

That shows you are in Ketosis, burning fat. It is only a problem with much higher levels of Ketones alongside much higher Glucose levels. Provided your sugar and Ketone levels don't climb a lot higher, you are in a very good place. Had your Pancreas been damaged, your sugar levels would be a lot higher. as a type 2 like myself, DKA is virtually impossible.

Not quite true. Sglt-2 medication like jardiance are know to have a risk or euglycomic dka. In other words without the high glucose levels normally seen with dka.

However if I read this right the op has only had one low carb meal so far so will in no way be in nutritional ketosis - due to diet - so something else is going on.

Personally I wouldn’t mix these meds with low carb due to this dka risk, especially when already unwell which can cause it’s own issues with meds.

 

[Nicel]

If you've only just started low-carb I'd be very surprised if you're fat-adapted and producing ketones in less than a day. I have been in (mainly) and out of ketosis for the last three and a half years and it usually takes at least three days to restart.

Of themselves the ketone levels you're reporting are not particularly high - I'd normally expect to be somewhere between 1.5-and 4 mmol/l.

However empagliflozin has Diabetic Ketoacidosis listed as a possible side effect and I think you should get some proper advice - try 111 as the first option?

Side effects of empagliflozin

NHS medicines information on side effects of empagliflozin and what you can do to cope.

www.nhs.uk

Hi. They are 8 mmol this morning . I’ve just called 111 and a doctor is calling me back

 

[Oldvatr]

Hi. They are 8 mmol this morning . I’ve just called 111 and a doctor is calling me back

Drink loads of water. Try to pee the ketones out. The Trulicity will be reinforcing the Jardiance, and may make the episode last longer since Trulicity is a spanner in the works. Make sure the Doc understands the Trulicity effects. Trulicity lasts longer in the body and is overriding the normal turn off mechanism via GLP-1

 

[HSSS]

Hi. They are 8 mmol this morning . I’ve just called 111 and a doctor is calling me back

Let us know how you get on.

 

[Nicel]

Let us know how you get on.

Really odd. Saw the doctor blood ketones 1.2 mmol. Urine ketones 6mmol. Went back after two hours ate carbs. Urine same. Blood 0.4mmol so he was ok with that. I used my strips and his for urine and we both got the same.

 

[Oldvatr]

Really odd. Saw the doctor blood ketones 1.2 mmol. Urine ketones 6mmol. Went back after two hours ate carbs. Urine same. Blood 0.4mmol so he was ok with that. I used my strips and his for urine and we both got the same.

Phew! It shows your kidneys are clearing out the ketones adequately. I have CKD so that is not so much a given for me. Beware of getting a UTI or kidney infection, or dehydration while on those meds.

But I am worried because I was unable to convince my GP to report my event in the Yellow card System. He would not because he had no evidence (medical tests) showing my condition, and it was therefore anecdotal. Even though your doctor observed his own tests, again, it was not n emergency event, and the readings were within recognised normal expectations.

The problem we have is what happens next time? If we see a reading of 8 mmol on our weestix, do we ignore it and wait for full blown DKA to develop? That is what I did in my case, but I was putting myself at risk. But my GP refuses to provide blood test strips even after my episode. As it happens I had one ketone test strip sample for my meter and it read 3.2mmol/l when my weestix registered 4.9

I am concerned that the recent licencing of Ozempic through WeightWatchers being able to prescribe over the phone or online without needing evidence of good kidney function. But that audience is not being warned of DKA or the need to monitor ketones. I am not sure if they triage on diabetes either. From the application form I saw it was simply height and weight. It seems our GP's are doing the same for us diabetics. Save the pennies on test strips and kidney tests, expend pounds on blue light taxis and hospital stays, because it is not the GP budget that carries that expense.

I note that Dapagliflozin is also being prescxribed for heart failure, and CKD in non diabetics. Trulicity is also being prescribed for general obesesity patients - again non diabetics. At least we diabetics get an annual review and screenings that are not the norm in the general populace.

 

[Nicel]

Phew! It shows your kidneys are clearing out the ketones adequately. I have CKD so that is not so much a given for me. Beware of getting a UTI or kidney infection, or dehydration while on those meds.

But I am worried because I was unable to convince my GP to report my event in the Yellow card System. He would not because he had no evidence (medical tests) showing my condition, and it was therefore anecdotal. Even though your doctor observed his own tests, again, it was not n emergency event, and the readings were within recognised normal expectations.

The problem we have is what happens next time? If we see a reading of 8 mmol on our weestix, do we ignore it and wait for full blown DKA to develop? That is what I did in my case, but I was putting myself at risk. But my GP refuses to provide blood test strips even after my episode. As it happens I had one ketone test strip sample for my meter and it read 3.2mmol/l when my weestix registered 4.9

I am concerned that the recent licencing of Ozempic through WeightWatchers being able to prescribe over the phone or online without needing evidence of good kidney function. But that audience is not being warned of DKA or the need to monitor ketones. I am not sure if they triage on diabetes either. From the application form I saw it was simply height and weight. It seems our GP's are doing the same for us diabetics. Save the pennies on test strips and kidney tests, expend pounds on blue light taxis and hospital stays, because it is not the GP budget that carries that expense.

I note that Dapagliflozin is also being prescxribed for heart failure, and CKD in non diabetics. Trulicity is also being prescribed for general obesesity patients - again non diabetics. At least we diabetics get an annual review and screenings that are not the norm in the general populace.

I know it all seems crazy to me. I’ve got a call with a GP to discuss this now. My Ketones are 0.5 this morning so that is better. I had some bloods recently and my kidneys and liver are all good so at least I know that. I disagree with these injections being used for weight loss. They are too dangerous.

I want to discuss coming off meds and doing this by diet now. The meds just make me sick.

Good luck with you