DKA again. (sigh)

[Angeldust]

So I'm in Montréal right now and have been since May, will be home next month as my 6 month visitor visa will be up.

As some of you may know, I suffer from very aggressive gastroparesis which lands me in hospital 10 times a year or so with flareups.

So far here I have had 2 and ended up in the crappiest hospital where they didn't have a clue about anything and couldn't even speak english.
Anyway long story short,,I started having a flareup at the weekend and demanded the only place I be seen is McGill.

They were the most attentive, efficient people I have ever seen in a hospital...ever. There were doctors around me non-stop, I stopped vomitting blood after one night (the other 2 times in the horrible hospital it lasted a week) because they listened and gave me all the right stuff.

Despite vomitting all day Sunday my glucose remained between 7-8 and when I started vomitting blood non stop went up to 12..which is in no way bad under the circumstances.

But

I was DKA
?????????

All my bicarbonates were completely off the scale. Now..back home in the 'stupid hospital' on my island they seem to have this idea that DKA can only happen if your sugars are off the scale. Which is dangerous..and completely ridiculous. They had me believe as long as my sugars were ok you could not go DKA.
THIS IS NOT TRUE.
As I had to find out unfortunately. I'm sick of them and their assuming that one that goes into DKA is one that is not looking after themselves, total, total cr*p. But the people in McGill were amazing.

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?

I'd just like to whine about the fact they wanted$800 up front just to be admitted. I said I couldn't afford it and the Dr said to me, look you are severely ill and will die we can't let you go. And cut the fee by half and I'm getting invoiced the rest which I will never ever be able to afford. (my insurance is a 90 day trip..I've been here since may). Ah well.

Sorry for the rant and thank you if you took the time to read it.
There's noone else I can moan to that really understands all this.

 

[benedict]

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

 

[Angeldust]

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??

 

[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?

 

[jopar]

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..

 

[phoenix]

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?

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)

 

[Angeldust]

Thanks very much Phoenix. That was useful.
Yes Jopar I was definitely DKA. My bicarbonates, potassium, sodium......everything off the scale.

Benedict I can consume nothing. Nada. Not even a sip of water. Once a flareup starts there is no chance of it stopping and not a chance in hell of consuming a drop. It is continuous chucking up blood and acid....non stop.

 

[moonstone]

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.

 

[janabelle]

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??

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

 

[Angeldust]

Hi guys and sorry for the slow reply.

Moonstone: I don't even think your post warrants a reply. But thanks for your understanding and sympathy in this awesome situation.....but I will address the fact that due to my health conditions..NOBODY would insure me..except the company I'd always been with,and their ANNUAL policy is a 90day per trip insurance. So ..I took the best I could get. And I'm here for love. The best thing that has ever happened to me. I am going to get sick regardless of where I am..and this makes everything a million times easier for me to get through, and also gives meaning to my life and a reason to fight and battle and get through the hell I have to go through. So yeah...I'd do it all over again with zero regrets.


Hi Janabelle and thanks. Well: why would you need novorapid if you were not eating and your blood sugar was normal?? My levemir was doing it's job. Any more and I'd have been hypo! hmm. This is what I really don't understand.

Also: nausea is the predominant side effect of my gastroparesis and I'm used to it. But let me tell you...you know when it's a flareup. It's completely different. And definitely not the levemir...I only feel all the better since I switched from lantus over a year ago.

 

[moonstone]

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.

 

[Angeldust]

I gathered you knew nothing of them simply through the tone of your first reply.
Now..being somebody that speaks 6 languages and travel and multi-culturism being my favourite things (after medicine)..I do NOT expect to go to 'a country that speaks another language and have them speak English'..I was simply highlighting the differences between the two hospitals..and let me tell you they could not have been more different. They were getting p*ssed at ME for speaking Parisian French and not fully understanding Quebecois. DOCTORS. The least you would expect from a DOCTOR is a grasp of the English language...I simply stated that because it would help most people understand what a horrible experience this was. But thanks for picking the most trivial point from my entire post...The whole point is I suffered MEDICAL NEGLIGENCE.

Now the main reason I'm replying to you is because your post has a very 'oh you're sick therefore cannot live' vibe. I would just like to stress I'm sick of being sick, sick of worrying and sick of not being able to have a life. So as soon as I was well enough, I started LIVING. I will not sit around and feel sorry for myself just to wait for the next flareup because getting sick is an inevitability.. I would rather spend that time living in the moment and making the most out of every day that I can.

 

[moonstone]

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?).