ketoacidosis

[sally jane rosie7]

Sorry if I haven't spelt this correctly. Three weeks ago I wasn't feeling at all well, I had and still have a nasty chest infection due to problems I have many health problems including congenital heart defects, pulmonary hypertension (not normal high blood pressure) vascultistis of the lungs. The hospital had no choice but to give me steriods for chest and I know the decision wasn't taking lightly for these steriods as my BS are not controlled at all running at 18 to 25 most days. To cut this short, I was feeling rotten and sugars were climbing, tummy ache and sick, and first thought this was gastropsis which I know I had but by 7pm I couldn't keep myself awake, seeing odd things and talking rubbish, sweating felt very poorly, my husband did my BS and were at 36.6 he phoned for help and the lady on the phone asked him to make me do a ketone pee test it was plus 4 I can't remember anything else until much later, having a drip and fluids in hospital, my BS had shot up to over 44. My blood also showed toxins I couldn't take out of my lungs because of chest infection was pretty bad, the hospital said it was infection dehydration through sweating so much that was the most likely cause of this episode. My question is this....my sugars are not coming down still at 25 most days, I feel constantly sick and throw up if I eat, I am still taking my insulin, I still have a chest infection and on antibiotics no steriods, my diabetic nurse is aware but sent a appointment for January...can I really wait this long like this ? My fear is having another episode like that honestly it was horrible and scary, I am doing everything I can to lower these levels but nothing is working, it if I am resistant to the insulin even if I increase it its having no marked effect, I am eating minimal food and the bits I do often come back up, I have lost over two stone in this last 6 weeks, I take humlinS morning lunch supper and levimar morning with humlinS and bedtime, 5 lots total in a day. What else can I do to help myself should I demand a sooner appointment with nurse ? I am constantly under attack with thrush in my mouth and elsewhere its most distressing. What do I do ? Would a pump be better for me now ? So many questions and no one to ask. I appreciate any help.
Thank you Sally.

 

[ButtterflyLady]

Holy ****, you don;t need to see a nurse, you need to see a doctor, and within the next 3 days I'd say.

You need antifungal pills for the oral thrush, you need an endocrinologist to review your diabetes treatment regime, and you might also need a gastroenterologist to assess you for gastroparesis.

IMO your GP should be pressing for you to get an appointment with an endo urgently.

I hope you are feeling better soon. Please let us know how you are doing.

I am tagging @Anaelena and @donnellysdogs because they know about gastroparesis (and T1) and @nosher8355 @himtoo and @Robinredbreast for general T1 advice.

 

[sally jane rosie7]

I should also say when I had this ketonacidonsis, I was taken to our neatest a and e and this isn't my diabetes hospital, the hosp

Holy ****, you don;t need to see a nurse, you need to see a doctor, and within the next 3 days I'd say.

You need antifungal pills for the oral thrush, you need an endocrinologist to review your diabetes treatment regime, and you might also need a gastroenterologist to assess you for gastroparesis.

IMO your GP should be pressing for you to get an appointment with an endo urgently.

I hope you are feeling better soon. Please let us know how you are doing.

I am tagging @Anaelena and @donnellysdogs because they know about gastroparesis (and T1) and @nosher8355 @himtoo and @Robinredbreast for general T1 advice.

Awww thank you so much,
I am due to see my endocrinologist in the end of October, but still thinking thid is to long to wait, I hate feeling I am a whinger and know the nhs is at bursting point, so have been sitting here not knowing what to do, I was diagnosed with gastro in 2013, with a endoscopy, I do take domiprone for it, bit often comes up not long after I taken it, and because of this sickness and the nature of the gastro the rest of medications heart tablets water tablets, wwarfarin, are not working either, my inr are so low I am having to have heprin, bit of a sorry state really as its hitting home as I am writing this, what makes me sad is that my own gp that I have had for many many many years retired in June and my new one doesn't seem to get all what's going on, and has said ccontact your nurse which I have and appointment for January. I just really don't know what to do or where to go, perhaps talk to my cardiologists I honestly don't know,all I do know, is that I feel pretty poorly again tonight and thought I would ask you lovely people here that go through the same for advice. I really do thank you for your reply.

 

[ButtterflyLady]

I should also say when I had this ketonacidonsis, I was taken to our neatest a and e and this isn't my diabetes hospital, the hosp

Awww thank you so much,
I am due to see my endocrinologist in the end of October, but still thinking thid is to long to wait, I hate feeling I am a whinger and know the nhs is at bursting point, so have been sitting here not knowing what to do, I was diagnosed with gastro in 2013, with a endoscopy, I do take domiprone for it, bit often comes up not long after I taken it, and because of this sickness and the nature of the gastro the rest of medications heart tablets water tablets, wwarfarin, are not working either, my inr are so low I am having to have heprin, bit of a sorry state really as its hitting home as I am writing this, what makes me sad is that my own gp that I have had for many many many years retired in June and my new one doesn't seem to get all what's going on, and has said ccontact your nurse which I have and appointment for January. I just really don't know what to do or where to go, perhaps talk to my cardiologists I honestly don't know,all I do know, is that I feel pretty poorly again tonight and thought I would ask you lovely people here that go through the same for advice. I really do thank you for your reply.

Ok yes the NHS is under pressure, but none of the doctors or planners who work for the NHS would want the people with the highest needs to miss out. You have complex heart, lung, GI, and diabetic conditions... you would be one of the highest need people I have seen on the forum so far. Your ketoacidosis was severe and your life could have been at risk if it wasn't for your husband getting help when he did. You're not going to be able to get your treatment for your other conditions optimised until you get your diabetes sorted out.

Your new GP is not up to scratch at all. Is there another GP in the practice that you can see? I suggest you take someone with you and go see your GP and explain what's going on. He has to get his head around how serious this is. He needs to get your endo appointment brought forward. The endos keep a small number of appointments each week aside for urgent cases. How you get one of them is through your GP updating them with the current crisis.

If you get no joy through your GP, then by all means contact your cardiologist, and they can contact your endo, and hopefully also your GP to inform him about what he should have done for you.

Hang in there. I suspect you are feeling lost and confused about what to do because you are so physically unwell. You did the right thing posting here... we can help you figure out what steps to take to get things back under control. Hugs.

 

[Spiker]

I agree this is a medical crisis and you need immediate attention. You have multiple issues driving up your BG. High BG makes infection worse and infection makes BG worse. On top of that you have steroids which also play havoc with your BG (blood glucose).

Do you know about the Sick Day Protocol and are you using it? At very least you need to be doing that. That means blood tests every 2 hours and a different dosing method. That is what you need to normalise your BG and give your body a chance to control the multiple infections. Call your DSN now to run through the protocol if you are not sure of it. If you are unable to cope, do call A&E because with steroids and multiple infection you are at risk of DKA (diabetic keto acidosis) and hyper osmolar hyperglycaemia. Both are dangerous and horrible. If you are unable to manage at all call 999 again. You are not being a troublemaker or anything, this is serious.

 

[Spiker]

The thrush is because of the antibiotics which kill the bacteria that normally compete with the thrush fungus. Get a one-off tablet of fluconazole aka Diflucan over the counter from Boots. That will knock it on the head. But unless you normalise your blood glucose the thrush will come back.

I know what you are going through as I was in a similar way a few times last year and it is really horrible. :-(

 

[zand]

Ask if fluconazole is OK for you first. I once took it without reading the leaflet properly and it caused my heart problem to return (atrial fibrillation). So be sure to tell the pharmacist all your medical details.

 

[ButtterflyLady]

I just had a thought... if all your tablets are coming straight back up, maybe you should be in hospital and getting your meds by injection?

 

[zand]

Yes I agree you need to be in hospital. As Spiker says it's a medical crisis.

Let us know how you get on when you get back.

 

[eddie1968]

I'm type 2 but am prone to ketoacidosis. I take Humulin M3 insulin. I do blood ketone checks if my BGs go above 13.5 mmol/l. If your ketone meter is showing 1.5 and above you need medical help immediately through NHS 24 or go to A&E. Do not mess about, it's a serious problem and has made me very ill (vomiting, abdominal pain and dehydration) so seek help please - don't delay.

 

[eddie1968]

Fluc

Ask if fluconazole is OK for you first. I once took it without reading the leaflet properly and it caused my heart problem to return (atrial fibrillation). So be sure to tell the pharmacist all your medical details.

Fluconazole is not recommended long term and is contraindicated for some people and does interact with other drugs.

 

[Spiker]

Fluconazole is not recommended long term and is contraindicated for some people and does interact with other drugs.

It's a one off solution only. If you need to take it again, don't, see a doctor.

And yes always check the patient leaflet for contra indications or ask the pharmacist.

 

[fred1234]

Oh dear what a terrible time you are experiencing. I would go straight to a&e.....you seem to be very unwell and need professional medical intervention. Your not a whinger and yes all nhs is busy because they are treating people who are Illl and you need to be included!!!!

 

[eddie1968]

Oh dear what a terrible time you are experiencing. I would go straight to a&e.....you seem to be very unwell and need professional medical intervention. Your not a whinger and yes all nhs is busy because they are treating people who are Illl and you need to be included!!!!

I agree, A&E is for emergencies and ketoacidosis falls into the criteria for a visit.

 

[Daibell]

I agree with Spiker. Thrush will only permanently go once your blood sugar goes down. Antibiotics won't stop candida. Yes, you need urgent attention and a new GP/nurse. I assume you are carb counting with the mealtime rapid insulin? Is the Levemir balanced to match your current background insulin needs. Does the Humulin S have any effect 2-3 hours after a meal?

 

[photognut]

Jeez, you also need the hospital consultants in the various departments to communicate with each other to protect the already compromised organs. If it were me, I would not let a GP anywhere near me with the severity of those complications until I had been stabilised and pulled out of crisis. Hang in there.....

 

[sally jane rosie7]

Jeez, you also need the hospital consultants in the various departments to communicate with each other to protect the already compromised organs. If it were me, I would not let a GP anywhere near me with the severity of those complications until I had been stabilised and pulled out of crisis. Hang in there.....

 

[sally jane rosie7]

Bless you all, I have had a longish spellIin hospital, trying to get this chest infection under control is proving rather challenging but I am getting there, blood sugars are more controlled now alot of what is going on is autonomic neuropathy especially the sickness and blood sugars up and down. I have been allowed home but seeing the consultants fortnightly and my gp and specialist nurses weekly for a while, I do have alot going on health wise and one doesn't seem to be helping the other, I am just very thankful the sickness is now periodically happening and not with everything I drink and eat, I got some drinks that help as food still and those are staying in, and drinks that replace salts etc I am loosing. My blood cultures will be back soon to see if there is changes from last ones, I am hoping there is improvement. I could go on and on with what went on in hospital but I am sure you lovely people know what went on. Can I thank you all for all your very kind and thoughtful messages, the evening I wrote my original message I did feel so so so so poorly and having just come out of hospital then, I really thought I was being a pain to our stretched services, but you were all very correct, I was a medical emergency the night I wrote this and been told never question coming in again the doctors can quickly rule things out and never hold out like I did...advice taken. All my consultants have combined now, so many different hospitals with specialities I go to are talking altogether and a proper care plan has been put into place, so that's a extremely positive outcome. My husband has booked a holiday break for us the end of this month for a few days, just to relax and enjoy a few days away, in the uk of course, I am looking foward to that. Again thank you ALL so much and pushing me to get help I have alot to thank you all for. Kindest thanks
Sally.

 

[ButtterflyLady]

I'm so, so relieved to hear this!!

You are sounding 100 x better than you were. And your hubby is a real trooper, isn't he? Enjoy your break away and I hope you keep improving each day.

 

[sally jane rosie7]

I am only sorry I couldn't message before catlady, the hospital wifi isn't great and trying to type and it dropping was very frustrating, I was very aware thinking gosh I write a post like this, and can't get to update anyone kind enough that answered me, it was one of the first things I did when home and settled. Yesssss he is a star booking a break away, so looking forward to it, has been a stressful time, time to put it behind us now and enjoy the break away with the dog. I do feel so so much better too catlady, all tablets are working again and benefiting from them. Gosh diabetes is very troublesome when it throws its worse at you. Do hope your all well. And thanks again your support and advice was very much welcomedm