Panic at 21.5 - what would you do?

[Hobster]

I've been on Dapagliflozin 10mg for the past week. I initally started on 5mg daily for 2 weeks. My BS have become a little more erratic at times, I guess the body is just trying to sort things out. I haven't felt well for the last few days, sleeping very heavy and not feeling refreshed. Anyway, today felt generally a bit worse (nothing specific to add, just feeling out of sorts), took my BS and it was 21.5. Talk about going into panic mode!! This was probably the worst thing I could have done, but I have never had a reading that high before and I've never been told what to do if that reading is high. Spoke to GP who said basically 'worry over 20, but don't worry about it' which is as useful as a chocolate tea cosy. This was 45 minutes ago and prior to this I had eaten half a banana on one slice of sourdough (which I've eaten many many times before and it has never spiked this high). Interestingly, my Libre has also picked up real lows of 3.5 in the past 48 hours too. Is it really possible to go from 3.5 to 21.5 in a matter of 6 hours?

I'm sitting at about 12.2 right now, I've been for a walk and I'm drinking water. I feel so out of my depth and lost and fear I will worry about going out on my own.

I understand no-one can advise me medically and I've spoken to my GP, the nurse is ringing me on Monday for a follow up. But, were yours that high? Do they still get that high at times? Type 2.

 

[Inka]

Don’t panic @Hobster If you’re 12.2 now then that’s ok. Did you fingerprick to check the 21? The Libre can read too high, eg mine once said I was 19.2 and I was 14.something. Much better and less scary.

As you’re on meds, then I suggest you have a read of the leaflet and try searches here on the forum. I’m Type 1 and know nothing about your medication, but I’m sure some Type 2s will be along who do. I think @Lucyr knows about this med. Have you tested for ketones? If not, you could buy a tub of Ketostix for £5 and know you were watching things, which should reassure you.

 

[rebrascora]

I second what @Inka has said. If that is a Libre reading the chances are that you were not actually that high, as it tends to exaggerate both high and low levels. When you say the lows were "real", is that because you double checked them with a finger prick? Libre typically reads about 1mmol lower than a finger prick for me so a 3.5 would in reality be about 4.5 which is a perfectly good level. Libre also suffers from compression lows, so if you lie on the arm with the sensor on it in your sleep, it will compress the tissue that the filament is sampling and cause it to give false low readings. It usually takes 20-30 mins to return to normal when you release the pressure.
If your 21.5 was a finger prick reading, did you wash your hands and test again with another test strip. Occasionally you can have a bit of residue on your fingers which can contaminate the result, or you get the odd duff test strip, so you should always wash your hands and double check a reading which is well above or below what you would expect.

Personally I would not eat banana and bread together as they are both high carb foods. I appreciate that you are on a "flozin" and can therefore not go too low carb but I would still avoid a combination of 2 high carb foods on one plate. The bread with peanut butter/marmite/cheese/ham/egg
or
the half a banana with some plain yoghurt rather than both together.

Those are my thoughts.

 

[Hobster]

Don’t panic @Hobster If you’re 12.2 now then that’s ok. Did you fingerprick to check the 21? The Libre can read too high, eg mine once said I was 19.2 and I was 14.something. Much better and less scary.

As you’re on meds, then I suggest you have a read of the leaflet and try searches here on the forum. I’m Type 1 and know nothing about your medication, but I’m sure some Type 2s will be along who do. I think @Lucyr knows about this med. Have you tested for ketones? If not, you could buy a tub of Ketostix for £5 and know you were watching things, which should reassure you.

Thank you for your reassurance Inka, it's really appreciated. I did fingerprick at 21 and know not to rely on the Libre for an exact reading in the moment. I did test for ketones (as my FP monitor reminded me to) and these were negative. Even if they were positive, I'm still not sure if I know what I should have done! I almost need a cheat sheet.

 

[rebrascora]

I also second testing for ketones when your BG levels are high or you don't feel well and to get some Ketostix if you don't have any.

 

[Hobster]

I second what @Inka has said. If that is a Libre reading the chances are that you were not actually that high, as it tends to exaggerate both high and low levels. When you say the lows were "real", is that because you double checked them with a finger prick? Libre typically reads about 1mmol lower than a finger prick for me so a 3.5 would in reality be about 4.5 which is a perfectly good level. Libre also suffers from compression lows, so if you lie on the arm with the sensor on it in your sleep, it will compress the tissue that the filament is sampling and cause it to give false low readings. It usually takes 20-30 mins to return to normal when you release the pressure.
If your 21.5 was a finger prick reading, did you wash your hands and test again with another test strip. Occasionally you can have a bit of residue on your fingers which can contaminate the result, or you get the odd duff test strip, so you should always wash your hands and double check a reading which is well above or below what you would expect.

Personally I would not eat banana and bread together as they are both high carb foods. I appreciate that you are on a "flozin" and can therefore not go too low carb but I would still avoid a combination of 2 high carb foods on one plate. The bread with peanut butter/marmite/cheese/ham/egg
or
the half a banana with some plain yoghurt rather than both together.

Those are my thoughts.

That's exactly what I need to do next time Barbara, yes it was a finger prick test. I need to wash my hands again and try another reading to confirm, I just panicked in the moment and have asked my partner next time to remind me to do this if I go into a tiswas. Thank you for your support and advice. I have got some ketone sticks and on this occasion it was negative thankfully.

I take on board the 2 carbs, but I have had this many times before (sourdough as the bread) and it hasn't affected me as much. However I appreciate not all days are equal and many factors can come into play.

 

[Proud to be erratic]

I stumbled, totally by chance, into Jason's seeded Protein sour dough bread which is only 22% carbs, ie c.13gms carbs per slice. There are 4 or 5 varieties of Jason's sour dough bread and the others are 45 to 50+ % carbs. So if sour dough is your preference, @Hobster, and want some help on the 2 carbs conundrum Jason's seeded Protein might help you out. I am not a sourdough connoisseur, I understand people can be quite choosy about where their sourdough bread originates.

 

[Drummer]

@Hobster Bread and banana? I am rather gobsmacked. Type 2 is an inability to deal with carbs so - why eat something so high carb when there are so many foods safer and more nourishing?

 

[Hobster]

I stumbled, totally by chance, into Jason's seeded Protein sour dough bread which is only 22% carbs, ie c.13gms carbs per slice. There are 4 or 5 varieties of Jason's sour dough bread and the others are 45 to 50+ % carbs. So if sour dough is your preference, @Hobster, and want some help on the 2 carbs conundrum Jason's seeded Protein might help you out. I am not a sourdough connoisseur, I understand people can be quite choosy about where their sourdough bread originates.

Thanks Roland, I'm am partial to a seeded bread so will check those out. Thank you 🙂

 

[DaveB]

Hi. I've been up to 24 once recently and at least I can inject insulin to 'try' to reduce the BS. As a T2 there isn't much you can do but as another poster said bananas are not the best fruit to have as a T2 and together with bread a lot of carbs. Best to avoid tropical fruit in general when you can.

 

[Proud to be erratic]

Thanks Roland, I'm am partial to a seeded bread so will check those out. Thank you 🙂

Yep, so am I which is why I glanced at the packaging as I went down the aisle. Our Tesco stocks this bread.

 

[Hobster]

@Hobster Bread and banana? I am rather gobsmacked. Type 2 is an inability to deal with carbs so - why eat something so high carb when there are so many foods safer and more nourishing?

Gobsmacked feels a little extreme there Drummer. I wasn't asking for judgement, please don't comment on my posts unless you have something useful/supportive to add. Thank you very much.

 

[Hobster]

Hi. I've been up to 24 once recently and at least I can inject insulin to 'try' to reduce the BS. As a T2 there isn't much you can do but as another poster said bananas are not the best fruit to have as a T2 and together with bread a lot of carbs. Best to avoid tropical fruit in general when you can.

Ooof, it's a little scary isn't it. They weren't the best idea with the bread for sure

 

[Inka]

@Hobster Bread and banana? I am rather gobsmacked. Type 2 is an inability to deal with carbs so - why eat something so high carb when there are so many foods safer and more nourishing?

I thought someone (Lucy??) said you shouldn’t eat too low carb with Dapaglifloxin @Drummer ? Not that sourdough and a banana is a crime anyway.

 

[Inka]

Thank you for your reassurance Inka, it's really appreciated. I did fingerprick at 21 and know not to rely on the Libre for an exact reading in the moment. I did test for ketones (as my FP monitor reminded me to) and these were negative. Even if they were positive, I'm still not sure if I know what I should have done! I almost need a cheat sheet.

I don’t know if this is of help @Hobster but here is the NHS advice about ketones:

If you use a meter to test for ketones in your blood:

• under 0.6mmol/L is normal
• 0.6 to 1.5mmol/L is slightly high – test again in 2 hours
• 1.6 to 3mmol/L means you're at risk of DKA and should speak to your diabetes care team for advice
• over 3mmol/L is high and means you may have DKA and should call 999 or go to A&E

If you use strips to test for ketones in your pee, over 2+ is high. This means you may have DKA and should call 999 or go to A&E.

 

[Drummer]

Gobsmacked feels a little extreme there Drummer. I wasn't asking for judgement, please don't comment on my posts unless you have something useful/supportive to add. Thank you very much.

When I was 2 years old we moved into my father's parents home to look after his mother who died from the complications of type 2 when I was 7years old.
I could describe the experience if it would help you understand the consequences of the condition if not controlled, but not on the public forum.

 

[Drummer]

I thought someone (Lucy??) said you shouldn’t eat too low carb with Dapaglifloxin @Drummer ? Not that sourdough and a banana is a crime anyway.

Dapagliflozin reduces reabsorption of glucose in the kidneys, so it is lost in the urine - so a low carb diet could certainly lead to hypos - however - bread and banana just seems a bit excessive.

 

[silentsquirrel]

Dapagliflozin reduces reabsorption of glucose in the kidneys, so it is lost in the urine - so a low carb diet could certainly lead to hypos - however - bread and banana just seems a bit excessive.

A low carb diet on a flozin is not advised because of the risk of DKA, even with normal blood glucose, so not just about hypos.

 

[Lucyr]

Gobsmacked feels a little extreme there Drummer. I wasn't asking for judgement, please don't comment on my posts unless you have something useful/supportive to add. Thank you very much.

Don’t worry about drummer, they’re extreme on every thread they comment on and not all that understanding of the forum motto that everyone is different. You don’t have to eat low carb just because you have T2, in fact you’re advised not to low carb with flozins.

If you want to eat a high carb diet and have banana sandwiches 4x a day then you absolutely could. It’s just about how you find the right balance of food, exercise and medication that works for you and that you can cope with.

 

[Lucyr]

I thought someone (Lucy??) said you shouldn’t eat too low carb with Dapaglifloxin @Drummer ? Not that sourdough and a banana is a crime anyway.

Yes low carb is advised against with flozins because of the risk of DKA. It’s recommended to eat around 130g carb or more per day and to test ketones when feeling unwell even if blood sugar is normal.

@Drummer please stop insisting everyone needs to eat low carb and actually take into account that it is dangerous with some medications. There are sticky’s at the top explaining that everyone is different and different approaches need to be respected. Perhaps you need to reread them for a refresher?