Warning about Dka and illness.

[JConnor]

I know this has been discussed before but I just wanted to remind people that Dka doesn't have to be with very high sugers.
I've been ill all week with a stomachs bug and feel pretty lousy. my sugers had been between 10-12 which i didnt think was to bad with how ill i felt. Friday I woke up fine but felt very tired and went to bed at 2pm at 7 I finally woke up but every muscle muscle ached I couldn't sit or stand or get comfy, I couldn't keep anything down and was feeling short of breath. Getting concerned I phoned out of hours GP who asked if I had checked for ketones (which I hadn't as hadn't passed urine since 7am) I decided to check blood ketones which came back at 6.9. My blood sugars where only 12.2. By the time I got to a&e I had deteriorated VERY quickly. The blood test came back and ph was 7, whisked straight into resus they was surprised I was still awake never mind walking. DKA hadn't crossed my mind at all because my levels wasn't in the 'danger' zone. It's only now I realise how poorly I was and if I hadn't phoned doctors when I did the outcome could if been very different. It has left me very shaken but determined to keep my eye on ketones when I'm poorly.
Life is to short live it to the max



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[Nickers]

Re: Warning about Dka and illness.

Thanks for the reminder good to make us aware


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[Nickers]

Re: Warning about Dka and illness.

Glad your ok aswell must if been frightening for u


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[mo1905]

Re: Warning about Dka and illness.

Good post. I was told only to check if 15 or above. Glad you're sorted now ;-)


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[hale710]

Re: Warning about Dka and illness.

Thanks for sharing! I too had been told to check above 15. Ill be more aware when I'm ill now just in case. Takes 5 seconds to do a test, a lot longer to recover if you don't check!

 

[JConnor]

Thanks guys I'm feeling alot better than I was but rough still. At dinner time still had very low potassium levels which didnt help matters. I never gave Dka a though until doc mentioned it and only checked so when I got to docs I could say it wasn't. Couldn't believe the 6.9 and rechecked it. The meter probably saved my life.


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[phoenix]

Re: Warning about Dka and illness.

I'm so glad you're OK . It's good that the GP was on the ball and realised that DKA was possible.

It's a good reminder to check for ketones if you are unwell, irrespective of glucose levels ( and particularly if vomiting/diarrhoea /not eating/pregnant).

We quite often read people insisting that DKA is only a threat at very high glucose levels. Yes, in most cases, people have higher levels but it's not always the case. Their have been other people on these forums who have also experienced it.
The earliest paper (1978) discussing and naming it as euglycemic DKA mentions that out of 211 cases of DKA, seven presented with levels less than 100mg/dl (5.5mmol/l).
The writers of a recent case study (blood glucose on arrival 118mg/dl; 6.5mmol/l) state

This case demonstrates that hyperglycemia is unrelated to the pathophysiology of DKA. The mechanisms behind DKA are stress, decreased insulin production or effectiveness, and increased glucagon production

(nb stress in this case includes a variety of possibilities. The ones they mention are physical (ie an infection etc), psychological and things such as alcohol/drugs)
http://journals.lww.com/jaapa/Fulltext/ ... ent.7.aspx

 

[Embabe25]

Hi guys thanks for posting this thread.

I've been feeling awful for the past few days. My kids have had D&V but I haven't had anything like that. Just off my food and the most god awful indigestion!

I've had DKA before and don't feel like I did then but was wondering what to do about my lantus. I take a split dose. I take about 35 units at night. Should I cut it and by how much or should I just miss it all together. It's actually painful to eat so I don't want to take it an not eat. My last BS was 2.7 about 20 mins ago. I've drank some irn bru and even that hurt.


Em x

 

[noblehead]

Re: Warning about Dka and illness.

Pleased your OK now JC.

You make a valid point about not being able to test if your not passing any urine, they always say keep hydrated but this is difficult when your vomiting with a stomach bug.

I asked my gp for the blood ketone strips after receiving a free meter but he refused to give me them, his reasoning was they are far too expensive and the Ketostix do the same job, next time I see him I'll be mentioning your scenario with a view to him changing his mind

 

[phoenix]

Re: Warning about Dka and illness.

You might in fact need more insulin when you are sick not less. You should not stop your basal.
SIckness can make you insulin resistant. It is also a lack of insulin that 'causes' ketones to develop and rise.

There are 2 ways to deal with bolus injections , if you are not eating,
1) (traditional as in the Nottingham guidelines) ie to use a bolus injection and take in some liquid carbs ( preferably with some nutrients but at the last resort sipping things like coca cola (flat if necessary)

2) as per DAFNE below ie no food bolus if levels are normal and there are no ketones . However a relevant corrective bolus is necessary if levels are higher and or ketones are present. (and if levels are low but ketones are present then that also needs some carbs alongside the insulin to prevent hypos)

Here's some general rules for 'sick days'
http://www.nottinghamdiabetes.nhs.uk/sickdays.html

These are the rules as apparently as taught on DAFNE. (they are very similar to the sick day rules I was given here)
http://www.diabetes-support.org.uk/info/?page_id=141
They rely on frequent monitoring when you are sick (both ketones and insulin). However, they also rely on you being able to calculate the doses correctly ; it would be a very good thing to discuss this with someone before you need it (to make sure you aren't making a big error/misunderstanding!)

I think the most last bit is really important

If you continue to vomit, cannot keep fluids down and/or cannot reduce your blood glucose or ketone levels (or if you are unsure what to do) call your GP, diabetes team or hospital as an emergency

Noblehead:
Remind him that the blood ketone strips are foil wrapped, I think I am correct in saying that they don't go out of date in the same way as urinary ketone strips.

 

[noblehead]

Re: Warning about Dka and illness.

Remind him that the blood ketone strips are foil wrapped, I think I am correct in saying that they don't go out of date in the same way as urinary ketone strips.

Yes I will........thanks

 

[Embabe25]

Re: Warning about Dka and illness.

Thanks Phoenix.

I took half my usual lantus dose and had a sugary drink. My BS was 8.8 this morning. Feel a bit better so took everything as normal this morning and had some toast.

My baby girl is better but my wee man in still ill poor wee guy

Thanks for your help Phoenix. I've bookmarked your link xxx.


Em x

 

[JConnor]

Re: Warning about Dka and illness.

Pleased your OK now JC.

You make a valid point about not being able to test if your not passing any urine, they always say keep hydrated but this is difficult when your vomiting with a stomach bug.

I asked my gp for the blood ketone strips after receiving a free meter but he refused to give me them, his reasoning was they are far too expensive and the Ketostix do the same job, next time I see him I'll be mentioning your scenario with a view to him changing his mind

I would maybe also try using the point that ketostix pick up in starvation ketones that may be expected during illness that would cost the nhs money to investigate where blood monitors don't pick up in them.
In very lucky my GP will prescribe me anything I can have 30 ketone strips a WEEK on repeat though obviously I don't put in a prescription anywhere near that often, before I actually brought a box of 10 from chemist it cost me £30 which us probably why GPS don't like giving them out. Good luck with it as I now strongly advise them, may well of saved my life


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