DKA -educate me

@tigger ,

Take a look at the main pages of this website.......

http://www.diabetes.co.uk/diabetes-complications/diabetic-ketoacidosis.html

@tigger, as I posted earlier, I had the joy of pulling a cannula out which resulted in no insulin for a few hours. During the time where I could assume there was no insulin, my background glucose production was about 3.6 mmol/l/hr. This meant that I was at 20 from a normal start (around 5) in five hours.

When using a pump, you could end up in full on DKA in s short period of time because once the pump fails there is nothing left. On MDI it is less likely due to the basal insulin in your system.

tigger said:

Yes understood. I think my block wuth this has been that dka doesn't always instantly occur. If you consider how long people lived pre insulin it varied a lot suggesting different onset times of dka. It would be good to know why.

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This isn't a definitive answer, but I suggest that it's partly down to genetics, and partly down to rate at which the beta cells are attacked, so the amount of residual insulin production remaining.

There's been a lot of research that shows that a significant percentage of T1s still have dormant or low producing beta cells, so it would make sense that once a person was put on to a very low carb diet, the beta cell destruction would be reduced (on the basis that the T cells attack the beta cells based on them producing insulin) and the amount of time that one could resist DKA would be prolonged. I would posit, therefore, that the earlier someone was diagnosed as T1, the more dormant beta cells would remain and the longer they could resist DKA, especially once insulin production was essentially switched off by use of exogenous insulin.

Just a theory!

DKA never occurs instantly. There is always an increase in blood glucose levels to a substantially dangerous level ahead of DKA, so it shouldn't ever be a surprise.

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tigger said:

Educate me -i've always understood that if you go hyper it would take a while before you hit coma level. This is partly based on my teen years where i regularly ran high levels thankfully so far with no long term damage and my diagnosis aged 3 where i think i was 44 and must have bern high for weeks. I've also had the odd very high reading when ill or miscalculated food. I've never been particularly concerned by this other than it feeling pretty unpleasant at the time and have just injected, drunk water and monitored carefully and not eaten anything til my levels came down. When i got a pump i was prescribed blood ketone strips (i'd only heard of the urine ones) but this isn't something i keep around usually.

Recently I've been reading various posts on here about dka happening suddenly and now this tragic story in the news today about the 27 year old who died and it's worrying me. Can you go from a reading of 14 (or 24) to a coma in 5 hrs?

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Hi tigger, reading your post you said you ran quite high in your teens and prior to that before being diagnosed. I would say your question is down to more than one factor, how your body copes with it and for how long so, it would be down to genetics and how your body copes with it. Remember, it's nearly always a sad/upsetting/tragic story that hits the headlines, but there are hundred's and thousands of good stories that never get mentioned. Try to get on with your life as best you can and live each day to the fullest
Take care RRB

Your health, your choices

Diabetic ketoacidosis

• Diabetic ketoacidosis
• Symptoms
• Causes
• Treatment
• Complications
• Prevention

Introduction
Diabetic ketoacidosis is a potentially life-threatening complication of diabetes caused by a lack of insulin in the body.

It occurs when the body is unable to use blood sugar (glucose) because there isn't enough insulin. Instead, it breaks down fat as an alternative source of fuel. This causes a build-up of a potentially harmful by-product called ketones.

Read more about the causes of diabetic ketoacidosis.

It's fairly common in people with type 1 diabetes and can very occasionally affect those with type 2 diabetes. It sometimes develops in people who were previously unaware they had diabetes. Children and young adults are most at risk.

It's important to seek medical advice quickly if you think that you or your child is experiencing the condition, because serious complications of diabetic ketoacidosis can develop if it's not treated early on.

Warning signs to look out for
If you take insulin to control your diabetes, you should keep an eye out for signs and symptoms of diabetic ketoacidosis.

Early signs and symptoms can include:

• passing large amounts of urine
• feeling very thirsty
• feeling sick
• abdominal (tummy) pain
• tiredness
• shortness of breath
• an increase in your blood sugar and/or ketone levels – self-testing kits are available to check these (see below)

You may become very dehydrated and if the condition isn't treated quickly, it can lead to vomiting, an increased breathing and heart rate, dizziness, drowsiness, a smell of pear drops or nail varnish on your breath, and loss of consciousness.

Read more about the symptoms of diabetic ketoacidosis.

What to do
If you think that you or your child are experiencing early symptoms of diabetic ketoacidosis, and self-testing shows you have a high blood glucose and/or ketone level, you should immediately contact your diabetes care team or GP for advice.

If this isn't possible, call your local out-of-hours service or NHS 111.

If you or someone in your care appears to be experiencing more advanced symptoms, go immediately to your nearest accident and emergency (A&E) department.

Treatment in hospital
In most cases, people with diabetic ketoacidosis need to be treated in hospital.

While in hospital, you'll usually receive a combination of:

• fluids pumped directly into a vein to rehydrate your body
• insulin (usually pumped into a vein)
• replacement of minerals you may have lost, such as potassium

You'll be closely monitored to check how well you're responding to treatment.

As long as there are no further problems, you should be able to leave hospital when you're well enough to eat and drink normally and tests show a safe level of ketones in your body.

Before being discharged from hospital, a diabetes nurse will talk to you about why you developed diabetic ketoacidosis and help you come up with a plan to prevent future episodes.

Read more about treating diabetic ketoacidosis.

Be aware of the danger
If you have type 1 diabetes, you're at risk of diabetic ketoacidosis when your insulin level drops and your blood sugar level starts to rise (hyperglycaemia).

This often occurs when you're ill with an infection such as flu or a urinary tract infection (UTI), as this causes the body to release extra hormones into your blood to help combat the illness. These hormones interfere with the effect of insulin, meaning that you need more insulin. It can also occur if you don't have enough insulin because you aren't following your recommended treatment plan correctly.

A simple finger prick blood test can be used to detect an increase in blood sugar before it becomes a serious problem, and kits to check your ketone level are also available. You should monitor your blood sugar and ketone levels closely if you have type 1 diabetes, particularly when you're ill, so you can spot any increases early on.

Generally speaking, a blood sugar reading of 11 mmol/l or more is a sign that you're at risk of diabetic ketoacidosis and should check your ketone level if you feel ill. A ketone level reading of 2+ or more on urine strips or 0.6 mmol/l or more in your blood is a sign that you need to take immediate action to correct your levels.

Adjusting your insulin dose as advised by your diabetes care team will often correct your blood sugar and ketone levels, preventing diabetic ketoacidosis. Seek medical advice if your levels remain high after taking insulin or you develop the symptoms mentioned above.

Read more about the causes of diabetic ketoacidosis and preventing diabetic ketoacidosis.

DKA isn't the point where you pass out and become very ill. Typically, DKA is the point at which you have high levels of ketones, are passing a lot of water, drinking a lot of water, losing weight. It's when your body is eating itself due to lack of insulin. Typically someone suffering diabulimia is already in a state of DKA, but sadly it is "managed" DKA. It's when you get to the tipping point that you end up unconscious and in serious trouble. Again, it's not sudden onset DKA, it's more like "endpoint" DKA. And it's no fun at all.


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