A friend went to the hospital due to DKA. Is it possible to be DKA after only 2 weeks of high blood sugars? He is saying his Dexcom was not working?
Depends on how high, and was it continuous. Did he stop bolusing, or have a bad batch of insulin?
If using pump or omnipod, may be bad infusion sites.
When in doubt, try syringe and new vial of insulin, and bg meter.
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I’d certainly think so, but as @MM1 says, depends what’s considered “high.” I’ve gone into DKA after just a day or two of norovirus, so long duration isn’t necessary
Wow that’s crazy!
He said his Dexcom wasn’t working correctly???
If he thinks this is the case, he should report it to Dexcom. A Dexcom error that sends someone to the ER should be reported. It’s a big deal.
Absolutely!
So, DKA occurs when you don’t have enough insulin to cover your body’s energy needs… not because of high blood sugar. You can have high blood sugar and not go into DKA and you can go into DKA without especially high blood sugar. The high blood sugars and how long they’ve persisted are kinda irrelevant. They’re just another symptom of not getting insulin, but not the cause of the DKA. Does that make sense? It’s entirely possible to have enough insulin to cover your body’s needs, which will keep DKA at bay, but NOT quite enough insulin to cover the food you’ve eaten and maintain pretty blood glucose data.
The ketones are a byproduct of burning fat for energy when the body can’t use the cleaner-burning glucose. Insulin is essentially the key that let’s that glucose get into our cells. Fat can slip in without that key, but it’s dirty and leaves a little poison in it’s wake. It’s not a big deal so long as we can keep up with the cleanup, but when the fat is making more poison than the body can clean up and it starts piling up, THAT’S when we get really sick. So how long it takes DKA to set in is entirely dependent on how much insulin the person can still make and much man-made insulin they’re actually getting into the body.
If a person is not making any of their own insulin at all anymore and they’re not getting any external insulin (mostly because of missed doses or pump delivery failures), DKA can set in after just a few mere hours. You don’t need weeks! On the other hand, if they’re still getting MOST of the insulin they need to fuel their body, and the body just needs to supplement with a little bit of burning fat, DKA may never set in at all. And of course, every time frame in between is possible, too. Hours, days, weeks, months, years, a lifetime, etc…
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Thank you Robyn for the education. Good to know!
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Excellent explanation. Since diagnosis a few years ago I’ve wondered at this DKA-blood glucose relationship. Now I’ve learned something important that answers my questions–thank you!
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DKA is actually an acidity issue. It comes from excessive ketones which build up due to insufficient insulin. It doesn’t take much acidity to send you into DKA.
I’m on a pump with only fast insulin. I start getting DKA symptoms after just an hour of no insulin, like if my pump tubing comes out, sometimes I don’t hear the alarms of my pump, cause maybe I tune it out. So 2 weeks of high sugars , it’s not just possible it’s likely.
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A wonderful explanation @Robyn_H . I was never taught about DKA and I remember first reading about it on TuDiabetes.
I found it interesting reading about Wil Dubois going into DKA within hours and not that high of BG levels. That article doesn’t seem available anymore, another article has been replaced in the link I had. If anyone has a link to the article I would love to have it! The title was " When I Landed in the Hospital with Diabetic Acidosis, by Wil Dubois"
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This link has a quote from him on his DKA experience.
How Long Can Your Body Survive Without Insulin??
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Thanks for that article.
I was thinking of trying tresiba at low dose to cover 40-50 % of my basal, and reduce pump basal. This article implies that might be a good idea in case of pump problems with delivery. When Tandem suspends my basal too long, I often get high rebound BG.
"If you have any residual insulin at all in your system, it can help hold off DKA even when your blood sugar level is high, according to Dr. Silvio Inzucchi, clinical director of the Yale Diabetes Center.
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Robyn’s explanation is good, and this is an important point that many miss. I’d only take issue with the equation of ketones with “poison”. As @Timothy pointed out, the problem with ketones is that they are acidic. Your metabolism can deal with a certain amount of acidity (lowering your blood pH), but without insulin, the unregulated conversion of fat to ketones lowers pH to dangerous levels.And it’s not far between Fine and Dangerous.
So: Diabetes (untreated) → Ketosis → Acidosis. DKA, aka Diabetic Ketoacidosis.
An improperly operating CGM (Dexcom) should not result in DKA unless the readings are constantly so low that the pump is suspending all insulin delivery for a long period of time (hours). Anyone with such low bg for so long needs to be asking why, and probably checking the CGM against a fingerstick reading. CGMs are wonderful tools but they fail far more often than test strips.
Anyone not using a pump should have a basal supplied by long-acting insulin adequate to prevent DKA.
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I knew that would be controversial when I typed it, but I stand by that statement. My beef is with a particular ketone, beta-hydroxybutyrate. The others have various functions in the body and can be reappropriated. They don’t tend to accumulate the same way. But beta-hydroxybutyrate terrifies me as a person with impaired metabolism and a background in molecular and cellular biology. I have zero qualms calling it a poison. It has the potential to kill.
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I wonder why in 65 years I have never gone into DKA except maybe when I was dx since I almost died. When young, my diabetic care on my part, was really bad. It has been very good for years now. Why do some diabetics never have to deal with DKA?
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Sorry, people with diabetes.
Out of curiosity, did you ever have your c-peptide or antibodies tested? Maybe you’ve just got really good luck or genes. Maybe you’re just the type of person to take responsibility and fix the situation before it gets out of hand. Maybe you lack the enzyme necessary to manufacture the problematic beta-hydroxybutyrate. Maybe you’re still making enough endogenous insulin to cover your tail, if not fully manage BG. It’s even possible that you might have one of the single gene variants, MODY, that might be giving you some extra protection. That one isn’t really commonly understood and few doctors would recognize or test for it.
Some researchers believe there could actually be dozens of different types of diabetes, and that we just aren’t knowledgeable enough yet to recognize them. That would certainly explain the variability amongst us.
No one else in my family has ever been diagnosed with type 1 diabetes. It definitely does not run in my family.
I have tested to see how much insulin I am still producing and the answer is zero. My resistance to insulin is quite low because of my diet. For at least 40 yrs I took 40 units of insulin. In the past 20 yrs I have taken 17 to 22 units because of the eating plans I have followed.
I try to keep right on top of my glucose levels, but there were years when I pretty much ignored my diabetes. I have never skipped a shot though. I have never been hospitalized because of my diabetes except when I was finally diagnosed in 1959. I can still function fairly well when my glucose level drops down into the 30’s which it did a couple of nights ago, because of a problem with my Tresiba dose.
I have never thought that I have good genes, because diabetes is just one of my health problems. I am very glad that I haven’t had to deal with DKA. I went for decades before I ever heard of it.
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I have gone into DKA 2 times, once at diagnosis when I almost died and once with a pump failure the very first month on the pump. I throw ketones very quickly for whatever reason but usually a pump issue. Hence I have given up the pump after 9 1/2 years and have gone back to shots. I don’t worry about DKA much since I see the shot go in. I do travel with a ketone check meter. You never know.
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