DKA

DKA is a medical emergency and not really ideal for self treatment.( It can move FAST) The best self treatment is to avoid its happening, by keeping BG low.
Hana

I think it does depend on your insulin therapy regime, for example pump users need to be much more cautious about DKA, simply because the nature of treatment means the entire reserve of insulin is external, not sitting in fat tissue being absorbed slowly.

In terms of monitoring, I would start to be more concerned if bg and ketone levels were static or increasing over a couple of hours (testing every half hour). For the numbers you quote, I would go straight to A&E - as Hana says, DKA really is serious and needs to be treated by a hospital.

How do you know the vomiting is down to a stomach bug? Also a symptom of DKA! NovoRapid peaks at around 90 minutes but can last for 4 hours or longer so you need to be very careful not to stack the doses.

Diabetic, high blood sugar, ketones present, vomiting, what more reasons do you need to get to hospital?! Go there now! And take care!

Hi Matt,
I can only give an example of DKA experienced by my son on New Years Eve which did result in a trip and stay in hospital. He had vomiting and diahhorea, bs never went above 15 but keytones remained at 4+. After several hours, ( i have successfully managed this condition at home before with insulin injections on a sliding scale and plenty of fluids) i decided it was time to hit the hospital when he could no longer keep any fluids down ( actually vomited up more than he had drank) and was showing signs of dehydration, headache and tummy pain. (hospital said re phone call i could manage at home, but i insisted i took him in, i was speaking to an F1!!)
At hospital DKA was confirmed, his potasium levels were almost zero due to vomiting, given a potasium drip and then given fluids, as he was border line dehydrated. After 1hr on fluids he was back to his perky, cheeky self. He left hospital within 36 hrs, with bs of 10 and keytones of 2+, but his consultant was happy for me to continue treatment at home.
Everyone is different, and DKA can come on very quickly and be fatal, a mothers instinct is what i use for my 11 yr old son, and do what i can to keep him out of hospital.
If along with high bs and keytones, you experience headache, irregular heartbeat, excess perspiration, fits, then an ambulance would be required ASAP. I don't think anyone can put a time frame on how long it takes to go into DKA, as everyone is different.
Hope this is of some help,
Suzi x

Absolutely right Matt. DKA is not to be played with, especially in children.
Hana

Hi Matt,
You did the right thing, you'll find parental instinct will always steer you in the right direction. When our children are diabetic it's always best to air on the side of caution. I've seen Andrew admitted into hospital and discharged within 3 hrs, and the medics have never thought of me as a paranoid parent, just a cautious one. I don't think you could have done anything more at home, when keytones can't be flushed out with fluids, and bs remain high regardless of insulin dosage, then its time to get in the proffessionals.
Take care,
Suzi x

Forgive my ignorance on this matter but how do you perform a SLIDING SCALE at home?

I thought this was only done on a drip like thing in a&e?

Hi Burtybob,
A childs sliding scale is worked like a percentage (i think) though when Andrew was in hospital last i had it worked out before the nurse came back with the imformation (i do it by, take the bs number subtract 7 and divide by 2, but this only works for bs up to 22) its used when 1st diagnosed, DKA or sick days. Andrews was used every 4hrs with DKA and no basal insulin was given. Hope this explains it and i hope my method is close to the mark, though i wouldn't recommend it for anyone else use without the ok from their DN.
Suzi x

If Khaleb has 0.6 ketones I'll make a phone call to the hospital. Depending on the illness might depend on what happens next. He hasn't had a vomitting session yet but I can say for sure I won't be hanging at home when he gets one of those. The last time I took Khaleb to the hospital was actually because I was having an awful time trying to keep his levels above 4. I'd done a few force feedings of glutose gel but knew I was out of my depth. We survived a bad chest infection before Christmas without too much trouble. If he's going really high I'm prepared to give small doses of Novorapid every 2-3 hours and test often. It ends up a 24 hour occupation but I really hate going to the hospital so try very hard to stay home.

Quick Question - Is DKA a lot more common in children? I have been a type 1 for 5 months and never had DKA (apart from +3 when i was first diagnosed). The only test method I have is a pot of urine sticks which will apparently turn a different colour if you have Ketones (although this has never happened...)

Apart from going to hospital, the best way to treat is to drink a lots of water, possibly inject some novarapid to lower BG right?

Just wondering in case I ever do get (mild) DKA and don't want to bother the hospital...

I think it is more common in children because they do dehydrate quite quickly. As a parent it wouldn't be advisable to give lots of insulin to a child who may very well refuse to eat at some point if that dose was too much. If I could tell Khaleb to drinks heaps of water that would be great but he just wouldn't. I think as an adult you could do things for your body to give it the best chance even if it wasn't what you felt like doing.

I don't think the hospital would think you were a bother if you needed help. DKA can happen very quickly and sometimes it is hard to stop without the IV drip. The biggest problem with hospital is that you go in with one thing and come out with something else. When Khaleb was first diagnosed and in hospital he managed to get Croup from the kid in the next bed. He got over that and got something else. He was in hospital for a month.

jameshallam said:

Quick Question - Is DKA a lot more common in children? I have been a type 1 for 5 months and never had DKA (apart from +3 when i was first diagnosed). The only test method I have is a pot of urine sticks which will apparently turn a different colour if you have Ketones (although this has never happened...)

Apart from going to hospital, the best way to treat is to drink a lots of water, possibly inject some novarapid to lower BG right?

Just wondering in case I ever do get (mild) DKA and don't want to bother the hospital...

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James

It's possibly more common (relatively) in very young children (under 4), who may have difficulty expressing exactly how they're feeling. But in the very young dehydration can happen a lot more quickly than for someone with greater body mass, and this is one of the key features of DKA.

Urine testing strips are not very accurate, but you can get blood ketone testing strips, which just use a drop of blood in exactly the same way as a normal bg test. Different scale of course but definitely worth having I reckon.

In 27 years I think I've been admitted to hospital 4 times with DKA (but never while on a pump...), which I try to avoid if at all possible, just so I don't have to have arterial blood samples withdrawn for pH testing - that ain't pleasant :evil:. Makes you feel pretty rubbish generally too.

But if you do ever have symptoms, don't delay going to hospital as it can be a lot easier to treat at an earlier stage than if someone has had to call an ambulance on your behalf!

After my dka experience the hospital is and will always be the way to go it's horrible and life threatening

My meter tells you to test for ketones anything about 16.4 or thereabouts. I have ketone test strips for the meter too which is more precise than the urinalysis- essential for T1

My bg was off the meter on diagnosis, and didnt come down with injected insulin so I needed IV drip four hours after I was admitted to hosp. At that point it was ++++ ketones and Im sure If I hadnt gone to docs with symptoms and waited over the weekend I would have been very very ill (and prob just put it down to a viral infection :roll: )

I live in fear of it and yes whilst you can use fast acting to get it down a bit, I would have NO hesitation in getting to A and E at the first sign I couldnt get it down.

Matt, my DN's gave me some info recently about double correction dosing for ketones, based on the level of ketones present, I can PM them to you if you like? Obviously as everyone has already said, there is no substitute for A&E if the levels are high, particularly if the person with ketones is unwell but I feel better 'armed' if you like, having this info in my file

I nearly died, had to go to hospital emergency two times during my teens. I have to say as soon as symptoms are there, do not hesitate, just go to the hospital!
Long term consequences of poor control gave me retinopathy and neuropathy. Not trying to scare you, but when I was managing well and it was all under control I thought it wasn't fair... guess one day the bill must be paid! Good luck and take care xx

juma said:

I nearly died, had to go to hospital emergency two times during my teens. I have to say as soon as symptoms are there, do not hesitate, just go to the hospital!
Long term consequences of poor control gave me retinopathy and neuropathy. Not trying to scare you, but when I was managing well and it was all under control I thought it wasn't fair... guess one day the bill must be paid! Good luck and take care xx

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Same here, had about 3 bouts in a year, one was really bad and I have no recollection o it and am suffering for it now with neuropathy!! Sounds like you made the right choice taking your daughter in. For me, it's high levels, ketones and if I'm vomiting. I tend to manage ok but when the sickness occurs I get straight down to the hospital.