DKA / Euglycemic DKA (Diabetic Ketoacidosis)
Users on Reddit, particularly those with Type 1 Diabetes (T1D), report serious experiences with Diabetic Ketoacidosis (DKA) and Euglycemic DKA (euDKA) while using GLP-1 medications. These incidents often lead to hospitalization and highlight the importance of careful management and awareness of risks.
Experiences with DKA / Euglycemic DKA:
A particularly vivid account of euDKA described symptoms such as: "Minimal to no hunger, slow digestion, constipation, vomiting, thirst without the ability to keep water down, lethargy, perfect blood sugar* - 95-110 straight line for a couple of days, some sort of reflux, breath was literally like smelling a corpse, and others. " This user was hospitalized in the ICU for six days. [5]
DKA has also been reported secondary to pancreatitis induced by GLP-1s, where the inability to eat led to insufficient insulin intake. One comment detailed a T1D patient who "Pancreatitis -> couldn’t eat -> didn’t use their insulin (Type 1 Diabetic) -> DKA -> new a fib -> stroked -> on CRRT for some time. "[1]
An emergency doctor shared an observation of a "patient with pancreatitis, DKA after about 3 weeks on meds, admitted for a second time after re-starting his GLP-1. "[12]
One user recounted an experience where severe appetite suppression from the medication led them to "almost entirely stopped eating and taking insulin," resulting in DKA and an ICU stay for three days. [10]
High ketones without full-blown DKA were also reported. A user mentioned, "I developed ketones from rapid fat loss during the first 2 months... The ketones went away when my weight stabilized. " They managed this with their endocrinologist. [9]
Identified Causes and Contributing Factors:
Rapid Insulin Reduction: A UK drug safety update mentioned "reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued" with GLP-1 agonists. [13]
Severe GI Side Effects & Dehydration: Vomiting and diarrhea can lead to dehydration, making insulin less effective. One user stated their insulin wasn't working because they were "too dehydrated for it to circulate. "[16] Another patient was admitted to the ICU for DKA due to hypovolemia from GI side effects. [2]
Appetite Suppression: Drastically reduced food intake due to appetite suppression can lead to patients taking less insulin, thereby increasing DKA risk. [10]
Confusion with SGLT2 Inhibitors: Some users believe euDKA is more commonly associated with SGLT2 inhibitors rather than GLP-1s. [17, 18] However, numerous accounts directly link GLP-1s to euDKA in T1D patients. [4, 5, 6]
Remedies and Preventions Recommended by Users:
Monitor Ketone Levels: Regular ketone testing with strips is strongly advised, especially for T1D individuals. "To stay on top of this, I recommend getting some ketone test strips to monitor your ketone levels. Small amounts of ketones are usually okay from time to time, but if you see large amounts, it’s important to contact your doctor—or even go to the ER. "[13, 21]
Close Medical Supervision: Working closely with an endocrinologist is crucial for dose adjustments, monitoring, and managing risks. "My best suggestion would be working closely and honestly with your endocrinologist. Mind was able to tell me when I was getting too close to not taking enough insulin and we moved from 12. 5 back to 10 of mounjaro and monitored it closely. "[7, 9]
Stay Hydrated: Due to potential GI side effects, maintaining adequate hydration is important. [5]
Recognize euDKA Symptoms: Awareness that DKA can occur with normal blood sugar is vital. Symptoms like severe lethargy, vomiting, or a distinct breath odor, even with normal glucose, should prompt medical evaluation. [5]
Cautious Dosing and Adjustments: Start with low doses and titrate slowly. Insulin adjustments should be gradual and supervised. [13, 21]
Address High Ketones Promptly: If high ketones are detected, one user suggested to "Eat some carbs and drink a ton of water if so! "[22] and consult a doctor.
It's also noted that some healthcare professionals are cautious about prescribing GLP-1s to T1D patients due to these risks, or prescribe them with strict monitoring and patient education.
Experiences with DKA / Euglycemic DKA:
- Several users, predominantly T1D individuals, have shared experiences of developing DKA or euDKA.
A particularly vivid account of euDKA described symptoms such as: "Minimal to no hunger, slow digestion, constipation, vomiting, thirst without the ability to keep water down, lethargy, perfect blood sugar* - 95-110 straight line for a couple of days, some sort of reflux, breath was literally like smelling a corpse, and others. " This user was hospitalized in the ICU for six days. [5]
- Another user warned, "Be aware of Ozempic-caused Euglycemic Diabetic Ketoacidosis.
Identified Causes and Contributing Factors:
- Insufficient Insulin: The most frequently cited cause is a lack of adequate insulin, which can occur even with normal blood glucose levels in euDKA.
Remedies and Preventions Recommended by Users:
- Maintain Adequate Insulin Intake: This is paramount.
It's also noted that some healthcare professionals are cautious about prescribing GLP-1s to T1D patients due to these risks, or prescribe them with strict monitoring and patient education.