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Really worried about my friend, DKA/Coma help and advice!

D

DiabeticDunce

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Hi, sorry am really new to this whole forum posting thing!

Basically, my best mate (and flatmate) is a type one diabetic. She has poor control and has been in hospital quite a few times this year with DKA. Now I've researched as much as I can about this to try and understand how it all works and how she feels, as I know she gets very stressed with it all.

She has never gone into a coma but am really scared she might do soon, although she's doing well at the minute it could quite easily reverse as I've heard the flu and stuff can even start this whole DKA thing off!

I want to know as much as I can about DKA comas incase anything does happen and I can somehow try and help. There isn't much info I could find on the net, so I hope you'll bear with me on these questions! I do worry about her, the little lamb :|

1. Could she breathe by herself? So if she were in bed, would it look as though she was sleeping? This one worries me the most as I could think she was having a lie in when she's actually really ill.

2. How long would it take for her to have high lvels to get into a coma?

3. What are the signs she's getting really ill? I know it's when you're sick and high levels it's A&E - any other distinguishing features?!

4. Can you tell whether it's a low level coma or a DKA coma?!

If anyone could help me I'd be really grateful. I'm sorry I'm not the most clued up but I just worry about her, she's been my best friend for 6 years and although I know she's independant and is a lot better with her condition, it really scares me to think of her in her room seriously poorly.

Thanks guys :mrgreen:
 
Re: Really worried about my friend, DKA/Coma help and advice

:D How sweet of you to look out for your friend. I do not know the technical answers to your questions...but can give you what advice I have.

Coma is very rare, where as serious hypos (lows) and hypers (highs DKA) are less you, so the chances are you friend will be able to tell youwhat is wrong, or do a blood test to find out. If she is in a coma, of either sort, the most important thing you can do is call an ambulance...and stress to them that she is a type 1 diabetic and is unconscious.

The outward symptoms of having a very high blood sugar as thirst, going to the loo alot. I have only had serious, hospitalisng DKA once...and that was enough! The outward symptoms were I looked very hung over...and I was panting, and breathing really deeply. i guess ultimately, you would stop breathing...and this is scary.

You ask about the how do I know if she is having a lie in, or really ill in bed? Really tough to tell to be honest sometimes..This depends on the relationship you 2 have, but if you are concenrned...I would have a chat, explain your concern..and ask her what she would suggest. If I were her, I imagine I would be saying things like....lets agree to say whether I am planning a lie in or not. If I am not...and you haven't seen me by 8am, then come in my room, and shake me, prod or whatever works, until you have got a response that I am OK. This could be a bit "nannying" to some though...so depends on her really. If she is low, she may be sweaty etc..if she is high, look out for the heavy breathing.

If she is on teh verge of being unconscious...but is still conscious enough to eat or drink...if you can't get her to test her blood...call the ambulance...and then get her to take a mouthful of fat coke or other sugary drink. OK, so if she is high, this will make her worse.....but if she is already in this state, and you have called an ambulance, you are not goingto do her any more harm...but if she was low, you may have stopeed her getting worse. Ambulance drivers tend to treat diabetics very wel. and are very used to treating them. I had a few problems when I was pregnant, and needed an ambulance to help me with low blood sugars. (Warning, some diabetics get very agressive when their blodd sugar is low...another sihn, although not a certaintity) They come along, test your bloood, and in my case, gave me a drip into my arm. My hubby says it is amazing to watch, as I went from trying to take a punch at teh ambulance man (in a really funny, completely incompetent way) to unconscious, to sitting on teh sofa, apologising like mad in about 3 minutes. the ambulance men all said (and this happened about 4 times) that they found treating hypos quite rewarding...as they can see that they are helping, the patient tends not to be ill becasue of something they have doen wrong (like derink or drugs etc) and they genuinely need help (unlike those people who phone ambulances to get a lift home!0 They all know that we can get a bit agressive, but tend to be so weak, it is like fending off an angry toddler. Please bear this in mind though for your own safety....and your friends blushes. If she is agressive, leave her alone for a few minutes...don't try and help physically if she is lashing out. You have to keep yourself safe after all.

Sorry, very much a ramble. I hope your freind is able to get her diabetes under better control. I now have "godd" (ish!) control, but I know my hubby still worries about me. I do sometimes feel like a child...when he asks if I am low..when I am actually just a bit annoyed with him..but, really, it is yet more proof, that he cares about me.

Thank you for taking such an interest in your friends diabetes...best of luck
 
Re: Really worried about my friend, DKA/Coma help and advice

Your friend should have worked out 'sick day rules' with her care team, guidence what to do when unwell or if she starts to show ketones.. It's a guide to how to monitor your diabetes and what actions to take etc to avoid the body going into DKA..

If she hasn't got this from her health care team, they she does need to sort it out and it would be helpful for you if you understand how it works etc...

Hypo's well pretty easy to determin by behaviour in the main, but if you find her unconsicous then it goes without saying, it's a 999 call out, you could check her BG to get a reading to pass the information on to the paramedics, and it's also usefull to know what insulin or other medication she takes to pass onto the ambulance crew if neccesary..

As to the DKA side of things, yes in one way these can essculate very quickly indeed, but generally you are aware that you are starting the DKA process, your BG is high, showing ketones in the urine and you feel eek... Following the sick day rules, will often bring it back under control and get you through..

But sometimes it can turn on you pretty quickly, if you know she's unwell then you can quietly monitor how she's fairing, sign that she is really starting to struggle, it can be individual or a combination of these symptoms..

Pale clammy
stomach pains
Vomiting
shallow breathing
pear drop/acitone smell on the breath
not responding well

But it goes without saying if at all concerned or unsure seek medical advice either via doctors/out of hours or phone for a paramedic..

As deciding what is or isn't a lie in, well I think that you have to discuss and sort out a protocall for deciding at what point you pop into check her, as she might want a slightly different protocall for a normal day (where she gone to bed feeling fine) or when she's not feeling too well..

Another thought is discussing, where if neccesary to find her hypo kit (what ever she normally uses to treat an hypo) where to find any medication that doesn't need to be kept in the fridge, where she normally kepts her insulin pens, meter to so if neccesary you can locate these if needed.
 
Re: Really worried about my friend, DKA/Coma help and advice

Hi

Do have a search on the forum for 'Hypostop' or 'Glucogel'. These are an absolute 'must have' in the cupboard to treat severe hypoglycaemia. It can work by soaking through the bucal lining inside the mouth and a small bead can be squirted inside the bottom lip along the gum line. Many people think that it can only work by being swallowed but that's not true. This may have to be repeated every 10mins but once someone is partly awake, they can then be made to drink some lucozade. A toddlers drinking mug is ideal for this.

Hypostop has saved me a few times now from being admitted to hospital when I have had a night time hypo and been half in this world and half in the next.
 
Re: Really worried about my friend, DKA/Coma help and advice

Hi guys, thanks for your quick responses, am very grateful!

Gosh, it sounds very scary :( I've never actually seen her go DKA, whenever she's felt poorly she's gone home (not hard, only other side of town!) and things have kind of progressed from there.
I appreciate the list of symptoms and how to recognise it though, thankyou! I'm going to print this thread off I think and keep it handy!

It's another worry with all this Novovirus going round, plus she is on placement at a hospital (nursing student!) I'm concerned she's going to fall ill when I'm around and I don't know what to do.

It's hard in that she is 19, she's independent and I don't think she'd appreciate me setting up a 'lie-in' rule with her...I don't know! She has a 'diabetic cupboard' where she keeps all her stuff and I'm pretty clued up on hypos, I'm just scared of my little love in a hospital bed again - she's spent most of 2010 in there, bless her.

Will have a talk to her and see how it goes. :D
 
Re: Really worried about my friend, DKA/Coma help and advice

Oooh! Forgot to put on other post:

If she's unconcious and I give her the injection (can't for the life of me get the name right - the orange one!) and she's actually DKA, would that really hurt her?!

Diabetes is waaaay too complex for me :lol:
 
Re: Really worried about my friend, DKA/Coma help and advice

Yes it will cause more harm if she's acatually DKA..

If you find her unconcisous for any reason, you will need to double check the cause by taking a blood glucose reading, if in the hypo range then the Glucagen kit can be used, any reading that is in the normal range or higher call 999

If she's hypo and you use the Glucagen kit, she should start responding within 10 minutes if she doesn't again call 999 for help..

As Glucagen is the hormone that instructs our liver to dump it's glucogen (sugar) store into the blood stream, if she already suffered a hypo in the last 24 hours she may not have enough stored glucogen in her liver to bring out out of her hypo probably..

It's a good idea if she's got a Glucagen kit that has or about to expire is instead of disposing it straight away, use it to practice setting it up for an injection, so if you need to use it your are more comfortable with filling it up ready to inject, and perhaps find something such as an orange to practice injection (do remember to throw out the orange etc afterwards)
 
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