Warning about Dka and illness.

Re: Warning about Dka and illness.

Thanks for the reminder good to make us aware


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Re: Warning about Dka and illness.

Glad your ok aswell must if been frightening for u


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Re: Warning about Dka and illness.

Good post. I was told only to check if 15 or above. Glad you're sorted now ;-)


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Re: Warning about Dka and illness.

Thanks for sharing! I too had been told to check above 15. Ill be more aware when I'm ill now just in case. Takes 5 seconds to do a test, a lot longer to recover if you don't check!

Re: Warning about Dka and illness.

I'm so glad you're OK . It's good that the GP was on the ball and realised that DKA was possible.

It's a good reminder to check for ketones if you are unwell, irrespective of glucose levels ( and particularly if vomiting/diarrhoea /not eating/pregnant).

We quite often read people insisting that DKA is only a threat at very high glucose levels. Yes, in most cases, people have higher levels but it's not always the case. Their have been other people on these forums who have also experienced it.
The earliest paper (1978) discussing and naming it as euglycemic DKA mentions that out of 211 cases of DKA, seven presented with levels less than 100mg/dl (5.5mmol/l).
The writers of a recent case study (blood glucose on arrival 118mg/dl; 6.5mmol/l) state

This case demonstrates that hyperglycemia is unrelated to the pathophysiology of DKA. The mechanisms behind DKA are stress, decreased insulin production or effectiveness, and increased glucagon production

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(nb stress in this case includes a variety of possibilities. The ones they mention are physical (ie an infection etc), psychological and things such as alcohol/drugs)
http://journals.lww.com/jaapa/Fulltext/ ... ent.7.aspx

Hi guys thanks for posting this thread.

I've been feeling awful for the past few days. My kids have had D&V but I haven't had anything like that. Just off my food and the most god awful indigestion!

I've had DKA before and don't feel like I did then but was wondering what to do about my lantus. I take a split dose. I take about 35 units at night. Should I cut it and by how much or should I just miss it all together. It's actually painful to eat so I don't want to take it an not eat. My last BS was 2.7 about 20 mins ago. I've drank some irn bru and even that hurt.


Em x

Re: Warning about Dka and illness.

Pleased your OK now JC.

You make a valid point about not being able to test if your not passing any urine, they always say keep hydrated but this is difficult when your vomiting with a stomach bug.

I asked my gp for the blood ketone strips after receiving a free meter but he refused to give me them, his reasoning was they are far too expensive and the Ketostix do the same job, next time I see him I'll be mentioning your scenario with a view to him changing his mind

Re: Warning about Dka and illness.

You might in fact need more insulin when you are sick not less. You should not stop your basal.
SIckness can make you insulin resistant. It is also a lack of insulin that 'causes' ketones to develop and rise.

There are 2 ways to deal with bolus injections , if you are not eating,
1) (traditional as in the Nottingham guidelines) ie to use a bolus injection and take in some liquid carbs ( preferably with some nutrients but at the last resort sipping things like coca cola (flat if necessary)

2) as per DAFNE below ie no food bolus if levels are normal and there are no ketones . However a relevant corrective bolus is necessary if levels are higher and or ketones are present. (and if levels are low but ketones are present then that also needs some carbs alongside the insulin to prevent hypos)

Here's some general rules for 'sick days'
http://www.nottinghamdiabetes.nhs.uk/sickdays.html

These are the rules as apparently as taught on DAFNE. (they are very similar to the sick day rules I was given here)
http://www.diabetes-support.org.uk/info/?page_id=141
They rely on frequent monitoring when you are sick (both ketones and insulin). However, they also rely on you being able to calculate the doses correctly ; it would be a very good thing to discuss this with someone before you need it (to make sure you aren't making a big error/misunderstanding!)

I think the most last bit is really important

If you continue to vomit, cannot keep fluids down and/or cannot reduce your blood glucose or ketone levels (or if you are unsure what to do) call your GP, diabetes team or hospital as an emergency

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Noblehead:
Remind him that the blood ketone strips are foil wrapped, I think I am correct in saying that they don't go out of date in the same way as urinary ketone strips.

Re: Warning about Dka and illness.

phoenix said:

Remind him that the blood ketone strips are foil wrapped, I think I am correct in saying that they don't go out of date in the same way as urinary ketone strips.

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Yes I will........thanks

Re: Warning about Dka and illness.

Thanks Phoenix.

I took half my usual lantus dose and had a sugary drink. My BS was 8.8 this morning. Feel a bit better so took everything as normal this morning and had some toast.

My baby girl is better but my wee man in still ill poor wee guy

Thanks for your help Phoenix. I've bookmarked your link xxx.


Em x