DKA

[searley]

I stopped my lantus last week on tuesday, since then my BG has risen a bit

Last night before bed i was about 17 and this morning i was 10.5

is it possible to have DKA without keytones present in the urine?

the reason i ask is the last 3 days or so i have had the constant feeling that i want to vomit, im thirsty all the time, my boss keep saying he can smell something like drain cleaner

my dog keeps trying to like at me which is unusual

but i have used ketostix, and they are not showing anything,

 

[sugar2]

Not sure to be honest. the ketostix can only measure what was going on a while ago...perhaps it might be better to get some blood ketostix? I know they exist for varios monitors.

The classic ketone smell is "pear drops" so "drain cleaner" is probably pretty close! If you feel dreadful (and smell bad!) I would try and get an appointment with your GP...even is it isn't DKA, there may be something that needs sorting out?

Are the ketostix in date by the way? That can cause problems is they are not.

You didn't say why you had stopped your lantus? Sounds like you should think about taking it again, or something else?

 

[searley]

I stopped levemir and lantus as both were giving me really bad headaches

Ketostix might be out of date, will have a look when i get home later

 

[RussG]

Hmm. You can have ketones in urine but not be have ketoacidosis if you are low carbing, or even if not. I was admitted twice with suspected DKA and high ketones but blood was okay - nobody ever said whether I was going into acidosis but not there yet or just not in DKA at all. AFAIK You can't get ketoacidosis without ketones, as it's the build up of ketones in the blood that changes the ph and makes it acidic (hence keto-acidosis).

I would have thought that it would be unlikely to not show in urine (although blood test is much more accurate). Also, normally blood sugar would be higher than 10.5, although 17 is in the territory and apparently you can get it with lower sugars. Difficult one. Ketostix need to be thrown away after they've been opened for a while and shouldn't be exposed to extremes of temperature, so that could also be at fault as others have said.

Did you take any advice before stopping insulin, i.e. does your doctor know?

I think the short answer is if you are not feeling well, have high sugars and develop any symptoms of DKA, see urgent medical help. Better to sit in the docs / A&E for a few hours and be okay rather than collapse in a coma. Things to watch for are vomiting, shallow, sighing breathing, confusion and dehydration. Drinking lots of water to flush ketones out would also help

I did find this from [url=http://www.patient.co.uk/...w.patient.co.uk/doctor/Urine-K ... itives.htm[/url]

False negatives
Most urine testing kits detect aceto-acetate, not the predominant ketone beta-hydroxybutyrate. It is possible for the test to be negative with high levels of beta-hydroxybutyrate and then, as ketoacidosis improves and ketone levels fall, the urine test becomes positive (to aceto-acetate).

 

[jopar]

I checked out your profile before answering which says you are T1..

As you said your BG increased slightly etc since stopping your lantus, background insulin actually take a couple of days to fully burn out the system even though after the first 24 hours they might not have much effect on the BG, but can prevent DKA setting in...

You need to replace this background insulin with something, there are several older Isophane insulin both Human and Animal (the cloudy ones) which you can replace with.. T1's can't survive on quick acting insulin alone.. Unless you want a lot of hassel..

I use a insulin pump, brillient piece of kit, but does have one draw back, it uses only quick acting to do both the background and the food you eat.. I can detach my pump anytime I want or for as long as I want but if I'm going to have it off for longer than 2 hours, I've got to bolus the missing basal, then I have to bolus the missing basal every 2 hours, otherwise I can go into DKA very quick..

Under normal circumstances you wouldn't expect to see ketones below 12mmol/l and BG's here or above needs ketone checking, but some diabetics are more resilient than others so could get quite high before they experience any ketones..

But you can must admit rare go into DKA at a normal BG levels.. This generally happen if it's going to when you already suffered a period of illeness, such as after you've recovered from a bug etc.. I had this while I was pregnant with my youngest daughter, BG hit 8mmol/l I went into DKA, and DKA is something that once you've had once you never want again..

As to whether the keton meters are better than ketosticks, not sure the meter are in some ways yes more accurate but can be missleading so you do have to know how to interpreate the results probably...

Yes Ketosicks, are based on a time lag, but in generally this time lag doesn't make the greatest of difference if you following the sick day rules plan, you see an hint you start making correction to your BG if they are high to bring them back into the normal range, plenty of fluid to flush them out, keep checking until sorted..

But as I said, if you are T1 and you've stopped your background insulin and having replaced with another type, then you need to see a doctor straight away otherwise you are going to hit serious trouble very soon

 

[AndyS]

One thing to remember with Ketostix is that they have a finite life (about a month I think) after you first open the tub.
So even if they are in date, if you have had them open for a while there is a chance they may give false readings.

/Andy

 

[searley]

One thing to remember with Ketostix is that they have a finite life (about a month I think) after you first open the tub.
So even if they are in date, if you have had them open for a while there is a chance they may give false readings.

/Andy

opened mine July last year

 

[LittleSue]

Just checked the label. Ketostix expire 6 months after opening, or the expiry date on the pack if earlier.

 

[noblehead]

I stopped levemir and lantus as both were giving me really bad headaches

Ketostix might be out of date, will have a look when i get home later

Please tell me you are using another insulin!

Nigel

 

[searley]

I stopped levemir and lantus as both were giving me really bad headaches

Ketostix might be out of date, will have a look when i get home later

Please tell me you are using another insulin!

Nigel

Yes I do have novo rapid

 

[noblehead]

Yes I do have novo rapid

As a type 1 you also need a background insulin too, I suggest you speak with your care team urgently.

Nigel

 

[searley]

Yes I do have novo rapid

As a type 1 you also need a background insulin too, I suggest you speak with your care team urgently.

Nigel

The care team is aware, but there was a disagreement about if the headaches were being caused by the levemir/lantus, my consultant insisting it wouldnt and i should see my doctor

So i stopped to see if the headaches went away, as i know what will happen if i goto my doctor, more test for this that and the other

The good news is i have no headaches now so i think i have proved my point

i will probably take Levemir for a few days as that didnt give me so much of a bad head as the Lantus, until i can get to chat properly with my DSN/Consultant

 

[LittleSue]

Quite apart from the risk of high sugars due to lack of background insulin, you should try reintroducing Levemir or Lantus to see if the headaches come back. Otherwise you haven't proved they were to blame, it could be a coincidence that the headaches went.
If you're LADA or type 2 you might not need basal insulin all the time, but if a true type 1 you're risking far worse problems than headaches. Seeing your doctor for more tests to clarify your type should answer the quesion of whether you can manage without Levemir/Lantus.

 

[searley]

Quite apart from the risk of high sugars due to lack of background insulin, you should try reintroducing Levemir or Lantus to see if the headaches come back. Otherwise you haven't proved they were to blame, it could be a coincidence that the headaches went.
If you're LADA or type 2 you might not need basal insulin all the time, but if a true type 1 you're risking far worse problems than headaches. Seeing your doctor for more tests to clarify your type should answer the quesion of whether you can manage without Levemir/Lantus.

I am trying to keep an eye on things, which is one of the reasons for the original question about DKA, a new pot of Keto stix still show no key tones!

as for type..

my 2 DSN's insist I'm a type 1 that honeymooning
my consultant will only say 'probably type 1'

my dad is a type 1 who had a long honeymoon period, infact he made the mistake of coming off insulin for quite a few months until he ended up in hospital again

 

[Snodger]

searley, do let us know what happens next, because I'm interested in how it goes with your HCPs.

I was also thinking about temporary ways round your problem and wondered whether you could increase your number of novorapid injections during the day. eg tiny amounts every 4 hours or so, as well as your bolus for any food.
it would be better than nothing but, problems I can foresee with this:
- very hard work to keep injecting
- doesn't solve the problem of rising bg during the night
However, it would help a little to reduce risks from running high due to the lack of basal. Could be a temporary solution while you are working out the relationship of the lantus to your headaches.

what do others think?
Better would be to have a doc who listens and is prepared to prescribe a basal insulin that suits you of course... crazy that they wouldn't just do that. :roll:

 

[sugar2]

I agree, there re few people who can not tolerate levinir and lantus. I beliebve Janabelle posts quite a bit about this, might be worth checking some of her posts?

Injecting small frerquents amounts of short acting is basically turning yourself into a human pump, as this is exactly hwat insulin pumps do. I would say it is fine for a day...but you can't keep it up long, and the amounts you would need would be tiny I would imagine. I am a long since honeymoon diabetic, and I am on 0.5 ul/ hour basal rate at times, so I imagine for someone in the honeymoon stage, or LADA or MODY or what ever they decide you are, the amoun may be smaller still...I would go for frquent testing and correcting myself, and try going back on teh lantus to see what hapens.

there are alternatives out there, but you need to get professional help to prescribe it.

 

[janabelle]

Hi again,
as previous posters have already stated, you cannot carry on like this and need a basal insulin.
Please contact the IDDT, if you need support re-your suspicion that you're suffering side-effects from analogues ; they are defo the people to speak to. They will be able to advise you on how to approach your doctor with your concerns. Don't be fobbed off by your care team, if you don't want Lantus or Levemir, you are quite entitled to ask for an alternative insulin type.
Best of luck
Jus

 

[AndyS]

could be worth trying some of the other long acting insulins.

Of the analogs the only alternative to Lantus is Levemir but there are lots of other obviously: http://www.diabetes.co.uk/insulin-in-the-uk.html

Maybe it is worth asking your HCP's about the alternatives, maybe even pumps since that is essentially lots of small doses of rapid.

 

[LauraNoraLoo]

Is it just me that thinks it really dangerous to just stop taking your background insulin like that?