3

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DKA after just beginning Paleo

Answered on August 19, 2014
Created December 23, 2012 at 8:20 AM

I have been reading about how Paleo or Whole 30 has helped some folks control their diabetes (be it Type 1 or 2). Now, mine is a slightly different case.

I'm a 26-year-old Malay Singaporean woman. I only discovered the Paleo way of eating about two months ago. I thought I'd give it a try, for the sake of long-term health, by taking it slow; first totally avoiding bread and drinking only plain water. I don't have a sweet tooth (in fact I'm quite averse to anything too sweet) nor am I a snacker, so avoiding sugars in processed, junk or fast food was pretty easy for me. I still ate white rice though, although there were one or 2 days in some weeks when I would go without and I ate only meat with vegetables. Since I live with my parents, my father once noticed I went without rice and he expressed concern that I might fall sick, insisting that one HAS TO eat rice at least once a day. I retorted by saying I wouldn't fall sick because I have read on the internet that this way of eating is safe. I also began exercising once or twice a week, at the most three. I followed cardio sessions like kickboxing, Zumba etc at a fitness centre, or I jogged.

Two weeks ago, I thought of trying out the Whole 30 for as long as I could. On my 4th day on the Whole 30, I skipped breakfast (after having eaten a very light dinner of beef, carrot and celery soup the night before). For lunch, I ate a fried egg then I cooked almost the same thing as dinner the night before, except with enoki mushrooms and it was a larger portion. Afterwards I was not feeling too good and went to lie down. I slept beyond the usual dinner time and woke up hungry. I drank some water, started coughing a bit and suddenly found myself vomitting out the soup and some carrot matter from my lunch. I didn't feel too sick so I thought it was because I had stomach wind due to skipped / delayed meals. I was even hungrier after the vomitting so I proceeded to make and eat sweet potato hash with fried egg. I ate slowly and took sips of warm water in between every few swallows. Towards the end, I vomitted again; bits of fried egg white came out.

I couldn't sleep well later that night, and after vomitting liquid at 2 am, I went to see the doctor at the neighbourhood 24-hour clinic. He said I had stomach flu, gave me an injection to stop the vomitting, and medicines for pain/fever, stomach wind, stomach pain, indigestion as well as hydrating salts. For the fourth time, I vomitted out more liquid minutes after leaving the clinic. I went home, ate the medicines at 6 am, and a few pieces of apple strips with warm water. The muscle ache that kept me up the whole night intensified in the morning, especially from the hips down. At noon, after eating a quarter bowl of rice porridge, I couldn't bear the pain anymore and got my mom to send me to the nearest hospital's A&E.

The diagnosis: Diabetic ketoacidosis (DKA). The doctor said I probably had been having diabetes for some time without knowing it. My blood glucose was at 19. After 5 hours in the A&E ward, I was transferred to the Intensive Care Unit where I had to stay for 2 nights as they tried to stabilise me with lots of insulin, 3 saline drips, some antibiotic, potassium chloride and something for my low phosphate. After that, it was 3 more nights in the general ward under observation. The endocrinologist said I definitely have diabetes, but it's yet to be known if it's Type 1 or atypical (ketosis-prone) diabetes, which is triggered when my body undergoes stress like sickness etc. For now, I have to inject myself with a basal dose of insulin (6 units) daily before breakfast and constantly monitor my blood glucose. I will meet with the endocrinologist in about a month for her to analyse my BG, and maybe do more tests.

My purpose for describing in detail what I ate and what happened prior to being diagnosed with diabetes is to get an alternative opinion. At the hospital, nobody wanted to listen to me when I say I changed the way I ate. Could it be that my body naturally produced less insulin since I had stopped eating bread and sugars? Then, perhaps since I had not eaten enough calories or fats, my body was going into ketosis, and whatever I ate after vomitting contributed to my high blood glucose level, and my body could not produce insulin fast enough since it had begun to be used to little carbohydrates and sugars in my system?

While at the hospital, I resumed eating bread and rice with meat and vegetables, food cooked in unknown oils, minimal sugar in tea (I refused to take the artificial sweetener). On that one day right after I was transferred out from the ICU, the nurses stopped giving me 4-hourly insulin jabs and my blood glucose level remained stable and normal throughout the day. The next day, however, they started me on the long-lasting 6 units single dose of insulin. The endocrinologist says my body is now in its 'honeymoon period'; after receiving treatment with lots of insulin, it might be producing insulin on its own now as it thinks it's all well and healthy again; however the insulin-producing cells may die in the next few weeks so she's not taking any risk - hence my prescribed daily basal dose of insulin.

It has been 4 days since I was discharged from the hospital; I have been taking the insulin and eating more or less like my pre-Paleo days, except little bread, minimal sugar (sometimes my BG drops below 4 so I take a bit of apple juice at breakfast), and I watch the amount of rice I take. So far my BG has been at ideal (non-diabetic levels) before meals, and sometimes it goes over to optimal (more than 7 but below 10) after meals, depending on what and how much I've eaten. My next question is: Would it be safe for me to resume eating Paleo in my condition? If my diabetes is really atypical (ketosis-prone) rather than regular Type 1, would that mean I can be off daily insulin? Would eating Paleo trigger another DKA?

B3173217a49b5b0116078775a17eb21d

(11488)

on December 25, 2012
at 12:43 AM

Sounds like a plan. Keep it up and you'll have it licked.

Afc881d196118e4f381e34c4e9c70b7a

(25)

on December 24, 2012
at 11:34 PM

Ah yes, my fiancé was trying to convince me that it isn't as bad as having kidney disease / failure. But I'm back to eating white rice (half of a small bowl, cooked), but switched to Basmati (it's long-grain and less sticky-starchy than regular rice from Thailand or Malaysia, and more expensive) because my parents are convinced that I ate paleo to lose weight and it's not sustainable; since I'm recuperating in my childhood home I won't argue. However I'm not going to touch bread or anything made with wheat, processed foods, and no sugary drinks. My BG's been at ideal or optimal so far.

B3173217a49b5b0116078775a17eb21d

(11488)

on December 24, 2012
at 03:41 PM

I understand. It definitely sucks, but you need to remember that nothing you did influenced it in any way. Diabetes isn't really all that bad (compared to cancer for example). You have a huge advantage in that you're already doing Paleo - a grain free low-carb diet is 80% if the battle. I'll promise that by next Christmas you'll wonder what all the fuss was about. http://www.eattoyourmeter.org/blog/just-etyfm/

Afc881d196118e4f381e34c4e9c70b7a

(25)

on December 24, 2012
at 11:36 AM

@borofergie I guess I'm hoping it had something to do with my change in diet, because I'm still in a bit of denial? To be told I have diabetes at age 26 is a little earth-shattering for me, since I've never been overweight all my life (I'm 1.49 m and the heaviest I have been is 48kg but prior to that I was always hovering below 45kg), I have never had any major health problems and as I've said, I have been eating a little healthier than others. I was hoping to never have to depend on any lifelong medication (my mom has high blood pressure, my dad has Type 2 diabetes), so to start at 26 is sad

Afc881d196118e4f381e34c4e9c70b7a

(25)

on December 24, 2012
at 11:24 AM

@Chrysaetos, thanks for clarifying that. I had a feeling there might be differences in the way blood glucose is measured in my country and elsewhere, but I don't know how the conversion works.

4124310384f9fa37a995730ca70d47de

(6)

on December 23, 2012
at 05:21 PM

@Chrysaetos, that makes more sense.

930d02c6cf3fb783f15d22e3b49e0490

(250)

on December 23, 2012
at 12:41 PM

Singapore doesn't use mg/dl as a unit. The 19 is in mmol/l. Converted, that's about 342 mg/dl.

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3 Answers

best answer

2
B3173217a49b5b0116078775a17eb21d

(11488)

on December 23, 2012
at 09:08 AM

DKA sounds to me like T1 diabetes. In practice it takes very little endogenous insulin production to put a "brake" on ketoacidosis, very few T2 (even those with very broken endocrine systems) ever experience DKA. I am pretty certain that your lack of insulin production caused DKA, and it had little to do with your diet at the time.

The good news is that a lowish-carb Paleo diet is absolutely compatible with diabetes. I'd strongly recommend that you get yourself a copy of Dr Bernstein's Diabetes Solution. While his recommendations aren't entirely "paleo" you can easily implement them in a Paleo framework. In fact I am strongly of the opinion that a low-carb Paleo diet is the best for diabetic control.

Don't even think about not taking your insulin. You might find that with time and experience that you can significantly reduce your dose (or even that you are really T2 and don't need it at all), but you've seen first hand some of the consequences of DKA.

B3173217a49b5b0116078775a17eb21d

(11488)

on December 25, 2012
at 12:43 AM

Sounds like a plan. Keep it up and you'll have it licked.

Afc881d196118e4f381e34c4e9c70b7a

(25)

on December 24, 2012
at 11:36 AM

@borofergie I guess I'm hoping it had something to do with my change in diet, because I'm still in a bit of denial? To be told I have diabetes at age 26 is a little earth-shattering for me, since I've never been overweight all my life (I'm 1.49 m and the heaviest I have been is 48kg but prior to that I was always hovering below 45kg), I have never had any major health problems and as I've said, I have been eating a little healthier than others. I was hoping to never have to depend on any lifelong medication (my mom has high blood pressure, my dad has Type 2 diabetes), so to start at 26 is sad

B3173217a49b5b0116078775a17eb21d

(11488)

on December 24, 2012
at 03:41 PM

I understand. It definitely sucks, but you need to remember that nothing you did influenced it in any way. Diabetes isn't really all that bad (compared to cancer for example). You have a huge advantage in that you're already doing Paleo - a grain free low-carb diet is 80% if the battle. I'll promise that by next Christmas you'll wonder what all the fuss was about. http://www.eattoyourmeter.org/blog/just-etyfm/

Afc881d196118e4f381e34c4e9c70b7a

(25)

on December 24, 2012
at 11:34 PM

Ah yes, my fiancé was trying to convince me that it isn't as bad as having kidney disease / failure. But I'm back to eating white rice (half of a small bowl, cooked), but switched to Basmati (it's long-grain and less sticky-starchy than regular rice from Thailand or Malaysia, and more expensive) because my parents are convinced that I ate paleo to lose weight and it's not sustainable; since I'm recuperating in my childhood home I won't argue. However I'm not going to touch bread or anything made with wheat, processed foods, and no sugary drinks. My BG's been at ideal or optimal so far.

best answer

2
930d02c6cf3fb783f15d22e3b49e0490

on December 23, 2012
at 12:52 PM

It wouldn't. As long as you continue taking insulin, you'll be fine. Ketoacidosis is caused by a deficiency of insulin. There's just not enough insulin for the body's regular needs.

You'll probably need to take into account the slight rise in blood glucose which protein causes. But compared to carbohydrates, it's much less likely to cause DKA.

Source: I'm a type 1. My brother was diagnosed two weeks ago as well.

0
4124310384f9fa37a995730ca70d47de

on December 23, 2012
at 09:25 AM

With DKA your blood glucose would be SKY high, and you would have hours to live without medical attention ASAP ( d/t labored breathing, and unconscious ). You would also be peeing glucose. At 19 glucose, you seem to have hypoglycemia. Hypoglycemia can be caused by not eating any forms of carbs. If you do have any type of endocrine issue, I would advise eating carbs and taking insulin. Please seek medical attention ASAP.

Type 1 DM would cause HIGH glucose when eating. But AFAIK, if you have Type 1 DM and dont eat, your pancreas will still not produce the Alpha (glucagon), and Beta(insulin) cells.

Type 2 DM = insulin resistant, which just means your insulin will not react with the receptors. Which tricks your body into thinking you dont have enough glucose, which it than starts burning muscle to get glucose, which in turn produces DKA (which you didnt have). Not eating with TYPE 2 DM would certainly not cause a low blood glucose.

-RN

930d02c6cf3fb783f15d22e3b49e0490

(250)

on December 23, 2012
at 12:41 PM

Singapore doesn't use mg/dl as a unit. The 19 is in mmol/l. Converted, that's about 342 mg/dl.

4124310384f9fa37a995730ca70d47de

(6)

on December 23, 2012
at 05:21 PM

@Chrysaetos, that makes more sense.

Afc881d196118e4f381e34c4e9c70b7a

(25)

on December 24, 2012
at 11:24 AM

@Chrysaetos, thanks for clarifying that. I had a feeling there might be differences in the way blood glucose is measured in my country and elsewhere, but I don't know how the conversion works.

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