What a week !! DKA

JConnor

Well-Known Member
Messages
106
Type of diabetes
Type 1
Treatment type
Insulin
As some of you may remember i have been in limbo between hospitals and receiving no support since diagnosis, After seeing the new consultant a few weeks ago my control suddenly changed to very poor to so so (no serious mid to high 20's anymore) and was feeling rather proud even managed to get a few in range readings!
Monday this week despite not changing my doses my levels suddenly soared high, early of Wednesday morning i woke up at 28.4 and felt like i was dying of thirst, by Wednesday morning my sugars had dropped to 18 but found 3+ketones. GP told me to go to A&E urgently and was confirmed had DKA drips insulin and 2 canulas later was feeling good!
I was transferred to Emergency Assessment unit and BM checked every hour, the ward was great EXCEPT FOR NIGHT TIME STAFF!!!! I have since lodged a complaint with the hospital as had so many problems, Going hypo on sliding scale due to BMs not being checked when they should be, staff refusing to give me info on my treatment using the words 'ive sorted it out' staff aggressive and rude to elderly patients etc.
Last night was the worst, i came of sliding scale and went back to managing my own treatment, my levels rockets to 21 when i was injected with actrapid by the nurse i was being sick and was very vacant, felt like i was floating up above looking down. My better half was worried sick but had to leave to collect our daughter (on top of all the medical stress it was first time i had spent time away from our baby and really upset me). i then felt like was hypoing which i was the nurse went to fetch me something and returned about 15 minutes later with some toast which she put on the bed and walked off not to be seen again for ages, while i struggled with the worst and longest hypo i have had. There was no follow up from her on how my sugars where even tho i had told how i had run out of test strips from my own supply she never checked my sugars again till the morning.
I am furious with care i recieved those 2 nights and the total lack of compassion and care.
luckily i am home now and can start battling to get my sugars under control which isnt easy am going from hyper to hypo in space of an hour or 2. one thing for sure im not going back to that ward anytime soon, my other half could have handled most of the care better himself than the nurses and assistants did and after less than 4 hours sleep in total since tuesday night i plan on sleeping all weekend!
 

Fallenstar

Well-Known Member
Messages
546
Wow Conner, that is shocking . You really have been through the Mill, so sorry to hear about such bad practice in the Hospital, being in Hypo for a long time is very scary. I really hope things settle for you soon. Do you know what brought the very high sugars on again, did you have a Virus or infection or something?
What did the Consultants think was making your BS swing so wildly?

I can understand why you don't want to go anywhere near that ward again, phew.
 

Superchip

Well-Known Member
Messages
512
Dislikes
GP's, Diabetes Nurses.Crazy NHS guidelines on diet for Diabetics, they are seeing off millions.
Cheap Whisky !
JConnor ! What a horror story, you poor lady ! Tragic treatment to be sure.
When you are back on an even keel perhaps a copy of your post here should be sent to

1. Your GP
2. Your DN
3. hospital admin
4. MP
5. anything else that other posters here can think of, I think that there is a hospital complaints admin.

It totally highlights a complete lack of knowledge and training in the NHS.
If it wasn't for forums like this we'd all be at serious risk of complications.

Keep up to speed on here and you will be a lot safer !

Sleep well JC

Roy
 
D

Deleted member 45091

Guest
Hi ive been diabetic about 23 years now, i had similar experience few years back. Had bad virus etc kept being sick with a bug, sugars was all over the place they put me on the sliding scale wow... i was crashing one minute then then they switched it then was going high i was all over the place.. think the problem is they have a set rule if your sugars are x amount you need this amount of insulin and its all ****. Different diabetics are on different regimes and require different amounts of insulin, it sounds harsh but i put zero faith in the NHS and think its only going to get worse. I was awake one night the night worker was picking her nose just before she was going round checking bloods etc its crazy, I take everything i need when i get admitted my own insulin orange juices food etc and my own blood meter. Last year i learned my lesson i was flued up abit for about week, had ketones was sent to hospital to make sure, soon as i got there the cannula was in suggesting i went on a sliding scale i refused the doctor told me to take 12 units of nova rapid to get my sugars down, i yet again refused, iam sure he had a chart what to take its crazy, i weighed up my personal situation realised it was coming up to lunch time i had nothing to eat i had 2 units of rapid insulin my sugars came back down and the ketones had gone, i was out after an hour or so. Iam not saying everyone should refuse certain treatment but the NHS regarding diabetics need to get real. There to generalised sooner or later they will get the message that each diabetic needs to be treated on an idividual basis, Ive just had a few **** experiences with the NHS care, But it says something when i take all my medication snacks food etc just to feel safe when entering the Hospital.
 

hanadr

Expert
Messages
8,157
Dislikes
soaps on telly and people talking about the characters as if they were real.
that's disgraceful!
does you hospital subscribe to the "Think Glucose" initiative?
they certainly DON'T follow its principles.
In myOpinion, Sliding scale isn't suitable for conscious patients, who are eating meals. According to my "Senior Sister" niece, It was never meant to be used in that way. You need to discuss all of this with the consultant. Contact your local PALS group through the hospital. They could have killed you and left a new baby without you
Hana
PS keep a careful written account of everything
 

jopar

Well-Known Member
Messages
2,222
Two things surprise me both with the OP and DannyH...

How on earth did you get sorted and out so quick!

Admittedly It's been a few years since I've landed in hospital with DKA, but when I have, each time I was in for a couple of weeks, each time I spent a week or so on the sliding scale to stabilise my bloods, then weren't allowed home until I had gone 48 hours clear of ketone's... And there's nothing worse then going 46 hours ketone free then finding them again, and having to stay for another couple of days...

Hanna

You aren't medically qualified to determine whether a sliding scale is appropriate treatment for a T1 if they are conscious, which shows because it seems that you don't really understand what the sliding scale treatment is about, and the dire straights the patient is actually in...

When you go into DKA crisis, not only are the level of your ketone's dangerous, but their effects mess up your electrolytes as well, you are dehydrated and in a life threatening situation..

So you need fluids quickly to rehydrate, and your electrolytes need to be stabilised asap, the most effective way of doing this is to deliver insulin straight into the blood stream but mixing it with the saline hydration solution...

Injecting insulin into the fat layer, costs precious time with several problems such as slow adsorption, uneven adsorption, increased insulin resistance etc...

Sliding Scales are done on a formula, body weight, BG levles etc to determine how much insulin to saline is required, the objective is to bring the BG down, stabilise the electrolytes and rehydrated the patient...

It's an emergency treatment to start, then it's a stabilising treatment take the sliding scale away too early before everything is stable, it's likely that you will drop back into a DKA crisis very quickly indeed..
 

JConnor

Well-Known Member
Messages
106
Type of diabetes
Type 1
Treatment type
Insulin
Thank you everyone for your replies.
I have complained to PALS and the ward leader contacted me but i am still not happy, her reply was that she hoped my 'next' stay was alot better experience!!!!
My blood sugars are still totally out of control one minute im on 9 next im on 21 with no food in between.
DKA was only mild, was fully alert and not feeling ill at all. was only picked up because i checked for ketones myself due to high BM's, they actually wanted to discharge me after the first night NOT because i was well enough to go home but because my 4 month old daughter came to visit me!! (that was actually my diabetic consultant)
I am terrified of DKA again and with my sugars being all over the place i am checking for ketones every time.
My partner works at the same hospital as management and he was been advised by HIS manager to whistle blow. the whole experience has left me very angry ( due to complications and no actionm being taken at the the time my 5 year old son was born with Cerebral Palsy at the same hospital) the hospital is only 2 minutes up the road from where i live but next time think i will travel 10 miles to the next hospital :(
A nurse on A&E told me i would be discharged in an hour as she couldnt smell ketones, Thank God a blood test was actually done.
 

CherryKerry

Member
Messages
13
I was in hospital a couple of weeks ago with DKA. I was also put on a sliding scale but luckily the nurse did come every hour to check my blood glucose. To start with they put me on a potassium drip and a insulin drip but the dozy nurse failed to put a glucose drip in also. As you can imagine this caused low blood sugars and the doctor who eventually came round to check on me then ordered a glucose drip too. About 4 in the morning my blood sugars dropped to 3.0 so they turned the release of glucose up and offered me some orange juice. Because I assumed that they are fully trained and know what they are doing I accepted the orange juice. This caused my blood sugars to shoot up (because of the extra glucose coming from the drip) making me feel awful. I was readmitted again last night due to ketosis but luckily was allowed to go home because the ketones had dropped. I was all ready to say no to treatment I felt wouldnt help. Safe to say I pray I don't have to go in again anytime soon!
 

bjy80

Member
Messages
7
Had a similiar experience in july...
Both my boys came home from their dads with type a flu & long story short i didnt look after myself properly & ended up dka...
Actually went to work on the friday as i was feeling better but woke up worse... Drove myself straight ti hospital after work...
I was on both drips & they couldnt work out that i had ketones yet my sugars were fine (duhhh the flu)... Refused the.short acting once but they talked me into having it once a hypo occured they started listening...

Think the medical staff need to start realising that diabetics know their own body & the sliding scale method simply doesnt work for everyone...

Hope you are feeling a bit better now.. Take care
 

jodysd6

Well-Known Member
Messages
190
I have been in DKA more times than I like to admit, I am probably just a bad diabetic or I just seem to go into DKA very quickly, but I have been there a few too many times and in different hospitals and have had a variety of experiences. Firstly I can semi frequently be getting very high readings, be getting high ketones and be tasting ketones etc but I do my best to avoid having to go to hospital, there are certainly times when I could have gone to hospital but did manage to get it back under control at home, and unfortunately there has been the opposite where I really should have gone to hospital sooner. My last admission (had a bent cannula and within a few hours was in DKA) I was pretty with it and actually the staff in A&E were totally upto date on DKA management (much better than when it was missed for several hours because I had 'normal' bg's and no one realised to do a blood test until I was hallucinating.) on the ward it was hit and miss really. I did convince the. To let me go back on my pump ASAP, and I had plenty of supplies, so I was testing myself a lot and I was having a lot of lows but once I ran out of hypo stuff if I asked them they would get me something appropriate straight away. They also offered me extra snacks before bed as I was having nighttime lows, but I would say that had I not been doing it myself and telling them later I don't think it would have been easy, they would have missed a lot of lows and probably over treated a lot of highs, and watching what they did with other diabetics was scary (ie insulin injections a long time before or after meals and then panic over lows and highs). So I suppose I am pretty informed and let them know that, I have found that treatment can be really bad though because most staff just don't know enough about diabetes and in particular about type 1.
 

hanadr

Expert
Messages
8,157
Dislikes
soaps on telly and people talking about the characters as if they were real.
Jopar
I know I'm not medically qualified, but I was trained as a research scientist in a biological discipline. I've been married to a T1 for 41 years and hae made it my business to study the subject in some depth. I do have the ability/education to do that.
In addition, when someone labelled "Senior Staff Nurse" tells me that increasing the saline on the sliding scale drip is to get the blood sugars down, I know she doesn't have a clue despite her medical training.
The sliding scale regimen as I saw it being administered was taking no account of normal mealtimes or of moving around and thus was utterly inappropriate for its use.
Look up the sliding scale regimens that are posted on the internet. Our hospital hasn't got its one up [or hadn't last time I looked] and decide if you think it would be fit for purpose with a conscious patient.
in addition,a few years ago, I was left by a GP to cope with a severe case of DKA, whilst he just went away. So I have seen it Over many years of using my brains to solve problems, there's not a lot I havent had to deal with.
PS my T1 husband is still alive and about 80% fit now just short of his 66th birthday. He wouldn't be if I didn't fight ignorance on his behalf. He' say that himself
Hana
 

Engcricket

Member
Messages
7
I am sorry to hear this story. I think ur experience was dreadful and it shouldn't happen again.
Unfortunately readin this thread I realise that there are a lot of misunderstandings about DKA.

First and foremost I am medically qualified and trained a few points
1) DKA protocols are present but they are not standard amount of insulin is calculated via numerous factors- so tho two people could be in DKA and the medics are using the same protocol the rate of insulin would be different depending on blood tests wight etc
2) the actually initially replace potassium and sodium with insulin until ones Bm drops below 15 at which point the fluid changes over to glucose and remains that way regardless of BM going up. Rate can be changed
3) they do not account for meals and activity as once u are on established meals u shoud come off insulin sliding scale and go back on SC. and DKA is lifethreatenig they really don't expect you to be walking around.

4) all of this doesn't change the fact that you had suboptimal care and that is not acceptable.

Lastly as someone who as had DKA and who was looked after brilliantly by the team I am sad that this hasn't been ur experience (the team were not aware that I was a doctor)
 

donnellysdogs

Master
Messages
13,233
Type of diabetes
Type 1
Treatment type
Pump
Dislikes
People that can't listen to other people's opinions.
People that can't say sorry.
Poor JC... You still havent got any response on why your levels are fluctuating so much or how to improve them.

Wish I could help, but have been on a pump too long now to advise on what to look at and change with injections etc...

I hope somebody may have a suggestion on how to re-establish levels... Incidentally.. You say you have a 4 month old child...have your levels changed in anyway related to this? Are you getting bad hi/low around certain times.. Is it after doing anything specific?
 

JConnor

Well-Known Member
Messages
106
Type of diabetes
Type 1
Treatment type
Insulin
Thanks everyone i dont seem to have much look at all really :( no support from anyone other than GP who admits she not very knowledgeable on diabetes.
I have not heard anything back from my complaint to PALS so will now be putting in a written complaint, the hospital in question has developed a very bad rep and have auditors all over place so will have to act on it.
I have had words with diabetes team today as finally recieved an appointment for 1st feb at 9am which i cant make as have to take eldest to school for 9am 5 miles away and apparently i cant change the appointment.
Can see more complaints going in soon, so bad have to fight for proper healthcare, but is same for my son who has cerebral palsy have to fight for everything he needs.
 

Sarahfergo

Well-Known Member
Messages
109
Nhs are rubbish a few years ago I went in hospital and had a hypo so the nurse gave me glucose gell I was sick straight away , the nurse just walked away and lucky there was some one with me because I went into a fit and was unconscious! Recently I w been admitted with dka but had to wait in a&e for 3 hours before being seen my bloods were reading HI on meter I had 3 +ketones when the eventually saw me I was very ill and rushed into resus they put me straight onto sliding scale! I was transferred to the ward 9 hours later and I had a hypo so they unplugged me from sliding scale for 2 hours ! The doctor came to see me and was really shocked with what they had done I was then put on it again, they were rubbish at testing my bg and ketones especially night staff. My diabetic nurse thinks there is not enough done for diabetics it's life threatening they should have a ward for diabetics only with the highest trained staff and doctors
 
H

Hooked

Guest
I've learned over the years that if it's not one of the diabetic consultants adjusting insulins etc, ask one of the staff nurses (or Dr themselves if they seem amenable) to double check the treatments prescribed with the DSN. Too many inexperienced Drs prescribed crazy rates for me over the years. Thankfully the staff nurses would come and run through it with me and ask my thoughts on it; if I was unsure or not happy the DSN would be contacted and I remember hearing Drs talking to her on the phone being told what I really needed medication wise so they could write it up for me.

Hope you are feeling better soon.
 

Sabantha

Well-Known Member
Messages
95
I've been dka a good few times, seriously ill infect and must say my treatment/care in hospital was superb!! I trust my team & doctor. I did once have a kink on my line when on sliding scale and got very ill quickly however they noticed as sugars increased and treated appropriately,

It's such a shame a horrible situation was made worse by in incompetent care, DKA is life threatening so if you don't think your care is up to par, you MUST voice concerns straight away avoid getting worse, I think diabetics admitted to hospital should always work with dr/nurses and be involved - as no1 knows your diabetes like you :)


Sent from the Diabetes Forum App