DKA recovery

[Agast]

I've been type 1 diabetic for 7 years now with decent control over my sugars. My average A1C is 7-7.5, recently I had some issues with insulin pump failure causing my sugars to go high for 2 days straight. Well that was enough to send my into DKA. Was in the hospital for two days. That was a little over a month ago and I'm still not feeling well. Just curious how long it took y'all to recover from DKA when and if you ever had it.

 

[DCUKMod]

I've been type 1 diabetic for 7 years now with decent control over my sugars. My average A1C is 7-7.5, recently I had some issues with insulin pump failure causing my sugars to go high for 2 days straight. Well that was enough to send my into DKA. Was in the hospital for two days. That was a little over a month ago and I'm still not feeling well. Just curious how long it took y'all to recover from DKA when and if you ever had it.

Oh dear Agast, that was nasty. Did you not realise your pump was failing, or were your efforts to correct matters just unsuccessful?

I'm not T1, and thankfully, have never been in DKA, so can't offer you any personal wisdom. In UK, where most of our members are based, it's very early morning right now (04:45), so responses may be limited for a while yet, but I'm sure they will come.

From what I have read, however, everyone differs how long it takes to recover from DKA. DKA is a huge physical shock to the body, not to mention the psychological impacts that can run alongside.

As far as I can garner, the secret is to be good to yourself; getting lots of decent nutritional food, carefully managing your bloods (nothwithstanding how tricky T1 can be sometimes!), plenty rest and it'll happen as and when your body is ready.

 

[Agast]

Oh dear Agast, that was nasty. Did you not realise your pump was failing, or were your efforts to correct matters just unsuccessful?

I'm not T1, and thankfully, have never been in DKA, so can't offer you any personal wisdom. In UK, where most of our members are based, it's very early morning right now (04:45), so responses may be limited for a while yet, but I'm sure they will come.

From what I have read, however, everyone differs how long it takes to recover from DKA. DKA is a huge physical shock to the body, not to mention the psychological impacts that can run alongside.

As far as I can garner, the secret is to be good to yourself; getting lots of decent nutritional food, carefully managing your bloods (nothwithstanding how tricky T1 can be sometimes!), plenty rest and it'll happen as and when your body is ready.

Hey DCUKmod I at first didn't realize my pump wasn't working. It didn't give me any warning alarms or anything. I just assumed it might have been a bad sight, so I changed it and my number seemed to go down. Then again later that day my number went up again and stayed high for the next day. Once I realized it was my pump not working correctly I went to emergency to get insulin, that's when I found out I was in DKA .

 

[DCUKMod]

Hey DCUKmod I at first didn't realize my pump wasn't working. It didn't give me any warning alarms or anything. I just assumed it might have been a bad sight, so I changed it and my number seemed to go down. Then again later that day my number went up again and stayed high for the next day. Once I realized it was my pump not working correctly I went to emergency to get insulin, that's when I found out I was in DKA .

Horrid experience, but at least you went to the correct place!

Again, from reading, I understand lots of folks on here, who pump, still have either a pen or empty disposable syringes and needles so that they can self administer insulin, should their pump malfunction. Is that something you might consider as a bit of a safety net?

Of course, they might not help you in a DKA situation.

 

[kitedoc]

Hi @Agast, A truly unpleasant experience for you ! As a T!D pumper, not as medical advice or opinion:
Being on an insulin pump myself for 7 years and on insulin for 52 years all up, I know how easy it is for an absorption of insulin/cannula or other pump problems to send BSLs and ketones into orbit !!
Did you and do you have a plan made out with your DSN or doctor for times when BSLs continue to rise or repeatedly rise?
Now is the time to revise or make that plan.
My plan, and since we are all different, it is individual and that is why you are best to see and work out your own plan with your DSN/doctor:
1) BSL up > 4 mmol/ within 2 - 3 hours after changing cannula, or unexplicably* > 14 moml/l other times--> test for ketones**
2) change cannula/infusion set and ring DSN to report BSL and blood ketone level to recheck possible causes * and confirm next step
3) ketone blood level < 4 discuss correction doses and other strategy***, Ketones > 4 consider hospital
but any vomiting or serious other problems like diahorroea, vomiting, high fevers > 38 degrees C means hospital anyway.
4) otherwise review BSL and ketones at least 2 hourly with further insulin and food until settling or not.
* Check list I use:
Insulin problem; inactivated by being frozen in fridge or elsewhere or exposed to heat > 30 degrees C, or more than 30 days out of the fridge?, incorrect dose and basal settings
Food /diet: overeating? unusual food, maybe with added sugar ?
Illness: feeling like a cold is coming on, ? urine infection (sometimes no symptoms or high BSL confuses things like having to pass lots of urine), sore tooth, rash etc
Stress/upset: sudden or recent emotional upset or stress of impending exams :
Pump problems: a) machine and software - alarms about pump and ring helpline, flat battery or loss of battery contact OR that I have lost my pump somehow or left it at home !!!!
b) delivery to subcutaneous site and absorption from there: ? leaking tubing/connections, ?dislodged or bent or blocked cannula ? cannula in scarred tissue from previous infusion over the years!
Other: nothing definitive I have for this category yet but always like to keep an open mind ?e.g. cyber attack !!!
** Ketone measurement: some meters have separate strips and the capacity to measure blood ketones: It would make sense if all insulin pumpers had these meters, and glucose and some ketone strips prescribed in the UK
(but as an Aussie I have no say in such a sensible suggestion not even when we have to purchase ours (on a subsidy) in Oz.)!!
And please see the ketone graph picture below (kindly provided by another poster a while back) for some idea about ketones but it is up to your DSN and doctor to interpret your results and advise you.
*** Strategies: will depend on what is or is not happening. A cannula change is always a good starting point I find as this, to me, is the most obvious first and easy step to do and the 'weak point' of insulin pumps. (and provided one carries spares everywhere) !
One problem after 52 years of injecting myself is that there is scarred tissue built up at my injection sites. The trick was to choose sites not used before and to alter the length of the cannulas to better access unscarred tissue.
Once BSLs are heading down a bit I try to have a little something to eat as I need my body to not be burning fat and producing more ketones, so insulin in and a little food.
I do not try to exercise as this sends my BSLs up further (if BSL > 14 mmol/l)
With an infection I will be upping my basal and bolus doses and using increased correction doses in steps that work for me, and seeking medical or dental help as needed.
One trick I have learned and worked out with my DSN is, in the case of situations where ketones and BSLs are rising is to make a correction dose with use of intra-muscular short-acting insulin. This requires me to possess syringes and needles which will achieve that (I have some 1" needles which are more than adequate) and the ability to give myself such an injection. So that may not be suitable for others. The IM injection seems to start working within one hours whereas the usual subcutaneous routine takes as least 2 hours. I feel immense relief when I can feel the high BSL starting to fall !!
I have never experienced a pump failure but always carry spare short and long acting insulin in case, with a plan for how to restart mdi if needed.
I hope your plan saves you finding yourself in the a DKA situation again and I am very glad you have survived.
I can only guess that maybe your slow recovery is related to the initial cause of your high BSL, ketones and DKA.
And that my my reading it seems that it can take time for the body to adjust back after changes in the salt composition of the blood during DKA. (se mayoclinic.org - DKA)
Best Wishes for an improved recovery time!!

 

[Juicyj]

Sorry to hear about your pump experience - has the manufacturer given you any feedback on what caused it ? Are you pumping now or back on injections ? I have heard about incidents with pumps in the US, are you based there ?

Good luck with the recovery, it will take time as @kitedoc has said for your body to adjust, best wishes J

 

[Deleted Account]

Looks as if you have some great information from @kitedoc.

I wanted to add a little bit about avoiding DKA.
You say you had problems with your pump. It is definitely worthwhile finding out what caused this. However, pumps are not fail proof and we need to be prepared for our pumps to have problems. Even when they do not alarm.
Do you have insulin pens as a backup? I have some small (cheap) syringes which I can use when out and about.
Therefore, I recommend working with your diabetes team to ensure you have a pump failure plan.
And of course, lots of boring testing when I think my pump has started to misbehave.

 

[Agast]

Hi @Agast, A truly unpleasant experience for you ! As a T!D pumper, not as medical advice or opinion:
Being on an insulin pump myself for 7 years and on insulin for 52 years all up, I know how easy it is for an absorption of insulin/cannula or other pump problems to send BSLs and ketones into orbit !!
Did you and do you have a plan made out with your DSN or doctor for times when BSLs continue to rise or repeatedly rise?
Now is the time to revise or make that plan.
My plan, and since we are all different, it is individual and that is why you are best to see and work out your own plan with your DSN/doctor:
1) BSL up > 4 mmol/ within 2 - 3 hours after changing cannula, or unexplicably* > 14 moml/l other times--> test for ketones**
2) change cannula/infusion set and ring DSN to report BSL and blood ketone level to recheck possible causes * and confirm next step
3) ketone blood level < 4 discuss correction doses and other strategy***, Ketones > 4 consider hospital
but any vomiting or serious other problems like diahorroea, vomiting, high fevers > 38 degrees C means hospital anyway.
4) otherwise review BSL and ketones at least 2 hourly with further insulin and food until settling or not.
* Check list I use:
Insulin problem; inactivated by being frozen in fridge or elsewhere or exposed to heat > 30 degrees C, or more than 30 days out of the fridge?, incorrect dose and basal settings
Food /diet: overeating? unusual food, maybe with added sugar ?
Illness: feeling like a cold is coming on, ? urine infection (sometimes no symptoms or high BSL confuses things like having to pass lots of urine), sore tooth, rash etc
Stress/upset: sudden or recent emotional upset or stress of impending exams :
Pump problems: a) machine and software - alarms about pump and ring helpline, flat battery or loss of battery contact OR that I have lost my pump somehow or left it at home !!!!
b) delivery to subcutaneous site and absorption from there: ? leaking tubing/connections, ?dislodged or bent or blocked cannula ? cannula in scarred tissue from previous infusion over the years!
Other: nothing definitive I have for this category yet but always like to keep an open mind ?e.g. cyber attack !!!
** Ketone measurement: some meters have separate strips and the capacity to measure blood ketones: It would make sense if all insulin pumpers had these meters, and glucose and some ketone strips prescribed in the UK
(but as an Aussie I have no say in such a sensible suggestion not even when we have to purchase ours (on a subsidy) in Oz.)!!
And please see the ketone graph picture below (kindly provided by another poster a while back) for some idea about ketones but it is up to your DSN and doctor to interpret your results and advise you.
*** Strategies: will depend on what is or is not happening. A cannula change is always a good starting point I find as this, to me, is the most obvious first and easy step to do and the 'weak point' of insulin pumps. (and provided one carries spares everywhere) !
One problem after 52 years of injecting myself is that there is scarred tissue built up at my injection sites. The trick was to choose sites not used before and to alter the length of the cannulas to better access unscarred tissue.
Once BSLs are heading down a bit I try to have a little something to eat as I need my body to not be burning fat and producing more ketones, so insulin in and a little food.
I do not try to exercise as this sends my BSLs up further (if BSL > 14 mmol/l)
With an infection I will be upping my basal and bolus doses and using increased correction doses in steps that work for me, and seeking medical or dental help as needed.
One trick I have learned and worked out with my DSN is, in the case of situations where ketones and BSLs are rising is to make a correction dose with use of intra-muscular short-acting insulin. This requires me to possess syringes and needles which will achieve that (I have some 1" needles which are more than adequate) and the ability to give myself such an injection. So that may not be suitable for others. The IM injection seems to start working within one hours whereas the usual subcutaneous routine takes as least 2 hours. I feel immense relief when I can feel the high BSL starting to fall !!
I have never experienced a pump failure but always carry spare short and long acting insulin in case, with a plan for how to restart mdi if needed.
I hope your plan saves you finding yourself in the a DKA situation again and I am very glad you have survived.
I can only guess that maybe your slow recovery is related to the initial cause of your high BSL, ketones and DKA.
And that my my reading it seems that it can take time for the body to adjust back after changes in the salt composition of the blood during DKA. (se mayoclinic.org - DKA)
Best Wishes for an improved recovery time!!

View attachment 31573

Thanks for sharing kitedoc. I had another visit with the diabetic clinic today and figured out a plan to prevent something like this from happening again. I now am carrying and insulin pen around just incase I run into pump failure or a bad sight. Thanks for all the helpful info. I don't get the chance to talk to other diabetics very often so this forum is really helping.

 

[Agast]

Sorry to hear about your pump experience - has the manufacturer given you any feedback on what caused it ? Are you pumping now or back on injections ? I have heard about incidents with pumps in the US, are you based there ?

Good luck with the recovery, it will take time as @kitedoc has said for your body to adjust, best wishes J

Hey juicyj just heard back from Medtronic today and it was found that a crack in my insulin reservoir caused insulin to leak back into my pump causing failure. My pump was out of warranty and I am currently working on getting another one. They gave me one in the meantime due to the failure comming from one of there products. Currently waiting on my provinces pharmacare to get back to me on coverage for my new pump. And to answer your question on location I am located in Canada. Cheers!

 

[Agast]

Looks as if you have some great information from @kitedoc.

I wanted to add a little bit about avoiding DKA.
You say you had problems with your pump. It is definitely worthwhile finding out what caused this. However, pumps are not fail proof and we need to be prepared for our pumps to have problems. Even when they do not alarm.
Do you have insulin pens as a backup? I have some small (cheap) syringes which I can use when out and about.
Therefore, I recommend working with your diabetes team to ensure you have a pump failure plan.
And of course, lots of boring testing when I think my pump has started to misbehave.

Hey helensarmy thanks for the response!, I went to the diabetic clinic today and we talked over plans if this happens again. I am now carrying a pen with me at all times as a back up. As for the pump we found out that there was a crack in the resevior causing insulin to go back into the pump. I was already in the process of getting a new pump. But I have a loaner in the mean time.

 

[kitedoc]

Thanks for sharing kitedoc. I had another visit with the diabetic clinic today and figured out a plan to prevent something like this from happening again. I now am carrying and insulin pen around just incase I run into pump failure or a bad sight. Thanks for all the helpful info. I don't get the chance to talk to other diabetics very often so this forum is really helping.

Great to hear you have a plan @Agast. May it keep up out of troubles forever !!
Interestingly enough I have been experimenting with use of a dressing patch under the patch with the cannula in it to reduce the depth of the cannula tip. I post results on the "Ideas for Lean Pumpers" thread.
I got to about 24 hours with the latest experiment and the BSLs shot up and so did the ketones. The dressing patch had swollen up ? partly from sweat and maybe from leaking insulin? The 6 mm steel 90 degree cannula depth had been reduced to just under 3 1/2 mm by the dressing patch swelling The patch was about 1 1/2 mm thick on application. I guess that is just asking for trouble.
So I changed tubing and cannula and put in a correction dose which I doubled because the high BSL of 17 mmol/l plus the ketones would increase the resistance to insulin. AND I gave myself 10 units of Novorapid intramuscularly. I did not know exactly how long I had had insulin leaking out and the biggie is that there is no reservoir of long-acting insulin in my body, no back up, It is all in the pump!! That is why being able to measure blood ketones is important to me. There are also some breathalysers that measure ketones as well. 3 hours later I was down to 7 mmol/l. Ketones back to OK range after 8 hours.
Best swishes and please keep posting. Ask questions, look at the Forum page and all the info there.

 

[kitedoc]

Hey juicyj just heard back from Medtronic today and it was found that a crack in my insulin reservoir caused insulin to leak back into my pump causing failure. My pump was out of warranty and I am currently working on getting another one. They gave me one in the meantime due to the failure comming from one of there products. Currently waiting on my provinces pharmacare to get back to me on coverage for my new pump. And to answer your question on location I am located in Canada. Cheers!

HI, Agast. This is one of the reported problems with some of their pumps. They are said to be hairline cracks so not easily seen.
Do you have an option to change brand of pump? You could ask questions on here about others so you can compare. And on the Forum page you can use the Search box Right upper corner to find threads: Like put in; Medtronic, Omnipod, Roche, Tandem etc.
Depends of course on what your pharmacare will cover !!