DKA... how much do you know?

The ADA posted a good article on diabetic ketoacidosis (DKA) this month, and its worth the read. I have been fortunate to never have an episode, but I know many have, it is quite scary.They posted some scary stats too…

"Between 1996 and 2006, there was a 35 percent increase in DKA-related
hospitalizations in the United States. Some studies suggest that
skyrocketing medical costs may be to blame; people may be putting
themselves at risk for DKA by cutting back on insulin to save money.
This disturbing trend underscores how essential it is to take care of
yourself, especially when you’re sick, by monitoring blood glucose;
keeping it under control with the right combination of diet, exercise,
and medication; being aware of the symptoms of diabetes complications
like DKA; and seeking treatment promptly if you need it."

Anyways, the link to it is http://forecast.diabetes.org/magazine/diabetes-101/diabetic-ketoacidosis.

Enjoy!

Thanks for posting this Emily! That is indeed a well-written article.

I wonder how many of the DKA cases are occuring at diagnosis?

That is the only time that I have been hospitalized for DKA. Given that there is an increase in the number of diagnoses, that could also be partly responsible for the increase.

Thanks for the article. I knew I didn’t fully understand DKA. I found it particularly interesting that it kills more children than hypo does, as the other D parents I know really, really worry about hypo. One wakes up every 3 hours, every night to check her child.

Other than trying people trying to save money on insulin, many people don’t seek early medical treatment because they can’t afford it. Very, very sad. 35% is a staggering increase.

I was admitted DKA to the ER & where I was diagnosed. I thought I had the flu & was clueless I was dying. Now when I get sick, I panic fearing another DKA episode. One was more than enough.

Thanks for posting the article.

I went into DKA in January 2008. Probably one of the most painful experiences I have ever had. I couldn’t stop throwing up, and the pain in my stomach was almost unbearable. Spent 3 days in the ICU, but that’s the price you pay when you don’t take your insulin. I definitely learned my lesson!

I was in DKA once when I was first diagnosed, thank god I haven’t gone through that again. Keeping control is the answer, but I’m sure many don’t keep a careful eye on their BS…

When I was 19, I forgot my morning Insulin in a rush to get to work on time. I ended up going through DKA and into a 3 day Coma. I did not forget my morning shot ever again nor did I repeat that crisis.

I don’t know how People who stop taking their Insulin to lose weight, survive more than a couple days. Sadly, some do not survive.

I am a former ‘diabulimic’ I am currently setting up a charity in the UK to try and get it recognised as a diagnosable eating disorder. You say you don’t know how people could do it but the mechanism and underlying issues are pretty much the same as anorexia and bulimia. I would be very surprised if the rise in DKA was not due to the rise in young women (and men) skipping insulin to loose weight. I support a lot if youngsters trying to get over deliberate insulin ommission and it is heart breaking. What I will say is that the medical profession has no idea what to do with this issue. I was diagnosed with type 1 at 23, I had allready had a long battle with anorexia followed by bulimia. No one ever mentioned it - Time bomb

Oh true, you’re right. People with Anorexia and Bulimia either wouldn’t consume food(or very little) or they would purge, over-exercise, use laxatives, etc. after eating. Whereas, I didn’t realize that I hadn’t taken my shot and I ate take-out food with Friends from work plus had a couple other large pop during the day because the weather was so hot and the fountain water tasted yukky.

That’s an interesting thought about the rise in DKA. That could certainly be a good part of the rise. These eating disorders have been hidden for a long time. I didn’t know about any of these disorders when I was a Teenager(of course I didn’t have much info about Diabetes either). I just heard about Diabulimia about 6 years ago.

That’s Great that you are giving your time and support to the Teens since you’ve been there and done that. They would respect your experiences and accept your advice moreso than their Parents, Drs. or other Medical Professionals. Still a tough job though. Best to you on YOUR continued Success and that of the future charity.

Hi Emily,

One question… Are we sure that this percentage doesn’t include patients that were misdiagnosed as type2? So many people I’ve talked to has told me this. And if that’s true. Type 1 people lives are in danger because of (in essence) doctor’s ego… Just my opinion…

I completely understand. I did the same thing for many, many years, to loose weight. I used to feel awful. Tired, sick, nauseous I have actually been hospitalized many times for DKA. I used to spend a couple of days in the ICU and then go back home and revert to the “old habits” because I had gained weight while I was in the hospital. This is clearly a psychological issue and one should be given the psycological treatments and therapy the same as anoxeria and bulemia. I also used to party and consume a large amount of alcohol which did not help with the blood sugars. I am VERY lucky to be alive. I met my husband fifteen years ago and he ended up on dialysis (not diabetic) and eventually had a kidney transplant. This soon, very soon, “wised me up”…and I realized I too could loose my kidneys. I do have neuropathy in the feet and legs, I have had lazer treatment for my eyes and cataract surgery and my 24-hour urines show there is some kidney damage. As I said - it is very IMPORTANT that when you are young and foolish - do not abuse your body. You WILL suffer the consequences when you get older. Control your BG’s and never omit insulin or cut back on dosages to stay slim.
By they way I now have had type 1 for 56 years.

That is a good question. When my GP refused to prescribe insulin claiming I would kill myself from hypos and I asked how she was protecting me from DKA, her answer was that obviously with DKA I would end up in the ER and I would be fine. FINE! How is that fine?

I’ve since learned a lot. I have ketostix and have on occaison tested. I also learned what the range of symptoms are and what to do when you dump ketones (particularly heavy ketones).

Call a medical team member
Inject an appropriate corrective dose of rapid (if you have it)
Stop Eating
Drink water like is the end of the world
Down electrolytes, salt, potassium, magnesium and zinc
And don’t forget to pee

The sad thing about DKA is that simple actions anywhere along the progression can generally quickly stop the progression, but all too often actions is finally taken too late through a tragedy of lack of knowledge, delay in response and incompetence and people are hurt. You are your first line of defense, protect yourself first.

Thank you.

I just wish there was more awareness within the medical profession but it’s like the big elephant in the room you know

The way that I see it at the moment is that the real issue is complete lack of awareness within the medical profession of how to handle it. If you are an anorexic or bulimic then there are dedicated centers to deal with that and recognised pschological interventions.

When I was at my worst I admitted myself to casualty in DKA, I spent 3 days in intensive care and a following 10 on the ward. I begged them not to let me out. I was completely upfront with them about why I was in DKA and that I needed some kind of help. They told me there was nothing they could do and if I wanted I could section myself under the mental health act (ie on my record forever). I said that would not be happening so they offered me ‘crisis intervention’ and discharged me. By the time I had my refferal through it was 3 months later and I had lost all the weight I had gained in hospital plus another 2 stones (28lb, 12Kg) and had developed retinopathy.

Thats why I’m screaming at the moment. My story is not that bad compared to some of the others I’ve had

Last week I read the obituary of a 28 year old diabullimic - Terrifying, she could have been me or any of the other girls I support

Good to hear your OK ! Very Encouraging

The last doctor refused me insulin. She kept prescribing all these meds that didn’t work. She basically insisted that because I am overweight, I was not in control of my sugars… In other words… It was my fault. I was not trying hard enough. Needless to say, I dumped yet another doctor.

Funny thing is, my new doctor gave me Novolog & Levemir. With some exercise and common sense eating. I’ve lost 6 pounds shortly after!! So I ask, how was I not in control?? I think the only reason why I never got severe DKA, was because I was already checking my sugar. My fasting sugars was about 250-350, and I was basically starving myself. And this crazy @s$ doctor would no give me insulin? WTF?

Granted, insulin isn’t for everybody. Some have a seizure just by the mere thought of it. But doctors do not have the right to take that option away, because they have issues with labeling their patients. No other freak’n disease do we have so much darn doctor/patient bull****

I say again, diabetes isn’t killing people… Doctors are killing patients!!

Not considering the fact that the all the type 2 medications given to me, made me gain even more weight… All I can say is, doctors have a long way to go. We also got to bring all the old doctors up to date.

I 100% agree with you. Whilst you are helping young people not to get started with this disorder I am at the other end of the spectrum and I am someone who is suffering the consequences of my deliberate actions to “stay slim”. Whether diabetic or not society puts way too much pressure on young girls to be “slim”. I spent the best part of my young diabetic life abusing my health. I console myself with the fact that there were no meters, A1c tests, no eduction out there. But what little there was out there I tended to abuse and say “it won’t happen to me”. I was raised as a child who was “not normal”, that there was something “wrong” with me. I always used to hide my disease. Rather than telling myself I have to be “slim” it is easier now to just say, as long as I eat “healthy” its OK. I also get a lot of my nutrients from drinks…juices-sugar free, green tea, water - if you feel guilty about eating - try the many nutritional drinks out there. They have carbs in them but they are “good” carbs, slow to absorb. Carrot juice, V-8. There is a whole host of them.
Sheila

Sheila, as someone who has had diabetes for a long time I think that the girls could really benefit from hearing your story. A lot of the resistance I face from them is because they think that they are so screwed that they will never recover anyway ‘so they might as well be thin’ . You are living proof that it is possible to get better and live a life with diabetes?

I know that you are suffering but (without sounding harsh). 56 years with t1 and a lot of that manipulating insulin and still being alive is what I would call a bloody whopping achievement. You know I think the issue with a lot of the girls is that they can’t forsee a future, that they’re going to be dead anyway. You are proof that that is not inevitable?

thats a good question, I’m not sure where this article got its stats from, but we can look into it. I’ve heard some instances of misdiagnosis, and thats very scary… good point.

Did we have the same doctor? It’s crazy to think that there’s more than one out there who REFUSES to let a patient use insulin appropriately.

When I changed doctors I walked out of my very first appointment with new scripts for insulin, WAY more test strips than my original doctor “allowed” me, and orders for all the labwork that eventually proved I was a T1 all along. I still wonder why I couldn’t have gotten the same from the first doctor I saw… it would have saved so much frustration.