How long to dka?

Hi @h4kr It's pretty normal to see sugars spike after food, so this doesn't put you into DKA danger by itself, however the combination of running consistently high BG over 15 mmol/l and for up to 24 hours would put you at risk. The most important aspect of DKA is how well you actually feel, with DKA eye's are blurry, pear breath - breathing difficulties, tiredness, thirst, peeing alot, any of these signs then it's straight to hospital.

@h4kr if I remember correctly, you have recently been diagnosed so are probably going through the honeymoon period where your insulin requirements are low and less predictable.
If you have a concern about your insulin doses, I would recommend talking to your diabetes team.

why have you stopped.

Hello @h4kr I doubt you will become ill from this as it's a food spike and your levels are returning to 'normal', if you are high (15mmol/l+) continuously for longer periods then yes there's good cause to become worried, it does sound like the honeymoon though.

I doubt you'll get into any DKA situation if you're using a CGM. That happens most often when people who really need to take insulin quit taking insulin and go over 12 for a few days maybe a week. The usual situation is before someone's diagnosed with Type 1 in the first place of course.

h4kr said:

So how long does it take to see signs of dka?
I haven’t taken my long acting lantus in 2 days and only a single unit of fiasp since Friday.
Sugars are just spiking after food and returning to normal afterwards by themselves.
Ketones are nominal too.. Would appreciate any advice/comments.
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You're likely to cause the destruction of your remaining beta cells faster if you don't take insulin. You might need very, very low doses but you should take insulin if you're a type 1, even if you're honeymooning. Ketones won't tell you how close you are to DKA. Ketones with a normal or lower blood sugar aren't a problem, it's only ketones combined with a high blood sugar that can cause rapid DKA. If you're afraid of hypos, don't be. Doctors will scare you about them when you are diagnosed but the truth is they are a normal part of treating type 1 as long as you are prepared for them, recognize them and treat them right away. I don't have too many days where I don't drift into the 3s at some point, but I'm always prepared for it and deal with it right away. It's better to learn how to deal with hypos early on than to avoid them but not taking enough insulin.

scotteric said:

Ketones won't tell you how close you are to DKA. Ketones with a normal or lower blood sugar aren't a problem, it's only ketones combined with a high blood sugar that can cause rapid DKA. If you're afraid of hypos, don't be.

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Wrong. Ketones don't CAUSE DKA, lack of insulin causes a metabolic derangement that RESULTS in ketone body production and resultant acidemia which IS called DKA. And of course lack of insulin starts with hyperglycemia.

Why is there always such confusion between symptom and cause when people talk about DKA......

@TheBigNewt I hope you can think of at least one way that DKA can develop without having someone having hyperglycemia first.

I got into DKA while wearing a cgm. I ripped my pump off at some point during a Friday night in November 2016, by the Saturday morning I was too hyperglycaemic and confused to realise the pump wasn't attached/test my blood sugar/pay any attention to the cgm alarming. I then didn't move, eat or inject until the Sunday evening (I'm pretty sure I was having auditory hallucinations) when my parents got hold of me on the phone - they couldn't get any sense out of me and an ambulance was called. Once I'd spoken to my parents I realised something was wrong, resisted a my pump, tested my sugar and gave a correction dose along with increased TBR. My blood sugar wasn't that high, around 18, and I usually have some trace ketones because I don't eat much carbs, but by the time I got admitted to A&E (around 8pm on the Sunday evening) I was properly acidotic, and I had a raised WCC and CRP from the shock of going into acidosis, I think, but obviously HCPs were keen to check for UTI chest X-ray etc.

So, on a pump with no fast acting insulin you can go into DKA overnight.

As a honeymooning type 1, I would be very cautious about stopping taking your insuli without guidance from your treating endocrinologist. You aren't misdiagnosed. Your daughter has type 1. You have type 1. It's not that uncommon for a type 1 diagnosed at an older age to have a long, strong honeymoon period. It can come on a few weeks months after diagnosis and commencing insulin. The beta cells have had a bit of a rest, they get a second wind, they are producing enough insulin to keep you going. The immune system of an older person isn't necessarily that efficient, so once your immune system has decided to kill off your beta cells, it can take a while. But it will still keep killing them off one by one until they all dead and you need the insulin. If you want to extend the honeymoon period it is thought that you do better to keep taking very low doses of insulin, so as not to over stretch the dying off beta cells.

As a honeymooning type 1, keeping a close eye on blood sugar levels you are less likely to end up in DKA. But do make sure to keep a close eye on blood sugar levels, if they sit in double figure for and extended period consider taking your insulin.

catapillar said:

So, on a pump with no fast acting insulin you can go into DKA overnight.

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Getting off track a bit, but why don't people on pumps use a very little bit of 36hr half-life insulin to product against pumps failing?

ringi said:

Why is there always such confusion between symptom and cause when people talk about DKA......

@TheBigNewt I hope you can think of at least one way that DKA can develop without having someone having hyperglycemia first.

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The confusion is because of the ketones that people find in their urine on a dipstick when they do an ultra low carb ketotic diet. DKA is caused when a diabetic (who doesn't make no stinking insulin) runs out of insulin. Insulin lets glucose into the cells for use as energy. No insulin, cells run out of energy, things start getting pretty haywire. Body looks for energy, starts breaking down its infrastructure (fats, proteins) looking for alternative energy source to glucose. In the course of that ketone bodies are a byproduct, and they are an acidic pH, so the body's pH (normally 7.14 as I recall) drops to maybe 7.08. Body can counteract that to some extent by "blowing off" CO2 so you start breathing a little faster. So a typical ARTERIAL blood gas (which is technically necessary to diagnose DKA, they poke your radial artery in your wrist not a vein in your elbow area) might read: pO2=112 (normally 88, pCO2=30 (normally 40), pH=7.10 (normally 7.14). The corrected pH would be 7.02 if you weren't hyperventilating to blow off CO2 (.08 in pH for every 10 in CO2). So that blood gas, WITH an elevated blood sugar AND ketonuria=DKA. I takes awhile to get there even for a diabetic. Not the blood sugar, not the ketones, the acidosis part.

EllieM said:

That's really interesting. As a long term T1 (since 1970) I've never had DKA (was diagnosed very early by T1 mum and have never been completely without insulin though I might misjudge doses). How long do you think I would have before falling unconscious if I stopped insulin altogether? (Obviously not an experiment I'm going to try!).

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I'd say a few days at least. @catapillar says she got there in about 48 hrs off her pump, but says she spills ketones normally on her ultra low carb diet. But I don't think those diets lead to any acidosis, at least I sure hope they don't for their sakes. The other thing is you get more and more acidotic as time goes on. You can compensate for it to a degree by blowing off CO2 but that card gets played pretty early and runs out. And then you die. I think in the days before insulin known diabetics (they could measure blood sugar) could last like weeks before they died but I'm not 1000% sure of that.

Thanks, @TheBigNewt for explaining it.

As Sodium-glucose transporter (SGLT) 2 inhibitors are now being approved for Type1, it will be interesting to see how many cases of DKA there are with normal BG readings....

ringi said:

Thanks, @TheBigNewt for explaining it.

As Sodium-glucose transporter (SGLT) 2 inhibitors are now being approved for Type1, it will be interesting to see how many cases of DKA there are with normal BG readings....

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What are those?

ringi said:

Getting off track a bit, but why don't people on pumps use a very little bit of 36hr half-life insulin to product against pumps failing?

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I got a feeling adding a second type of insulin (with a peak to it) to the mix might be a little risky. I would think the pump would alarm the wearer somehow if the infusion stops but I guess if the cannula dislodges it will still pump the insulin out just not into the person's body.

I find it all quite worrying really, how some type 1's casually stop or seriously reduce their insulin with no input from any Doctor. I get that Drs may not be the fonts of all knowledge on diabetes per se but surely any type 1 should seek advice before stopping such a lifesaving drug.

TheBigNewt said:

What are those?

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Sodium-glucose transporter (SGLT) 2 inhibitors reduces how much glucose the kidneys reabsorb, so hence removing glucose from the body. Their usage is becoming more common in Type2, and are in the process of being approved for Type1. They can keep BG low even when insulin is VERY low, hence the risk of DKA not being detected.