Sweet Pee or other GLP-1s for weight loss in Type 1

don’t do anything you are uncomfortable with, If you think your Dr has it wrong, seek a second medical opinion.

I think…
DKA is a whole different ball game and sounds like what the dr is describing.
It’s not unusual for some doctors to not understand dietary ketones… lowering bolus insulin to the g carbs and maybe 1/2 the protein eaten. With normal BG and hydration, any resulting dietary ketones below 3 is fine 1 to 3 is the target range

this may help with DKA ketones

I still eat a very low carb diet. The SGLT drug usually results in lowered insulin requirements as your body excretes glucose instead of depending on insulin for glucose uptake. I consider the argument that the DKA is caused by lowered insulin doses to be a “theory.” There is still a strong belief that ketones cause DKA and that if you have ketones on a low carb diet that places you at risk of DKA. I’m not so convinced.

I would argue that staying hydrated is just a good practice since we know that becoming dehydrated is really bad for someone who is insulin dependent. If you want to eat some more carbs and use more insulin that would at least enable you to follow your doctor’s advice.

My concern with the super low-carb diet is this:

  • For someone with Type 1 on a normal diet, high ketones +/- high BG are clues that one may be headed toward DKA
  • For someone with Type 1 on a low-carb diet, high ketones + high BG are clues that one may be headed toward DKA
  • For someone with Type 1 on an SGLT2 inhibitor, high ketones + normal BG are clues that one may be headed toward DKA
  • For someone with Type 1 on a low-carb diet and SGLT2 inhibitor, high ketones + normal BG could be normal or could be DKA

So for that last scenario, you’ve lost both your clues (high ketones or high BG) that DKA may be developing. That is what I’d like to avoid. I’d like to keep one of those warning signs. My doctor did say that there are currently clinical trials of SGLT2 inhibitors in people with Type 1, so it’s not totally crazy to prescribe it.

I’m not going to go to a diet of 300 grams of carbs per day or anything like that. But maybe 90 or 100 grams per day. Just high enough that my body isn’t producing a bunch of ketones as a baseline. (I’ll admit, too, that I want to eat more carbs: doing super low-carb while also coping with multiple food allergies is very difficult when eating any food I haven’t prepared myself, so eating more carbs would make eating out a lot more relaxing!)

as I said, don’t do anything that you are uncomfortable with and approved by your Dr. or a qualified second opinion. (sadly, this can take a bit of work locally)

There is a reason it’s differentiated ‘diabetic ketoacidosis’ and it’s not just called ‘ketoacidosis’. There are a few reasons you can get ketoacidosis, generally >10. If there isn’t valid reasons, lower levels are given as a warning of a possible onset coming., Though the acidosis diagnosis is actually a measure of the blood PH being acidic.

Alcoholic, can be a well known reason, because of the excessive dehydration. It now seems that SGLT2 inhibitor, as another drug induced way. Is to be added to the list.

My doctor is awesome and he would not be prescribing something if he thought the risks far outweighed the potential benefits. This also came about from a mutual conversation between the two of us, it wasn’t something he prescribed as a medication that I “have to” take. It’s something to try as an experiment. If it helps, great. If I run into any issues at all (or am at all uncertain), I can stop it and that’s also okay. He doesn’t think I’ll have any problems, but these medications are very new for Type 1 diabetes and there have been many reports of severe DKA, so he’s being very cautious with his advice. We’ve never really talked about diet, but I have mentioned to him that I do eat low-carb at times, and he hasn’t had any issues with it. However, I’m not wedded to any one particular diet. Whether I eat low-carb or not doesn’t bother me philosophically. As long as I can achieve a balance between diabetes control and enjoying life (which, lately, eating very low-carb was actually hindering) that’s what’s important. I was just curious, given the risks, whether @Brian_BSC still chose to eat low-carb.