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Worried :(

lcarter

lcarter

Well-Known Member
Messages
513
Location
Nottingham
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
My pancreas
Hi guys...

Just had a chat with 111 because my ketones are showing at 3.4...glucose levels are 11mml.

So now I'm on my way to a&e...panicking. I've been on jardiance for a month now so I'm guessing it's to do with this...but I dont know.

I feel ok in myself, but they are adamant I'm at risk of dka.



Anyone else had ketones like this? Thanks x
 
Well if you are heading towards DKA you are catching it early before it gets serious and that’s huge. If it’s not, then all is well. Hope it is not...
 
Have you started the keto / low carb yet only i was taken off it because they don't work together, gosh, i hope you're ok x
 
How did you get on? I have had ketoacidosis as type 1 and would expect you to be acutely ill if indeed you are in ketoacidosis (vomiting, extreme thirst etc). The blood sugars and ketones don't add up to DKA though you are right to take the possibility very seriously.
You are taking an sglt2 inhibitor so this drug should be helping you pee out excess glucose so its worth knowing what your normal bgs are when taking this and I am wondering if you have a water or yeast infection which is more of a risk?
 
I'm still sat in A&E they want me to be admitted to a ward...they said it's not DKA..but my ketones are still high. Had 2 bags of iv fluids now.
NicoleC1971 said:
How did you get on? I have had ketoacidosis as type 1 and would expect you to be acutely ill if indeed you are in ketoacidosis (vomiting, extreme thirst etc). The blood sugars and ketones don't add up to DKA though you are right to take the possibility very seriously.
You are taking an sglt2 inhibitor so this drug should be helping you pee out excess glucose so its worth knowing what your normal bgs are when taking this and I am wondering if you have a water or yeast infection which is more of a risk?
Click to expand...
 
Hi @lcarter

I have just googled Jardiance contraindications and found this:

https://www.pdr.net/drug-summary/Jardiance-empagliflozin-3597

and specifically

Diabetic ketoacidosis, type 1 diabetes mellitus
Empagliflozin should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis (DKA). Reports of ketoacidosis, a serious, life-threatening condition requiring urgent hospitalization have been identified in postmarketing surveillance in patients with type 1 and type 2 diabetes mellitus receiving sodium glucose co-transporter-2 (SGLT2) inhibitors, including empagliflozin. Patients treated with empagliflozin who present with signs and symptoms consistent with severe metabolic acidosis should be assessed for ketoacidosis regardless of presenting blood glucose levels, as ketoacidosis may be present even if blood glucose levels are less than 250 mg/dL. If ketoacidosis is suspected, discontinue empagliflozin, evaluate the patient, and institute prompt treatment. Treatment of ketoacidosis may require insulin, fluid and carbohydrate replacement. In many of the postmarketing reports, and particularly in patients with type 1 diabetes, the presence of ketoacidosis was not immediately recognized, and the institution of treatment was delayed because presenting blood glucose levels were below those typically expected for DKA (often less than 250 mg/dL). Signs and symptoms at presentation were consistent with severe metabolic acidosis and included nausea, vomiting, abdominal pain, generalized malaise, and shortness of breath. In some but not all cases, factors predisposing to ketoacidosis such as insulin dose reduction, acute febrile illness, reduced caloric intake due to illness or surgical procedures, pancreatic disorders suggesting insulin deficiency, and alcohol abuse were identified. Before initiating empagliflozin, consider factors in the patient history that may predispose to ketoacidosis including pancreatic insulin deficiency from any cause, caloric restriction, and alcohol abuse. Consider monitoring for ketoacidosis and temporarily discontinuing the drug in clinical situations known to predispose to ketoacidosis (e.g., prolonged fasting due to acute illness or surgical procedure).

If you are low carbing, to ketogenic levels, then I think that may be a factor, and your medical team need to know, so that they can assess whether Jardiance and keto should be used at the same time.
 
Hi all, well I'm home now. They said I was in starvation ketosis, and that it wasn't anything to worry about as I'd spent a day fasting and low carbing..they have taken me off the jardiance and said I'm fine to do keto as a type 2, but just to make sure to test for ketones if I'm feeling at all unwell. Been on an 2litre iv fluid drip today so my ketones are now at 1. So I'm thinking maybe o need to be drinking more than 2 litres a day if possible, but I'm relieved to have got rid of the jardiance. They mentioned possible adding trulicity if my glucose levels raise after coming off jardiance, but I'm hoping with keto they wont be too high. So as it stands, I'm now on 2mg metformin and thats it. Just glad to be home, thanks to everyone for your messages and support it means so much when you're heading to a&e alone and scared xx
 
Well that is excellent news, i shall keep looking at your posts because we have a similar effect from all of this but i see you are now on metformin and i did not get on with that at all and hence i'm on nothing, i don't have a ketone tester so am very interested in seeing how you manage, wishing you well x
 
Great news that it was all caused by you being too well!
That is always the big problem for those who are on Insulin, Glic etc. Because conventional medicine still says that T2D is progressive and irreversible, thus Health Care Professionals tend to expect patients to eat to their medication, instead of medication to their patients needs/diet.
 
miffli said:
Well that is excellent news, i shall keep looking at your posts because we have a similar effect from all of this but i see you are now on metformin and i did not get on with that at all and hence i'm on nothing, i don't have a ketone tester so am very interested in seeing how you manage, wishing you well x
Click to expand...
I had to go for metabet, the much slower released version as I nearly quit xx keep in touch x
 
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