DKA again. (sigh)

Hi Angeldust, sorry to hear about your awful experience

When you couldn't eat for 2 days, were you still injecting your long term insulin?

Benedict

i guess if you haven't eaten in two days your body would need energy from somewhere and breaking down fats would be a logical choice.

same action as in hyperglycaemia, just a different cause.

i've seen it recommended that if you can't eat you should take surgary fluids (presumably in small or gradual amounts) -this does make sense now i think about it from this angle.

any chance of running this by one of your health team in the near future?

Wonder if you were actually DKA?

Or just chucking out ketones?

If you consider the theory behind Bersnstien and Atkins and their extreme low carb diets, using fat as fuel rather than the carb this naturally produces ketones which the body dumps through the urine? Assumption being that this is not harmful, as BG would be within the normal range :?

Every T1 will have a slightly different threshold in blood glucose to where they will start to produce ketones and start going into DKA, Most will start at a point past 12mmol/l this is the point where we should be testing for ketones but some diabetics can have quite high numbers before they see any signs of ketones and start going into DKA..

I went DKA because I couldn't eat for 2 whole days and then on the third vomitted non stop. I was severly dehydrated and my body went into ketoacidosis because it had no fuel and had to start breaking down fat cells, right?

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Exactly right!
It was good that the doctors at McGil recognised it, . Hopefully you're on the mend now and you'll find some way to get out of the payment difficulties.
It actually has a name Euglycemic ketoacidosis and is rare but associated particularly with vomiting and continued insulin use, thought it can also arise because of fasting ie a low intake of food concurrent with an infection. As there are no glycogen reserves the body uses it's stored fat for fuel and produces ketones, these can multiply quickly.
http://pjms.com.pk/issues/janmar08/article/bc2.html
When I looked this up some time ago I also found a paper from (I think) India which said that quite a lot of newly diagnosed type 1s in developing countries have DKA with normal blood glucose levels, this is presumably because of malnourishment (starvation)

On the DAFNE course it was made very clear that dehydration was extremely dangerous because of the risk of DKA.

On a completely different note, I can't understand your annoyance that French people in a French-speaking city "couldn't even speak English"? Why should they...? You went to their country, not the other way around, they didn't come here and try to treat you with no English language skills. Also I can't understand why, if you know you are likely to be hospitalised 10 times per year with the gastroparesis let alone any random diabetes issues that could crop up, you only took out 90 days of insurance and let it lapse months and months ago? I know I might sound a bit like I'm telling you off but maybe you should have a sit down and think about what's important to you. Getting yourself into thousands of pounds of debt for medical treatment will only add to your woes and possibly make you more sick. Plus, you were very lucky that the Doctors treated you anyway without the 'entrance fee' - they didn't have to do that. You probably already realise this but I think you should get yourself some insurance asap because if it happens again (which it's likely to, from what you've said), what will you do? What would happen if you were so sick that you had to be repatriated - that costs tens of thousands of pounds. I'm not telling you off, honestly, but maybe you need to get more awareness of the situation you're in over there, with no NHS.

Angeldust said:

Yes,yes I was.
No novorapid but as always I never skip the levemir.
I was NOT hyperglycaemic yet went DKA.
I had insulin in my body.

Could other hormones be the cause? Cortisol, adrenaline? Or is it all simply dehydration from severe vomiting??

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Hi Angeldust,
It sounds absolutely horrendous, I really feel for you going through this on a resular basis. Clutching at straws here, but you state that you had insulin in your body, which isn't stricly true, Levemir in an analogue insulin. As you might be aware there are many people who suffer dreadful effects on them, interestingly enough someone told me this week that nausea can be a side-effect of Levemir. although I've not heard of anyone on it suffering the awful side-effects many people report on lantus, which do include gastro and bowel problems. I suffered diorrhea, acid reflux, nausea and constant hunger amongst other things.
Everyone is different and while clearly many people get on fine with analogue insulins, it is becoming abundantly clear that a growing number of people are experiencing side-effects. Worth considering it as being a possible cause for your problem.
Are you currently on any other medications?
Hope you feel better soon.
Jus x

You know what, you don't have to justify yourself to me. Having said that, it does now make sense. From what you previously wrote, you went to live somewhere non-English speaking, allowed your insurance to lapse knowing what was probably going to happen, and then the inevitable happened and you then moaned that the hospital didn't even speak English, which they were never going to. It didn't come across very well tbh and I can't abide victim mentality (which it initally came across as) but I now completely understand what lay behind it all. I can understand why you want to stay there, but maybe you could gradually convince your partner to come back to the UK with you where you're more likely (though not guaranteed) to get care in the English language but above all it will be free and available 24/7? I feel you're a bit stuck between a rock + a hard place. Unfortunately I can offer no understanding about DKA or gastroparesis having never suffered either of them and I realise this is beginner's luck so one day I'm sure I'll have more of an idea how upsetting it is.

Not at all, I have not implied you're sick therefore cannot live and I don't really understand what you mean by that statement? In fact I did say twice that I now completely understand why you're there with no medical insurance and I wish it could be different for you, ie to have the benefit of good, available healthcare in the same country as what sounds like the love of your life. That's what I meant about being stuck between a rock + a hard place - it seems unfair to me that you should have to choose one or the other. I'm really not very well either so we're in the same situation, everyone here's got something wrong with them, not to put too fine a point on it and your illnesses don't trump mine and vice-versa - you don't know what the last 2.5yrs have been like for me and I really hope you never do - it's been hell. I did also say you didn't need to justify yourself to me - you don't have to; you explained, I understood, I told you that - I get it, there's no other way to say it, and there's nothing in my last post that can be taken any other way. In my original post, not only was I not "picking on" anything at all (merely questioning what you had been saying, which I found illogical), but I also didn't "pick on" anything insignificant - to you, that was very significant, because you talked about it. Insignificant things don't get mentioned. You weren't questioned about it but spontaneously talked about it, and having seen what you said about the Doctors I understand even more why it was of such significance that you couldn't effectively communicate with them - they were acting ignorantly towards you in your hour of need, which is unthinkable. I studied French & Law (British, European and French Law), and I also speak several languages; I'm not a student of multiculturalism because I simply am multicultural, being half British and half Italian. On the legal side, unless you paid in some way for that medical care or were entitled to free care then I can't see you having a claim for medical negligence as there was no contract or agreement in force. If however you did pay in some way, or were entitled to free care, then if you can deal with a court case you should pursue them not only for yourself but to ensure they don't mistreat anyone else in future. And on the languages side, while it must have been overwhelmingly irritating, especially whilst feeling so absolutely awful, to have the Doctors demand you speak Quebecois (very, very petty indeed - at least you were speaking French in the first place, it's like a Doctor in Newcastle demanding you speak Geordie), I don't agree with your asssertion that all Doctors worldwide should have a grasp of English - that's a pre-requisite for pilots, but not medical professionals. Yes, it would be fantastic, but it's not going to happen abroad. In fact, you are one of the 'special people' who do what I consider the right thing by ensuring they know the language of the country they're going to live in and that should have been enough - it's the Doctors' totally ignorant behaviour that caused the problem, they could have easily understood you - no English required. They probably made the DKA worse by adding even more stress to you. Maybe you can pre-prepare some cards to keep in your wallet with things you want to say or ask for in Quebecois for next time you end up in that hospital (if you do?).