Diet after DKA

Hello thank you for the info. I am a type 2 and I am at a loss I was recently admitted to the hospital with DKA but on the low end my sugar was 110 and 100 through the stay. I had 3 doctors called in because they had never experienced that. BMy A1C was 11.8 they said I would have probably died in my sleep. I was strictly keto for about a month and started taking invokana and metformin only 500mg at this point. The doctors were so angry that my doctor said keto was okay. I have 8 different doctors telling me 8 different ways to eat and I’m so scared and having trouble eating at all. I don’t know what to belive anymore. I’m out the hospital almost a month on 2000mg in the am and my sugars are still 290-450 daily all I drink is water. No added sugars at all and trying to limit and no sugar at all. I’m trying to find a diet that people have had success with. My drs said that keto only masked the issue lowering my sugar until I ate something different. I just don’t know what to do. I vomit every day for over two years and now I have this burning like lava in my veins and no one knows why! Has anyone experienced that? I had Covid for 6 weeks and they just say could be related to that. Thank for any feed back or ideas!

What type diabetes do they say you have. Sounds like they are treating for type 2 but what ever they are missing the mark. With readings in the range you describe more needs to be done. Have they considered that you might be type 1 diabetic, have they done any antibody testing.

I have moved @Holly3’s post to a new topic

Gary

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You don’t mention anything about taking insulin and that sounds to me that you need it.

40% of us type 1’s are misdiagnosed as type 2’s at first and it happens constantly. One of the problems is as a type 1/LADA you still make insulin for a while until you finally completely stop, sometimes up to 8 years or more. That period you still make insulin we call the honeymoon period. And drugs and change of diet work at first and slowly stop as you make less and less insulin.

DKA is way more common with type 1, although some medications can cause it in a type 2. DKA is caused not by high blood sugar numbers but a lack of insulin which usually occurs at high numbers. But it’s the lack of available insulin that actually causes the issue.

You don’t say what type they have said you are, but I am assuming since you don’t mention insulin you have been told you are type 2.

If you haven’t gotten them already I think you need to be tested for type 1. The 2 most important are an antibody test and a c-peptide test. On an antibody test if you have antibodies you are a type 1, although some type 1’s will test negative but still not make insulin and they don’t know why. The second is a c-peptide which shows how much insulin you are making. Low or low normal is a sign of type 1 as you make less and less insulin until you stop, high or high normal is a sign of type 2, because you still make insulin you just don’t utilize it right and your body will try to make more to make up for it.

Your liver makes glucose for fuel whether you eat or not. So even drinking water as a type 1 your blood sugar level will go up because you are lacking insulin to deal with it.

I’m sorry you are going through all this. good luck and I hope you feel better soon. I hope you find your answers.

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@Holly3. There is a less common variant of DKA called Euglycemic DKA which can sometimes be caused by GLP1 drugs and has normals bgs.

" Euglycemic DKA (EDKA) is a clinical syndrome occurring both in type 1 (T1D) or type 2 (T2D) diabetes mellitus characterized by euglycemia (blood glucose less than 250 mg/dL) in the presence of severe metabolic acidosis (arterial pH less than 7.3 and serum bicarbonate less than 18 mEq/L) and ketonemia."

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In addition to what @Marie20 stated above, many people, usually adults, are assumed to be T2D by their doctors based mostly on their age. This may not be true for you and your recent course of Covid-19 complicates things.

The links that Marie provides to Diabetes Forecast are very good sources for factual and dependable information.

Another resource from a long-term TuD member, @Melitta is a great one to explore. Here’s a link to some solid information:

Blood sugar levels in the 290-450 range do harm health. Effectively treating those abnormally high glucose levels should be job 1 and if it takes insulin to accomplish that, then so be it.

I’m sorry you’re struggling but I do think you can turn things around and feel much better. Good luck and please report back when you learn more.

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It is also possible to be both types at once.

Having Covid may have been the trigger for developing type 1 diabetes. Many people develop type 1 diabetes after getting a virus. I got diabetes as a toddler after getting the flu. You need to see an endocrinologist as soon as possible and demand testing for type 1. If you are not eating and your BG’s are that high you are at constant risk of going into DKA again.

The reason your BG’s were normalized in the hospital is probably due to the electrolytes they were giving you and they may even have given you some insulin to bring you down but didn’t prescribe you any to take afterwards so your BG’s have crept back up into dangerous territory. Keep drinking water and add an electrolyte supplement to it that does not have carbs. Emergen-C makes one and there are several others out there. Alternatively Gatorade zero or Powerade zero are also safe and will help replenish lost electrolytes from the high BG. The risk with DKA is kidney damage or failure so do whatever you need to to stay out of that range.

Go to the pharmacy and pick up urine ketone test strips and and a blood ketone meter and strips if they have them and check your ketones daily or if you are throwing up. This will all get sorted out soon and you will get on a proper treatment plan. Please keep us posted and if you start experiencing symptoms of DKA again go to the emergency room.

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Hopefully they’ve taken you off invokana. If you Google it’s a known side effect with T1. There is a lower probability of it being dka with type 2.
There is no reason why a keto diet would cause dka. They are barking up the wrong tree there.

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From what you are saying, it seems like it’s not likely about diet—it’s likely that you need insulin right now, no matter what you eat, if you are going into DKA. I would also be concerned about being on Invokana if you are needing insulin but not on it, since it can mask that need, but it sounds like your blood sugars are running high enough that the Invokana likely isn’t even a factor, since all it does is lower your kidneys’ threshold for releasing glucose, but 200s+ is at a point where anyone’s kidneys will do that regardless.

I would find a doctor willing to prescribe some insulin and evaluate for T1D ASAP. Even if it’s temporary COVID-induced state that will improve in time (it’s unclear if COVID-induced islet cell dysfunction will be temporary or permanent), you need insulin now. With the first SARS virus, most (but not all) of the documented cases who did afterward recovered and eventually did not.

I agree, you need insulin.Good luck ,please let us know how you are doing. Thanks, Nancy50