My dad (64) has been type 2 diabetic for years and is morbidly obese.  He started keto to lose some weight and he's down 50lbs but my mom has noticed some changes in his behavior lately.

She said he hasn't been eating much and sleeps during the day, staying awake most of the night.  He has taken a few falls lately with no good reason.  When he falls, my mom has to call the fire dept out to pick him up because he is too heavy to get himself off the floor.  She said he loses track of time because his sleep cycle is so messed up.  He ate very little yesterday and nothing today.

This evening, she went to check on him in bed and he was unresponsive, had foam in his nose and mouth, but was breathing.  She called 911 and the paramedics took him to the ER.  When he arrived at the hospital, his blood sugar was 14 (I don't know what that means, just that it's dangerously low).  My mom said they were able to get his blood sugar up to 50 when she last heard an update.

They had him intubated when she last saw him so he didn't speak but she said he appeared conscious even though he could barely open his eyes.  The doctor told her they were taking him to the ICU and would run tests to figure out what's going on.

Does anyone have any experience with this sort of thing and potential lasting effects?  The waiting game to find out if he's going to be okay is fucking brutal.

Final update:  My dad passed on Sunday night.  I was by his side with my mom when it happened.  His heart was very enlarged and weak.  He hadn't seen a doctor in over 2 years because he was so stubborn about medical issues so it was only a matter of time before something major happened.  Thank you guys for the thoughts/prayers.

.....The doctor told her they were taking him to the ICU and would run tests to figure out what's going on.......



Dude, there is nothing any one can tell you until doc comes back with tests other than wild guesses and speculation.


Chill.  If you don't trust the doctor get another one, but for goodness sake don't rely on GD for solutions to this.

I hope everything turns out ok OP.

I'm not so much asking for a diagnosis as a "Me/my parent/my friend went through this and..."

I know jack and shit about diabetes.

Wish your father comfort and a good recovery.

Eta: Is it the case his meds were not adjusted as he lost weight and his insulin resistance decreased? Let your doc think it through.

Way too much that could be "off" (I hesitate to use the term 'wrong') to guess at over the internet.

With T2D, you need a good endocrinologist if you want a second (or even third) opinion. Your dad will likely have an internal medicine doctor providing care in the hospital and he should have a follow-up appointment with primary care.

That said, his weight loss could be key here depending on his meds and other factors.

Just make sure the docs know about the keto and weight loss as well as the symptoms.

what diabetes meds is he on?

When someone is that unresponsive it’s common to be intubated for airway protection.  14 is an incredibly low blood sugar.  Like deaths doorstep low, especially the condition it sounds like he was in.

Signs of consciousness are a good sign.  He will be on sedating meds to keep him synchronous with the vent.  The hospital will do breathing trials daily to assess for extubation readiness.  Without knowing what’s really going on, people recover from things all the time.  Blood sugar is correctable and people get off vents.

Sorry you’re going through this.  Prayers out for you dad’s speedy recovery.

I don't know but I need to find out.

I'm 2,000 miles away and talk to him a couple times a month but he never talks about anything health related.

Holy shit

Normal is 80-120.  14 is like "getting ready to visit St Peter" low.

That's what I figured out through googling.

My primary concern is that this is a "no coming back from that" sort of event, but it doesn't sound like that's the case.  From what I've been reading, he can return to normal as long as he reached medical attention quickly enough.

Prayers

As a type 1 diabetic, yeah that's scary low. I think the lowest I've ever recorded was around 19 and I was pretty much useless at that point, luckily I had family to get dextros tablets into my cheek until the EMS arrived...

To be that low after or during sleep is almost a death sentence

Your body starts shutting down vital bodily functions to preserve the brain, but it can only last so long. Prayers for the OP's dad, hopefully he'll be able to pull through.

Would be a good candidate for a constant glucose monitoring system, i dunno if insurance will pay for it, but that's a lot of blood sugar fluctuations

ETA

So long as your dad was still breathing there's a good chance he'll be okay. There may be some damage if this was long term, but he still had some sugar in his blood stream, so to be honest you may have caught it in time. I had 2 hospitalizations when I was a kid, and both times I can't even remember what happened, just like a blank. So aside from some memory loss of the incident I don't see why he wouldn't be able to recover, but again i'm going to push the point of constant glucose monitoring... it could very well be a life saver, a lot of the systems can alert another person Via cell phone is blood sugar levels drop too much.

He is lucky to be alive at 14. Lowest I've gone was low 30's. I was miraculously still conscious and was able to crawl to the fridge and chug a bunch of orange juice. Scared the shit out of me since I was alone, and asleep. I woke up because I felt like I was going to throw up.

If he is seeing a primary care doc for it, he needs to stop NOW and go to an endocrinologist. He also needs to get a Glucagon kit that can be administered to him by your mom at home in the event this happens again.

Treatment plans for more advanced diabetes need to be custom tailored by the endocrinologist. Everyone is different. Some of the SGLT-2 inhibitors they are prescribing for T2 can knock your BG levels down really low like that if the doses aren't tuned right.

Type 1 here.  The standard deviation of the blood monitoring devices can be quite large, so he might have not been that low in actuality. I have been that low once or twice and it can be a little of nothing or it can be very bad.  That low of a blood sure is not something Type 2 diabetics typically deal with, what medication is he on?  Being that low for long periods of time can cause some level of brain damage, but how much is dependent upon a lot of variables.  I have been really really low before, and am mostly normal, unless you ask my wife.

Glucagon is something that I would keep around if this is something that might happen again.

depends on many things. How long was his Glucose low? How use to large shifts or mostly how use to large blood sugar drops is he? IS there an underlying physiological reason why his glucose dropped that low, or is this just a symptom of something else? Hopefully the physicians can give you a better picture. I've seen patients as low as his recover but it is dependent on other factors.

Here is an article that goes over some things that can happen:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784865/

I would find out what meds he is on...some meds (like insulin or sulfonylureas) can result in hypoglycemia...especially if he is skipping meals. I would also ask if he could not feel the low blood sugar? The more often you run low, the more your body adjusts to running low all the time so when you run dangerously low you can't feel it. If this is the case or if he is a brittle diabetic...a CGM device can be extremely helpful in preventing future episodes..I have T1 DM use dexcom myself but will probably switch to the freestyle libre 2. Lowest I have ever been back when lente was a thing was 20..and that was at diabetes camp.

If he is eating a Atkins or other low carb diet a CGM can help him to make sure he doesn't run too low again. It sounds like he really needs his meds adjusted. I would also have the doc prescribe a glucagon or baqsimi kit for emergency lows.

Best wishes for your father.

I've been using the FreeStyle Libre since it was approved in the US. They are legit for the most part. You can use your phone to read it. I've had one bad sensor in the whole time I've been using them (readings were nowhere close to the finger stick reader), but Abbott promptly sent me a new one.

If you sweat a lot, they will want to come off. SkinTac and a Tegaderm patch can mitigate this. I liked them better when they were the 7 day ones. The 14 day ones usually come off of me after about 10 days. They need better adhesive.

I hope yall find answers and get help op.

We just found out my 2 year old daughter is type 1 diabetic last week.  The Dexcom monitor has been a godsend to us. It allows multiple people to monitor glucose levels in close enough to real time. It starts blasting alarms when she gets low or high. We've had to wake her up a few times to give her some honey while they were figuring out what her insulin doses should be.  Maybe you can convince him to ask about getting set up with it so you can be alerted when something is wrong.

Assuming he pulls through this okay, there will probably be a lot of issues revealed that he was too stubborn to mention before.

My mom has noticed changes but he's the type that would never admit there's something wrong until it's too late.

Interesting you bring up psych issues.  When I called him on Father's day, he sounded depressed and I haven't heard him that bummed out in a long time.

I've been out on the same patients numerous times over the years and seen teens and 20s multiple times. It is concerning, especially early on in treatment, but the situation is far from hopeless.

Encourage him and your mom to stick to a schedule or routine.  Without a routine, it is easy to miss doses, take doses too close together, forget to eat, etc.

So sorry about your dad! My guess is he went keto and failed to get beetus meds adjusted. Starting keto-sticking to it, while great for T2 diabetics, absolutely needs monitoring by healthcare team cuz changes will need to be made quick. But that’s just my 2¢ as an armchair quarterback. Hope he’s on the mend soon.

Hope your Dad pulls thru. I have bad kidneys and a moderate type 2. I really worry more about hypo than hyper glycemia, at least over a short term - eg., driving. I've been at 50-60 mg/dL, and I'm getting tunnel vision and feeling really bad.

14 is very very low.  While it should be a reversible condition, there is something underneath driving what happened.  Is it his body has gotten healthier with weight loss and he is now taking too much metformin or other T2 diabetes drug?  Or did several hormone changes take place from various systems in his body to get him here over time?  Could be an infection or an antibiotic got him here.

When your sugar is that low, 14, you have to worry about how long it was that low.  If it was that low for too long there could potentially be brain damage.  Years ago we had a T1 diabetic get very very low and she spent a month in ICU, most of it unconcious.  She came out of it few deficits.

Not really enough known information to work with, but it is possible it could be very serious and it is possible he will wake right up and be fine.  

There are many smarter guys than me on this site but feel free to @ me at anytime for a firefighter/paramedic point of view.

From personal experience my own mother has gotten down to 19 and still be awake to talk to me, very silly nonsense talk but still awake.  

Best wishes for your father.

I know almost nothing about diabetes. but prayers for your dad.

Prayers sent for you and your father
Being type 1 diabetic for 47 years if my blood sugar gets lower than 30 I go into Convulsions like a fish out of water cold sweating buckets.

The real question is if there he suffered any neurological damage during this event

He will be evaluated by Neuro while in the ICU once stable

Praying your pops has a full recovery.

See if he can get a continuous glucose monitor. Lots of insurances and medicare/medicaid provide them now. Know what the sugar is all the time with no finger prick. Set alarm for too high or too low. They provide a receiver to set all that. If you want to get fancy if you have a cell phone the app runs on it will show on the phone and he can set it up so you can check his sugar or his wife or whoever on your own phone.

My guess is he is taking medication to lower his blood sugar and changed his diet without changing his medication which made his blood sugar get that low.

This.

Worst would be a doc who insists your dad start eating carbs to “balance his meds “
You may need to help your mom with this: find a doc who knows how to manage keto and meds.

This.  Insulin-dependent diabetics have to be careful and closely monitor glucose levels with keto.

ER nurse here. There’s a lot that could be going on OP without being there. Prayers sent.

My BIL died from diabetes. He went into many comas during his life. Don’t let him drive. Keep honey and orange juice all the time, even when traveling. Give it to him as soon as the first sign appears. Keep check on blood sugar.  All I got.
Terrible disease OP. Prayers for him and family.

ER worker checking in:

Wasnt eating much, but was he still taking his insulin? That may have been the issue.   Older people are sometimes so set in their ways they just take stuff.  With the diet change and weight loss, his dose/sliding scale may have been pretty far off.  Combined with 24+ hours of reduced intake, If he took his insulin it would have tanked him bad.  

Or if he is on both types (rapid and slow), he may have gotten them mixed up.   I've seen that one too.  Thats a battle.

Has he been screened for obstructive sleep apnea(OSA)?

If he’s obese & “sleeping all day” it can be a sign of OSA which can lead to high blood in the lungs & right side of the heart, as well as strokes, death, heart failure, leg swelling, cellulitis, sepsis, etc.

It can lead to not eating, which leads to low blood sugar.

Best wishes for your dad’s recovery.

IMing you my number. Text me if you have questions about something they are doing (or not doing).

Keto and weightloss probably drove down his medication needs, if he wasn’t monitoring closely and working with his doctor, i’d suspect the cause.  I’d also continue keto and try to keep the weight loss and medication going down.  You might want to look into virta health’s program for him,

I'm a Type 1. Thats really low blood sugar for a Type 2. Typically that only happens in Type 1's who over bolus their insulin or undereat for a specific bolus shot. Exercising heavily can do it as well. I think my lowest was around 25-30 but I never passed out.

Has he been prone to dropping that low before? As a type 1 I keep a glucagen pen handy in case i've ever become unresponsive. In 23 years of being Type 1 i've never become unconscious or unresponsive from hyper or hypoglycemia though.

He definitely needs to get hooked back up with his endocrinologist. If you can manage/afford it I would suggest getting on a continuous glucose monitor (CGM) for a couple weeks at a minimum to track his blood sugar along with all medicines, food, and exercise during that time as well. That will be the best way to accurately see what his body is doing. If not it's just playing a guessing game with the doctor, especially with people that don't take the disease seriously. If insurance allows it then try to get on one full time.

Diabetes is a very dynamic and personalized disease so he need to do his part every single day to monitor and manage it.

I wish him a speedy recovery.

Fucking this.

A diabetic needs to be making changes under the supervision of their endocrinologist.  Making significant dietary changes, that while it may create significant weight loss, following a fad diet is a good way to have things like this happen.  While I do applaud his effort to work towards a healthier self, there are safer ways to do this.

Has he been checking his sugar regularly?

I have personally seen someone conscious but delirious at 14, although they were a type 1.  Sugar fixed them up quickly.  Best of luck to your father OP.

+1

1) Keto represents a drastic change in the diet so he should have been monitoring his blood sugars very closely and adjusted his insulin and other diabetes medication accordingly, in close cooperation with his doctor.  If he wasn’t doing this, he eventually started taking more insulin than he needed for the calories (specifically carbohydrates) he was consuming, and he bottomed out his blood sugar.  Insulin causes cells to absorb sugar from the blood and this causes a drop in blood sugar.

2) The blood sugar has likely been getting lower and lower for days, and his brain wasn’t functioning properly which accounts for the falls.  There may be other reasons as well such a diabetic nerve damage in the feet which can mess up the nerves that allow for normal position sensation.

3) Back in the early part of the last century, they used to treat depression by giving IV injections of insulin which would cause the blood sugar to plummet down into the 20’s and teens and trigger a seizure.  They eventually replaced using insulin with electric shocks to trigger seizures as many patients would lose their IV’s and they couldn’t give them IV sugar and they would die.  So sugars that low can be fatal.  It’s possible that the foam was there due to a seizure, but without anyone witnessing it, it’s hard to say for sure.

4) Low blood sugars can damage the brain.  The most sensitive part is the hippocampus which regulates memory.  If he has only mild damage, then the short-term memory would be affected.  If there is more damage, then it will affect his cerebellum and cause balance problems.  Even further damage will next affect the cerebral cortex and his cognitive function in general will suffer.  Without knowing how long his sugars were critically low, there is no way to tell how much damage was done if any.  If they caught it early enough, there may not be any damage at all.

Prayers sent and please keep us updated if you can.

ETA:  When I was an intern, I took care of a 60 year old Asian woman who had an insulinoma, an insulin producing tumor.  When I would round on her in the morning, she had blood sugars in the teens and would act drunk, laughing and giggling.

I fix people in the field regularly with blood glucose levels around that, many don't even go to the Emergency Department afterwards. The real question is how long was he like that? what is his normal blood sugar? Why and who intubated him (new medic that didn't know any better, good medic that couldn't resolve the low blood sugar with D10 or D50, or a Doc for the same reasons)?

Also it is common for people that hypoglycemic to have seizures. Which is a good possibility given a BGL of 14. Not typically life threatening seizures but it depends on how long he was like that.

I hate to give you all that info not knowing all of the story, but if you have questions PM me and I'll tell you what I know.

He might be what is called a "Brittle Diabetic"  

I knew a woman like that. She would be fine then a second later was passed out on the ground.

Her husband and kids knew to immediately give her some meds to get her blood sugar back up.

It was scary.  I can't imagine living that way