T Nation

Diagnosed with Uncontrolled Type 2 Diabetes

Well its confirmed, I have euglycemic diabetic ketoacidosis, my keystones are very high 5.0 (<3.0) and it feels like I got acid in my blood, skin is dark red, very dry and burns like hell!

The elevated ketones is causing organ dysfunction, my GP has check just about every organ and has really struck out since last Nov 15th. He couldn’t pin the tail on a donkey with his eyes wide open. He checked ketones when I was in the ER in April which showed elevation (5.0), but on June 2th he ran another, the very day the cypionate left my system (stopped TRT) and reached zero, therefore no keystones detected. If only he had waited till June 6th, the day my HPTA rebooted exactly 4.5 weeks after stopping TRT (4/29/19) (HPTA reboot 6/6/19).

TRT or any amount of testosterone exacerbates the condition, that 15 year long chronic cough, the high acidity in stomach, fruity taste in mouth, confusion and nausea after eating, lower esophagus erosion and the acid for blood burning my skin, GI dysfunction all started shortly after going on TRT. The withdrawing off klonopin and the low testosterone diagnosis and cause is more than likely euglycemic diabetic ketoacidosis.

I wonder if I can treat euglycemic diabetic ketoacidosis and restore my natural testosterone, but I’m not holding out much hope because this has been going on for a long time.

I haven’t talked to my doctor yet, soon though, but just wondering if anyone know how to treat euglycemic diabetic ketoacidosis. I already been diagnosed with Type 2 diabetes–>euglycemic diabetic ketoacidosis.

I don’t know anything about this, but I’m very sorry to hear. Best of luck.

Sorry to hear about your situation.

I guess you akready know that EDKA is difficult to treat. Maybe one thing to discuss with your physucian is B1 supplementation as many patients develop B1deficiency and this excarbates ths anion gap. There is a clinucal trial ongoing to investigate inti this supportive option.

Search at Clinicaltrials.gov for NCT03717896

Best of luck!

1 Like

@unreal24278

Oh fuck! This is serious, I’m sorry to hear about this

If it makes you feel any better, I’m in constant moderate/severe pain right now. There’s a decent chance I’ve torn my rotator cuff (or at the very least immensely strained and/or have a slap pain… I always knew my joints, tendons and connective tissue would give out at a young age with my medical pathology and history of chronic pain… but this is a bit early. If anything I firmly believe testosterone, weight training and staying active has legitimately amoreliated said issues from progressing at a much more rapid pace… I’ll be damned if I’m going to give up without a fight though, I will do everything in my path to maintain an adequate quality of life… which means being able to work out 6-7 days per week, go out without terrible pain and stand for long periods of time lol… I don’t care if I have to be on pain medication full time anymore (this possibility was recently suggested to me), it beats being in constant pain…

But fuuuuucccccckkk dude, Diabetic ketoacidosis… that’s sseeeeeerrrriioouuuss shit… Have you been given fluid/electrolyte replacement? Is the NIDDM being managed?

Is it type I or type II diabetes? (It could be late onset type I that is slowly progressing). High ketones with euglycemia is extra problematic. Do you tend to eat more fat or carbs in your diet? Are you thin or fat.

OK edit I see it is type II. Have you lost a lot of weight from it? Are you taking metformin or insulin? Again, low or high carb diet? Do you have fatty liver or high triglycerides? Stress hormone problems or a chronic infection should be ruled out as the driver of ketones first and high fat diets, while they can be good for euglycemia can also drive the ketone levels. Also, how did the doctor prove that you don’t have late onset type I diabetes?

I’m not doing well, I was told I would receive a call from my doctor yesterday and this hasn’t happened. I called and told the person over the phone my right arm, left hand, both feet are numb on and off throughout the day, vision is weird, muscle spasms in legs, extreme nausea and can’t stay awake throughout the day especially after eating.

I can’t get my doctor to respond, the facility is always slow to respond to patients and rarely follow up in a timely manner. It’s always been like this, often no follow ups at all until things start progressing to the point of life threatening and even then you get in the improper diagnosis and are left asking Siri and finding out your doctor is getting it wrong.

In April I was in the ER having some type of what I realize must have been a diabetic attack of some kind of seizure where I was barely with it, I’ve been left without treatment for 5 months as doctors run tests. I’ve been to the ER so many times in the last 5 months and my GP never takes any notice, I have to call him and he says that’s why we are running all these tests.

My glucose is always 140-160 and lower at night time. The testosterone injections worsen the problems as I took 6mg Thursday and Friday and hyper responded.

Type 2 diabetes = euglycemic diabetic ketoacidosis = normal glucose levels is under 250 mg/dL.

If anyone is thinking about joining Kaiser Permanente, run and don’t look back!!

Back in April when on TRT I lost 15 pounds in less than one week, no exercise. I have to be injecting testosterone for this to happen, because this is when the symptoms worsen.

Metabolic ketoacidosis with normal blood glucose: A rare complication of sodium–glucose cotransporter 2 inhibitors

Ketoacidosis is a significant and often a life-threatening complication of diabetes mellitus seen mostly in type 1 diabetes mellitus as well as occasionally in type 2 diabetes mellitus. Diabetic ketoacidosis usually manifests with high blood glucose more than 250 mg/dL, but euglycemic diabetic ketoacidosis is defined as ketoacidosis associated with blood glucose level less than 250 mg/dL. Normal blood glucose in such patients results in significant delay in diagnosis and management of diabetic ketoacidosis, thus increasing mortality and morbidity. We present a case of euglycemic diabetic ketoacidosis secondary to canagliflozin in a type 2 diabetic patient.

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus that mainly occurs in patients with type 1 diabetes mellitus but also in patients with type 2 diabetes mellitus. DKA is a complicated metabolic disorder characterized by ketoacidosis, marked hyperglycemia (>250 mg/dL), and anion gap metabolic acidosis which is induced as a result of a significant deficiency of insulin and rise in counter regulatory hormones. In some instances, it does occur in the presence of normal glucose levels. This latter form of DKA is known as euglycemic DKA, which is defined as ketoacidosis with blood glucose levels below 250 mg/dL.

What’s your current height and weight?

Have you been doing any exercise? Walking, lifting, anything inbetween?

What’s your nutrition plan?

I’m 6 ft, 235 pounds.

Yes, sustain walking, example at the malls, I start feeling faint, light headed and and have trouble staying awake. Sugar really improves my symptoms whether orange juice or grapes.

I eat banana with breakfast, spinach, asparagus and lot’s of other veggies, freshly cook chicken and lean steaks, orange juice which does a lot to help with the symptoms. I actually overdosed on vitamin C 250mg for 6 weeks which increased my AST levels to the point of stabbing pain in my abdomen, which forced me to lower to below normal to satisfy the liver and within a week AST levels are on the bottom end of the normal ranges (22).

The liver enzymes are good even though there is fatty liver which I haven’t been able to lose any weight except for last April when I started having these problems. There is some function within me that isn’t working correctly. Now I eat and pass out where before the orange juice helps with digestion, otherwise I have digestion problems. I have to plan to eat when I know I’ll be home because 30 minutes after eating I can’t stay awake.

I had imaging done yesterday which took 3 hours, the tech had me eat an egg sandwich with radioactive elements, soon after I became extremely nauseated and slept in between imaging sessions, he had to wake me up everytime.

3 hours after eating I was back to normal, until I would eat again.

You’ve got a bigger frame, which can be a plus in the long run. But, dude, your bodyfat (30+%) is only hurting your health overall and has been for a while. Getting that down should be up there on the priority list, as it’ll no doubt help with the rest of the problems.

I am sorry to hear you’re dealing with this serious issue, and the details of handling it are quite a bit beyond my wheelhouse. I’d suggest finding a dietitian who has experience with this type of disease and consider “exercise snacks” instead of longer workouts.

If longer periods of walking leave you trashed, keep the time shorter but increase the frequency. Knock out a set of 3 or 4 perfect push-ups a couple of times a day, do a handful of unweighted squats sporadically, etc., instead of trying to get through a 15-20 minute walking session.

No complex carbs or fiber outside of veggies? And low fat? Both of those things help to regulate blood sugar. From some quick reading, it seems like avoiding carbs may exacerbate your issue, so you may want to incorporate something more like a “40:30:30”-type old school balanced diet with more healthy fats, quality protein (like you’ve got), and complex carbs to stabilize insulin levels after meals.

It sounds like you’re using OJ more like a medication, which is weird and, while an seemingly effective Band-Aid solution, probably not really helping things overall. If you’re not already on medication for insulin management, consider a glucose disposal agent/nutrient partitioner like Indigo-3G on top of tweaking in your diet.

2 Likes

Please answer these to the best of your ability.
Are you taking metformin or insulin?
Low or high carb diet?
Do you have fatty liver or high triglycerides?
Stress hormone problems (Cushing’s, Kohn’s, Pheochromocytoma) or a possible chronic infection?
How did the doctor prove that you don’t have late onset type I diabetes?
What is the standard used for euglycemia (What is your A1C)? It could be an A1C of <7.0 but true euglycemia would be <5.8 and if you are at 7.0 you could push your blood sugar lower, and a ketone level of 5.0 is not really equivalent to ketoacidosis levels. Non diabetics on a ketogenic diet can be in the 5.0-8.0 levels in a fasted state without having severe health hazzards. https://keto-mojo.com/article/testing-what-should-ketone-levels-be/

Problem with sugar is that while it turns down ketones, too much raises fatty liver and those fats end up turning to ketones. Also, with low fat diet all around, muscles get horrible at burning up fat and using ketones. Ketones can ONLY come from dietary and body fats and ketogenic amino acids.

He may be talking about a blood ketone reading (potentially a capillary test???). A blood ketone reading of more than 3nmol is dangerous, 1.5-3nmol would be considered adequate for dietary ketosis (with ketosis induction starting at roughly .5nmol)

5nmol would require immediate medical aid

I am talking about blood ketones too. At 3.0 diabetics (at least) are recommended to treat as an emergency because 1) they are delivering insulin or for type IIs may not be producing enough to clear ketones, and 2) tend to underestimate increased need during an illness or may have a degraded pump site, or insulin that has been damaged by heat. Runaway DKA only happens at much higher levels but ketones can progress from 3.0 to 10.0 a couple of hours. Also, with normal blood sugar, runaway DKA is slowed down because blood volume stays normal, but when blood sugar rises with ketones the glucose gets cleared through the urine and this causes increased urination which can lead to dehydration, further concentrating ketones quickly to levels around 10.0 or so with an increased pH.

One thing to keep in mind is that insulin doesn’t just move glucose into cells, but it signals the cell to continue making enzymes that burn glucose, so if insulin levels are low for a long time, someone may be able to avoid low blood sugar, but they may not derive adequate energy from the glucose they eat.

There are other issues, but high ketones with normal blood sugar for a diabetic is similar to high ketones in a non-diabetic. Adipose, liver and muscles all can have different relative sensitivities to insulin.

Cyanidin-3-glucoside may help. I will mention that there is evidence that it increases insulin sensitivity in muscle AND fat cells which means that it might keep fat bottled up in fat cells rather than allowing them to be released for fuel.

Also, fatty liver provides the liver with a source of fat to oxidize and produce ketones even if adipose levels are not high, so reducing fatty liver can reduce ketone production. While sugar from fruit may turn off ketone production in the short term, it also creates fatty liver deposits. The same is true for alcohol.

There are only 4 ways the liver can normally get a hold of fat to make ketones. Liver fats, adipose, dietary fat and ketogenic amino acids (leucine and lysine). https://www.diapedia.org/metabolism-and-hormones/5105758814/amino-acid-metabolism. Lysine and leucine are essential, so you have to consume some of them in the long run, but ketone prone individuals may limit their intake for a period.

1 Like

I will mention that this is similar to the phenomenon that people experience when they try to run a ketogenic diet but don’t do a good job of it. They get ketone production, but insulin and available glucose stay high enough that the brain and muscles never get “good” at using ketones for energy. There is a “no man’s land” where your body doesn’t have the glucose it needs, but never adapts to use ketones, and that is where many keto attempts land. Enough carbs and insulin block ketone production. Low enough carbs and insulin get the brain running well on ketones-at that point, the brain uses up around 100 grams of ketones a day. People who are keto adapted have had their blood sugar levels pushed in to the 20 mg/dL range (1 mmol/dl) with no cognitive impairment because the brain has adapted to ketones. In adaptive ketosis, ketone levels actually usually drop to the 1-2 range because the brain and muscles are disposing of them as a fuel source.

I have fatty liver and high triglycerides. I have been monitoring my glucose levels throughout the day, in the morning is it 140-160, I eat breakfast and feel nauseous right after, insulin is now 200 and stays there until I eat lunch, right after eating lunch I feel even more nauseous and feel like passing out and fall asleep, but it doesn’t feel like sleep, then hours later I come out of it and eventually eat dinner, then things really go from bad to worse and glucose levels are now above 200 and my arms, leg are numb.

My glucose levels never decline through the day and bloating is non-stop after each meal, can this lack of production of insulin explain all these symptoms of feeling nausea after eating and all these multiple mineral deficiencies?

Doctors think I have a niacin deficiency as well, that’s more than 5 deficiencies and they seem to keep piling up.

So I need to treat my diabetes, to increase insulin and each lots of carbs to block keystone production?

Yes. Insulin turns off ketone production. Also, insulin lets your cells process glucose for fuel-that is as important a role as moving glucose out of the bloodstream. I would also not call 140-160 fasting and 200+ post meal glucose as “euglycemia”. Insulin would lower your blood sugar and reduce ketones and help save your pancreas from burnout. You should ask your doctor about taking a long acting insulin like Lantus in the morning, but it is quite expensive and if you are insulin resistant you might use 10 Lantus pens in a month. You could also ask about taking “regular” insulin, or as a stand alone option to help bring down glucose after meals. Your remaining insulin can keep your ketones down at night, but when you eat, it gets depleted trying to move glucose from your meal into your liver and muscles and then ketones rise.

No, you don’t need to eat carbs to block ketones in your case. If your doctor prescribes insulin to inject, it can turn off the ketones. You do not technically have euglycemic ketoacidosis since your fasting blood sugar is over 125 and you experience peak blood sugars of over 200. That is non-euglycemic.

You still haven’t told me if you are using insulin. If you can’t lose fat and reverse the fatty liver disease right away you will be using insulin to stay alive pretty soon.

  1. Are you using insulin? How much per day?
  2. How did the doctor prove that you don’t actually have late onset type I diabetes? Did they do a autoantibody test or just assume it because you were an adult and overweight?

My suspicion is that you have rapidly progressing type II diabetes which is moving into insulin dependence due to pancreatic burnout.

Losing bodyweight through a caloric deficit is the best way to improve insulin sensitivity and preserve natural insulin levels and reverse fatty liver. Fatty liver reversal also requires elimination of alcohol and reduction of sucrose and possibly milk sugar as well since galactose and fructose tend to get turned into triglycerides in the liver (fatty liver and triglycerides are built on fructose, alcohol and galactose, particularly in a caloric surplus.

I was prescribed Glucotrol XL 5mg per day which seemed to knock glucose to 146 within an hour from 250’s. There was extensive testing to look at liver, thyroid and antibodies, echocardiogram, kidneys, RA factors and autoimmune testing. I never get the flu or colds, I haven’t had the flu since 14 years old. I can be around sick people and never worry about catching anything, my brother is the same.

I switched doctors yesterday and he concurs with this assessment, I commented about my glucose levels while on TRT which was 140-150 morning glucose and 110 glucose at night before bed. Since I stopped TRT in April my glucose has been gradually getting out of control, now morning glucose is still 140-150, evenings glucose is 252 last night in fact even after taking the medication to control it.

The multiple mineral and vitamin deficiencies convinced me to stop TRT for the time and get these to healthy levels, but in doing so I have worsened my diabetes. I need to improve my diet and get my diabetes under control before I attempt restarting TRT, because last Thursday I restarted daily injections and crashed hard two days later as I was vitamin C deficient do to the diabetes causing my entire GI tract to experience poor absorption, dysfunction of the nerves that propel food causing gastroparesis as you probably already know a condition in which emptying of food from the stomach is delayed leading to retention of stomach contents which caused bloating, early satiety, distention, abdominal pain and nausea.

I’m concerned about eating lightly with all the mineral deficiencies, my diet is unbalanced and I’m starting another thread in supplements and nutrition. I have no clue how to eat properly without it causing more problems.

If I don’t get nutrition corrected soon, my condition will worsen.