dapagliflozin

[Louise1]

recently been prescribed this as metformin wasn't agreeing with me, now i have suspected ketoacidosis. what alternatives have other people been offered

 

[rebrascora]

Hi and welcome.

When you say you have suspected Ketoacidosis. I hope you are being treated at hospital as that is a very dangerous condition which can escalate rapidly. What symptoms are you experiencing? How high are your ketones?
Hope you are OK.

Would you be able to tell us a bit about how you came to be diagnosed? ie. Were you symptomatic or was your diabestes discovered through a routine blood test or some other means? The reason I ask is that DKA (Diabetic Ketoacidosis) is quite unusual in Type 2 diabetics and I am wondering if you might not be a Typical Type 2 and perhaps a slow onset Type 1. Unfortunately GPs tend to assume you must be Type 2 if you are middle aged and perhaps a bit overweight and often don't consider the possibility you might actually be Type 1 and some actually believe that Type 1 only happens to children, which is totally wrong, as there are many of us here on the forum who developed it later in life.

 

[Lucyr]

Hi and welcome.

When you say you have suspected Ketoacidosis. I hope you are being treated at hospital as that is a very dangerous condition which can escalate rapidly. What symptoms are you experiencing? How high are your ketones?
Hope you are OK.

Would you be able to tell us a bit about how you came to be diagnosed? ie. Were you symptomatic or was your diabestes discovered through a routine blood test or some other means? The reason I ask is that DKA (Diabetic Ketoacidosis) is quite unusual in Type 2 diabetics and I am wondering if you might not be a Typical Type 2 and perhaps a slow onset Type 1. Unfortunately GPs tend to assume you must be Type 2 if you are middle aged and perhaps a bit overweight and often don't consider the possibility you might actually be Type 1 and some actually believe that Type 1 only happens to children, which is totally wrong, as there are many of us here on the forum who developed it later in life.

DKA is a side effect of dapagliflozin tablets, so DKA doesn’t always mean not T2, I had DKA with empagloflozin. DKA from the tablets doesn’t always need to be treated in hospital depends on whether it’s caught early enough, as stopping the medication improves things, though of course always should consult a medical professional ASAP where ketones are involved.

There’s lots of other medication options, you may be advised to try something like gliclazide next as that doesn’t cause DKA, but talk to your doctor and see what they recommend.

 

[rebrascora]

Thanks @Lucyr I very nearly tagged you as I thought I remembered you had had DKA with this family of drugs.

Yes, I was aware that it may be a side effect of the tablets but still not something to take lightly and always worth considering a possible misdiagnosis especially if you the OP is not an atypical presentation of Type 2..... Talking of which... Have you had your C-peptide results back yet?

 

[Lucyr]

Talking of which... Have you had your C-peptide results back yet?

No, I don’t know how I’ll get the results, won’t appear in the GP app as were done by the hospital, not had a letter or call from the hospital, or had any follow up appointments booked, I’ve left a message to ask too.

 

[rebrascora]

Must be frustrating not knowing and not having an avenue to find out, but I guess after all the years you have been diagnosed a few more weeks or months are not going to make a huge difference although obviously, if it changed your diagnosis, it would mean you would hopefully get Libre or other CGM on prescription and each month that goes by would make a significant financial impact in that respect if you are still self financing. I would like for that snotty consultant you last saw, to have to eat some humble pie if you turned out to be Type 1 as well as be extremely happy for you to get better support of course.

 

[Louise1]

Hi and welcome.

When you say you have suspected Ketoacidosis. I hope you are being treated at hospital as that is a very dangerous condition which can escalate rapidly. What symptoms are you experiencing? How high are your ketones?
Hope you are OK.

Would you be able to tell us a bit about how you came to be diagnosed? ie. Were you symptomatic or was your diabestes discovered through a routine blood test or some other means? The reason I ask is that DKA (Diabetic Ketoacidosis) is quite unusual in Type 2 diabetics and I am wondering if you might not be a Typical Type 2 and perhaps a slow onset Type 1. Unfortunately GPs tend to assume you must be Type 2 if you are middle aged and perhaps a bit overweight and often don't consider the possibility you might actually be Type 1 and some actually believe that Type 1 only happens to children, which is totally wrong, as there are many of us here on the forum who developed it later in life.

checking at home with ketostix and if i go above 2 i need to go to hospital. i have stopped the medication immediately and definitely feel better. your comments re slow onset type 1 is interesting. my eldest child is type 1 and i am aware that it is hereditary. i was diagnosed with type 2 two years ago and i a overweight and middle aged. how would they test to see if i am in fact type 1?

 

[Louise1]

DKA is a side effect of dapagliflozin tablets, so DKA doesn’t always mean not T2, I had DKA with empagloflozin. DKA from the tablets doesn’t always need to be treated in hospital depends on whether it’s caught early enough, as stopping the medication improves things, though of course always should consult a medical professional ASAP where ketones are involved.

There’s lots of other medication options, you may be advised to try something like gliclazide next as that doesn’t cause DKA, but talk to your doctor and see what they recommend.

since stopping the meds i am feeling much better

 

[Louise1]

DKA is a side effect of dapagliflozin tablets, so DKA doesn’t always mean not T2, I had DKA with empagloflozin. DKA from the tablets doesn’t always need to be treated in hospital depends on whether it’s caught early enough, as stopping the medication improves things, though of course always should consult a medical professional ASAP where ketones are involved.

There’s lots of other medication options, you may be advised to try something like gliclazide next as that doesn’t cause DKA, but talk to your doctor and see what they recommend.

since stopping the meds i am feeling much better

 

[Leadinglights]

since stopping the meds i am feeling much better

The tests for Type 1 are c-peptide and GAD antibodies. The results can take a while to come back and need a specialist to review and interpret the results.
I am pleased you are feeling better but it sounds as if it needs some discussion with your GP or nurse.

 

[rebrascora]

@Leadinglights types slightly quicker than I do, but those are the two tests.

What are your BG levels like and how did your diagnosis come about? Was it a sudden onset or just picked up through a routine blood test with no symptoms? Was your HbA1c pretty high at diagnosis or just over the threshold?
Have your levels responded to normal Type 2 medication and dietary changes or perhaps initially responded and then deteriorated?

My gut feeling is that there may be far more misdiagnosed middle aged Type 1 diabetics who have eventually progressed to insulin but not been tested and just retained that Type 2 categorization. I am not saying that there aren't plenty of insulin dependent genuine Type 2s but I think there may be a percentage of late onset, Type 1s within that cohort who just haven't been properly diagnosed. We get some here on the forum who don't get the correct diagnosis until many years later and I am sure there are plenty more who simply never get rediagnozed.

You may wonder what the difference is, and unfortunately for Type 2s, who are treated as somewhat second class citizens in this respect, quite a big difference, often even just down to how sympathetic or dismissive medical professionals can be, but mostly the access to education, support and technology and the correct treatment plan. Some people had to battle high BG levels for may years risking long term damage, because of a reluctance to prescribe insulin, when as a Type 1 they would be started on insulin straight away. I am not in any way saying that insulin is an easy option because you will know how difficult it is to balance it with food and exercise and hormones etc, but it enables better management that trying to keep a lid on your diabetes with ineffectual Type 2 meds when your body simply isn't capable of producing enough insulin to keep your levels in check.

All this is just for your information. I have no idea if you are Type 1 or Type 2 but there are certain little indicators like your child being Type 1 and you developing ketones (even though I accept Flozins can cause ketones) which just bring the possibility into question.