Is NO insulin in the body the ONLY cause of DKA?!

TheSparkyPony

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Just been released from hospital again after a 2 week stint with DKA :roll:
Really scared me this time as have never been so ill with it, was very tachycardic (172 bpm! :shock: ) and very high resps. Honestly thought this was it!
Anyhow, while in hospital I managed to get DKA again during the night about after a week of being in (after coming off drips).
I raised my concerns with my consultant, as I feel it was poor management from the staff - I read as HI at 9.30pm, then the same at 11pm and 1am, only to be given 6u of Actrapid at the late time of 1.30am :evil: by which point I was well away.

He had a rather smug look on his face and told me that the only way I could have DKA-ed was if I had NO insulin in my body at all, which in turn is insinuating that I haven't been doing my insulin. Whilst in hospital, the nurses observe you doing them, and besides why would I not want to do them?! To be in such a state as in DKA?!

Am struggling to find any information online so was wondering if any of you knowledgable lot have any input?

Many thanks, as always! x
 

TheSparkyPony

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Celtic Piskie, thankyou, interesting link!

So (sorry am such a numpty with things like this!) in essence, if I were to have, say, a UTI, still injecting insulin, I could still DKA?

It's a shame I can't actually talk and ask my consultant these things :roll: but never mind! x
 

Celtic.Piskie

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No problem at all.

http://en.wikipedia.org/wiki/Diabetic_ketoacidosis

A UTI Is listed as one possible cause. Basically, even in 'normal' people, the blood sugar rises a lot with infection / illness.
With diabetics, we use up all the available insulin, but still need more. He is right in saying that the cause is no insulin, But that means you didn't take enough, not that you didn't take any.
 

janabelle

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Hi Sparkypony,
I just came across this thread on another forum that might interest you.. diabetesforums.com/forum/diabetes/31472-levemir-side-effects.html
Particularly the post 3/4 of the way down the page by seanmarr.
Jus
 

jopar

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I would ring your consultand secretary, explain your concerns and ask if the consultant will speak to you concerning them... There is a good chance they will

But DKA is normally a case of not enough insulin, on another thread in this section is a link that Pheniox posted, which explains a rare conditions that brings on DKA at lower levels when not expected!

I know that when I was pregnant many years ago, I used to start going into DKA at quite low levels of 8mmol/l :shock:
 

TheSparkyPony

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Right bear with me whilst I reply!

Celtic.Piskie - thankyou for clearing that up for me. Was wondering as reading through my discharge form, I was admitted with a urinalysis of Ketones +++ (obv), protein and Leucocytes (sp?!) which I know is an indicator of a UTI.

Janabelle - Interesting link. I do wonder though whether it would apply to me as I've been on Levemir for a good few years now, although the dosages have increased dramatically over the past few months, from only 30u at night to a whopping 74u at night and 20u in the morning.

Jopar - I did try to speak to my consultant, but unfortunately got rather upset as I feel after 11 years with T1, my confidence is shattered and the frequent DKA-ing is not helping.
I'm 18, nearly 19 and looking to go to uni next year which is impossible under these circumstances! He simply gave me the number for the diab nurse (again!) and reiterated that the only way I could have DKA-ed was no insulin. I wonder what his intentions are by relaying this over and over, especially seeing as the nurses were administerating/observing ALL my injections :roll: Nevermind!

Thanks guys for all your input, it's reassuring! :p xxx
 

Angeldust

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Hi, I'm so so sorry because I know EXACTLY what you are going through and it's horrible. I'm sick to death of the stupid hospital back home insinuating I don't take insulin and am not looking after myself frequently because I am DKA. SICK of it. Truth is I have never ever taken better care of myself and everyone that knows me says they've never seen a diabetic person look after themselves so well. So it's really hurtful and insulting to me.

Here's proof for you that it's not the insulin: a couple of weeks back I had a gastroparesis flareup. Vomitting nonstop for the day, and in that entire time my BG did not go over 7. I took my full dose of levemir.

By 7pm I knew it was time for IVs or DEATH. I was severely dehydrated and fullblown dka and my blood sugar was still normal. My bicarbonates, potassium, sodium..everything..was completely off the scale. Through the VOMITTING.

I'm in Montreal right now and went to McGill hospital..I have to say it's the best place I've been in my life. Everyone was so attentive, and KNEW what they were dealing with. My flareup stopped overnight simply because they knew exactly what they were doing (sometimes I'm stuck in hospital for 2 weeks) and after 2 days my bloods were back to normal and ketones gone.

With the gastroparesis...nothing will stop a flareup. If it happens...it happens. And it's hospital time. Around 50% of the time the vomiting will land me in DKA so I've had to accept it.

I really hope you feel better soon,
Linda
 

janabelle

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Sparkypony & Angeldust,

Angeldust you stated that your BG was normal when you went into DKA, and from what I read about DKA I'm not surprised your doctors are puzzled.
Levemir is NOT insulin, it is a copy of insulin , a drug which lowers blood sugar levels. I just wonder whether there is something lacking in this drug which although your BG is not high, causes you to suffer DKA.
Angeldust you said "Here's proof for you that it's not the insulin: a couple of weeks back I had a gastroparesis flareup. Vomitting nonstop for the day, and in that entire time my BG did not go over 7. I took my full dose of levemir." Sparkypony you said "I do wonder though whether it would apply to me as I've been on Levemir for a good few years now, although the dosages have increased dramatically over the past few months, from only 30u at night to a whopping 74u at night and 20u in the morning."
I know Levemir is different from Lantus, which I had problems with, but they took a while to show themselves, and the most common time period for people experiencing problems (or realising it)with analogues is 18 months or over, which is why they're often not recognised.

Personally I have no experience of DKA, not even at diagnosis nearly 22 years ago. Since that time I have had 3 pregnancies , severe flu many times and the usual run of the milll illnesses. After reading both your stories I feel very lucky, it sounds absolutely horrendous.
Someone suggested recently on this forum that the probs people suffer asscociated with analogue insulins are an "allergic reaction" which I don't entirely believe but then everyone reacts differently to medications, so it's not beyond the realms of possiblity. But were that to be the case, it could be possible that you have both developed some sort of reaction which is resulting in your DKA, even though your BG is "normal"-ish and you have been taking your medication.

Analogue insulins have not been around for long, we are (I was) the long-term studies, maybe this is totally new ground for medics and hence the confustion.

I could be barking up completely the wrong tree,but after reading up on DKA I'm as puzzled as you both are. Of course not everyone on Levemir OR other analogue insulins suffer DKA in the way you both do, but we are all different, and I feel it's worth considering.
Whatever the cause, I hope you both get it sorted and don't have to suffer this anymore
Jus
 

janabelle

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Hi again, another thought. Did either of you have an Hba1c test while in hospital and if so what were the results? Or results of any recent Hba1cs
Jus
 

Angeldust

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Mine is around 6.
And my episodes of DKA have nothing to do with levemir...I can't even get my head around that notion.
Severe gastroparesis and DKA go hand in hand.

edit: I read a post from OP in another topic saying they have nerve damage to their stomach which makes them vomit..
Gastroparesis.

Now it all would make sense..
 

janabelle

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Does it make sense? Having a relatively normal BG level and developing DKA?
The question "is no insulin in the body the only cause of DKA", I was making the point that neither you or the OP are on insulin, but insulin analogues. A very different kettle of fish altogether :? .

I'm sorry if my suggestion offended you, and I wish you better health in the future.
Noticed on your other post that you were vomiting blood, you should get that checked.

Jus
 

Angeldust

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Yes..this happens every single time and is a prevalent symptom of my condition. I have the best consultant and GP I could hope for. I am in the best hands.

I think there's a misunderstanding. This time (here at (Hospital name removed) is the only time this has happened. DKA with my levels remaining normal.

This might come out wrong but really I don't intend for it!..do you really think we don't know that what we are injecting is synthetic insulin!? To us diabetics these injections are our insulin and when we are referring to having 'insulin in our bodies' I think clearly we speak of our insulin injections being in effect.
 

KimSuzanne

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Hi all

Not sure if this will help as its not classed as DKA but ketones can also be produced if your not eating, I think I've seen a few bits on TV that say thats what the Atkins Diet does.

And also Angeldust & SparkyPony I know exactly what your going through I spent four years in and out of hospital with DKAs being accused of all sorts, mine turned out to be fairly unique though. I had chronic pancreatitis from the age of 11years old - 16, removed 11 years ago and they still the complications I have now are my fault. It drags you done and you begin to wonder why you bother but stick in there!

Kim
 

Angeldust

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Hi Kim,
really sorry to hear that and glad you are doing better.
It really is horrible...there's good doctors and nurses out there but they are very hard to come across.
I have good doctors now but every time I end up in that hospital back home it's the same old cr*p.
It really is disheartening but you have to find a way to rise above it and not let it pull you down. DKA is going to be a part of my life now..so I have to deal with it. I'm smart enough to get myself to A&E asap when I know it's happening so I haven't had a coma for a few years.

It's hard to tell though because sometimes I can vomit all day yet still manage to recover by myself (like yesterday,,,today I'm ok) and others while I'm vomiting I'm goingDKA. I wish I had a way of testing my own potassium sodium and bicarbonates!
 

natasha61

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I've had diabetes 1 for over 32 years and fortunately have always been able to get rid of ketones quickly by testing very frequently and raising both my insulins as recommended in DAFNE. I have a daughter who developed diabetes at the age of 2 years, she has very frequent episodes of DKA through mismanaging her diabetes i.e. not taking her insulin etc. I normally treat her ketones very aggressively doing blood tests every 1 1/2 to 2 hours. Her diabetes nurse does not agree with the way I approach it, I feel that the no. 1 goal is to get rid of the ketones asap and it is only by the use of insulin in larger doses that this can be achieved. If someone is in hospital apart from problems finding veins etc. because of DKA in my opinion they don't take hard enough measures to get rid of the ketones. What does anyone think of my view?
 

jopar

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How different are the sick day rules you'll using differe to what they are suggesting you use?

There could be a problem with not so much how quick you are dealing with the ketones, but how you are dropping her blood glucose to stop the body from producing them... Dropping the BG too quickly can cause as many problems as it solves.


You need to speak to her team ask for exact reasons, and come up with a plan that both you and your team are comfortable with to implement on sick days, but you also need to work with your daughter and her team to see if you can find out why she's missing her insulin injections, finding a way forward in helping her to tackle this and take better control of her diabetes to prevent her getting into this situation in the first place...
 

Celtic.Piskie

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Dropping the glucose levels too quickly can lead to low potassium, imparing the heart, nerves, and muscles. It can lead to muscle cramps, weakness, and arrythmia, an irregular heat rhythm. There's a reason they don't do it agressively in hospitals.
Children can also develop cerebral edema, basically swelling in the brain. This can occasionally be lethal, and and have long term complications.

Treating it too agressively a lot of the time is more dangerous than the ketones itseld.