DKA and DUK Balance mag advice

[Daibell]

Anyone else spot the interesting DKA treatment advice in the current issue of Balance mag if you receive it? In the 'Spotlight on' window it says "It is important to drink plenty of sugar-free fluids and keep up your carbohydrate intake". Wot? Adding more carbs when your blood is swimming in glucose seems just a little strange....

 

[paul-1976]

Anyone else spot the interesting DKA treatment advice in the current issue of Balance mag if you receive it? In the 'Spotlight on' window it says "It is important to drink plenty of sugar-free fluids and keep up your carbohydrate intake". Wot? Adding more carbs when your blood is swimming in glucose seems just a little strange....

That does seem pretty strange-a bit like treating alcohol poisoning with vodka!

 

[kesun]

"It is important to drink plenty of sugar-free fluids and keep up your carbohydrate intake". .

If we need to keep up our carbohydrate intake, why bother to keep our fluids sugar-free?

Kate

 

[mrman]

Works for me

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[mrman]

If in dka, luckily only once at diagnosis, I was given the sliding scale drip. dka as most know is a severe lack of insulin, causing raised sugars and ketones. To correct dka insulin is needed which will lower sugar levels. What would happen if you didn't have a steady supply of carbs. A hypo. So to avoid a hypo from having the insulin needed to correct the dka, and also to prevent a huge dramatic drop in levels, suger is needed.

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[Daibell]

Hi Brett. Thanks for that explanation; it does clarify things a bit. I'm not an expert on DKA treatment or sliding scale stuff but to my engineering sense I would have thought when in DKA it might make sense to have an initial big shot of insulin to get away from excessive blood sugar but not too big and then to slow it right down to get the balance right without needing any carbs. I'm sure there are good reasons for the current approach but do I have a sneaking suspicion that the NHS love affair with carbs might be lurking in the background as well?

 

[paul-1976]

Luckily I've never had DKA that has needed hospital treatment but I have been on a sliding scale in hospital before surgery and my levels were terrible on it-another type 1 I know found the same whilst in hospital so I believe just because something is current NHS practice-doesn't make it right,if it was purely a 'sliding scale' then surely with close monitoring of BG levels the ratio of glucose to insulin should be tweaked so that more glucose wasn't required simply to avoid hypoglycemia and less insulin being delivered would be the right way?

 

[mrman]

The problem is when the blood levels are only slightly elevated but ketones remain dangerously high. a balance of insulin and sugar is then required to reverse dka whilst having ok blood sugar levels. This is why if in dka, having a big shot of your own qa insulin is not enough by itself and hospitalisation is required.

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[mrman]

Even if on sliding scale, this uses qa insulin and once "fed in" simply cannot be slowed down immediately. Once in, it will still last 4 ~ 5 hours.

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[noblehead]

Thankfully not had DKA, finally got some blood ketone sensors from my Dr but I noticed that the pot says to throw away 3 months after opening, thought they'd come individually foil wrapped as the ones that came with the LX meter were

 

[phoenix]

The protocol depends on whether I am eating or not and whether glucose levels are high or low

It says to use sugary drinks (sip them) if glucose levels fall but ketones are still high (especially if you are vomiting or have diarrhoea )As previously said You need more insulin to get rid of the ketones but if blood sugar is low but you can become hypo but still have ketones
Like the article (I assume, haven't read it) If I were able to eat but had ketones, it says that I should eat normal meals and that includes carbs (most people I know here continue to eat fixed amounts/doses as prescribed ) The normal dose would be taken with the appropriate (prescribed)amount of insulin on top to deal with ketones. The amounts of insulin needed rise considerably with high ketones.

The consultant reckons that those who follow the protocol we were given could in most cases avoid getting to the state that they need help in hospital. ( that's his hope anyway because everyone on the course was given the direct 'offduty' phone numbers for the two doctors if it doesn't work and I don't think they wanted lots of phone calls)
.