Hiya,
Im pretty sure its 3 months before Dka kicks in…
But i just wondered how long ?
thanks x
http://www.youtube.com/watch?v=eWVuCDQKB5k
talks about Elizabeth Hughes, who lasted 3 years after dx in 1918. They knew usable insulin would likely be figured out soon but weren’t sure when. Her diet was 350-400 calories/ day (less than 1/2 what people in concentration camps were fed, although likely higher quality food, as she came from an affluent background…). She was 5 feet tall and weighed 45 lbs when Frederick Banting started treating her.
Well depends if you’re still honeymooning. I’ll be in DKA in less than 6 hours if my pump site goes bad. A few months ago, I had to deal with this. I was fine before I went to bed, woke up with projective vomiting and trouble catching my breath. Meter was friendly and said “HI” to me. I think I’ll be dead within 48 hours without insulin.
It totally depends. I wouldn’t try and find out the answer. I know I’ve had no insulin for a couple of days in the past without DKA, but as I get older (nd have had T1 longer) I feel like my body can’t hold up like it used to. Now I can go into DKA a lot more easily than I used to.
Three months before going into DKA?? Not likely unless you still have significant insulin production or you starve yourself as AR describes. I’ve never gone into DKA (and hope I never do!) but one time when I was new to the pump I woke up around 8:30 at 175 so questioned whether my site was bad but decided to wait and see for a bit. At noon I was up to 375! (and promptly changed my set). So yeah, I would assume 3 days would be a more reasonable estimate (though as always, we’re all different!).
But Elizabeth Hughes was likely honeymooning and/or still producing some insulin. There has been a lot of research to look into different kinds of T1D. For example, it seems (based on what I read in the book Breakthrough) that Elizabeth Hughes’ diabetes was brought on by a series of illnesses she had just prior to diagnosis. I’ve read research that suggests such individuals actually have a different form of T1D and generally still produce very small quantities of insulin (some of them have measurable levels of c-peptide, indicating insulin production). Anyway, that might have helped her survive longer than most other people with T1D were able to survive on the Allen diet.
I’m with Zoe. I had a pump mishap once but went into DKA within 10-12 hours. Had to go to the hospital and get IV insulin to bring me down. It was really scary. I don’t think I would survive three months. But I will say I have this thought from time to time (the “how-long-can-I-survive-without-insulin” thought) and it really scares me, especially during a time like this when we’ve had two “disasters” in one week. Let’s just say I’ve been very careful with my supply of insulin these past few days…
going from 75 lbs to 45 lbs counts gives here a few T1 points I would think?
As I’ve mentioned before, at age 19(with 16 yrs. Type 1 then), I forgot my important morning Insulins since I was late for work and later also forgot that I hadn’t taken them. No starvation diet included and no time to make my own lunch, I had a Mc’s meal and regular soda that day. I think I took my basal Insulin after work. I felt Very tired and threw up once a few hours later. Then in and out of consciousness. Early morning hours found me on my way to the ER while throwing up blood. I was into a 3 day Coma early the next day. Thankfully, I have never forgotten my morning Insulins again and no Bad DKA’s with vomiting, Comas or ER trips.
We were raised not being allowed to take our Insulin or Clinitest to School so at age 19 I applied the same plan. No meters then either.
I know that I wouldn’t survive 3 months – I would be surprised if I survived 3 days. I have forgotten my insulin before and it doesn’t take long for my BS to start shooting up. When I was on the pump & it broke, I was pretty sick that morning when I got up – I think I woke up at 4 AM so it wasn’t like I was in bed for a long amount of time either. I didn’t test for ketones but I would be surprised if I didn’t have them. Someone that can survive longer is most likely producing some insulin on their own – I am not.
I think most of us were honeymooning when we were first diagnosed. Your pancreas doesn’t go from 100% to 0% in one day, after all. Even though we had symptoms ranging from weeks to months before diagnosis, I doubt we could all disconnect our pumps or discontinue our shots and expect to live that long now.
Also, I have read research that the younger someone is diagnosed the faster all their beta cells are killed off and the sooner they produce no insulin after diagnosis. So a 5-year-old will produce zero insulin faster than a 10-year-old who will produce zero insulin faster than a 15-year-old who will produce zero insulin faster than a 25-year-old who will produce zero insulin faster than a 45-year-old and so on. This is research on regular Type 1, too, separate from LADA who have an even slower onset.
It’s interesting that when you read one of the books on Hughes (I forget which one as I’ve read several), many of the diabetics survive for years, but every single mention of someone under 10 years old says they died within weeks or months. Not much different from those of us who had symptoms for a month before showing up at the hospital …
I think Elizabeth Hughes was extraordinary not only in her willpower (she was so weak she couldn’t even stand on her own by the end of those three years), but also in the fact that her parents could afford to hire a private nurse and ship her off to the country where her one and only task was literally to survive. It mentions that she couldn’t live at home or she would start “spilling sugar.” Most diabetics didn’t have that kind of single-minded support.
About a year ago I “forgot” to reconnect my pump after changing clothes. I happened to test just before changing and had been at 5.1 (92 mg/dl). Five hours later when I began to feel sick I realized something was “missing.” I hadn’t had anything to eat, but in that time my blood sugar had gone up to 21.5 (387 mg/dl) and when I tested ketones it went to the darkest colour on the strip.
This was when I was taking Humalog and it kind of scares me that things might happen even faster now that I’m using Apidra.
I definitely wouldn’t last three months. I’m not even sure I would last a week. I think two or three days is more like it. I am pretty sure that if I went to bed without my pump and slept for 8-9 hours I would be in DKA when I woke up.
I’ve done that too, Jen. I don’t disconnect my pump to get dressed because I use the 43 inch tubing so I can get dressed with the pump on the bed (which is why I like the longer tubing), but I do disconnect to take baths and once I disconnected, took my bath and then went to bolus for my meal. Luckily I got the “what’s wrong with this picture?” and went and got it. But then I haven’t been on insulin for nearly long as you, and since I will be decidedly ancient if I live long enough to “catch up” I’m sure my incidents of forgetting will grow exponentially! A sense of humor is definitely a good thing with D …as with life!
I’d side up with Zoe on the 3days time span being the average.
But I also believe that the tighter your control is,the faster DKA’s onset is.When I was on lantus and my A1C is 8.9 at best I forget my lantus and feeling tired and dizzy only after a day or so.Now pumping,when I go past 200 I’m so tired and spent and I feel worse by the minute.
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I’m just curious,how do you DEFINE ketoacidosis?Is it when the ketones are past a certain number?,or when you throw up?Or when you pass out?,I’m really interested in knowing the answer since it’s been on my mind for as long as I can remember.
DKA is when there are so many ketones in your bloodstream that it starts to affect the pH level of your blood.
Ketones doesn’t automatically mean DKA, but it does mean you’re headed for it if you don’t intervene.
True DKA you can’t treat at home because your electrolytes and such are all out of balance. But lots of us have headed off near-DKA at home, which is why things like sick day guidelines exist.
Also, I would think the opposite of what you say would be true: the worse your control, the easier it is to go into DKA. If you have an average blood sugar of 300 and are spilling small amounts of ketones regularly and something goes wrong, you’d already be in the beginning stages so it wouldn’t be hard to go the rest of the way to full-blown DKA. If you have an average blood sugar of 150 and aren’t spilling ketones, it would take something much bigger (or a bunch of small things) going wrong to get to DKA—plus, you’d probably notice how crappy you felt before being there and do something about it.
Those of us on the pump are at higher risk of DKA (and will get there much faster) compared to those on Lantus or Levemir because there is no long-acting insulin in our system. If you forget a Lantus shot you’ve still got residual Lantus from the previous day floating around in your system, which will slow down DKA. If you get disconnected from your pump, you don’t have any long-acting insulin for a backup. DKA only develops when there is literally almost zero insulin in your bloodstream. You won’t get DKA if you eat candy and don’t bolus for it (although you’ll have super high blood sugars), but you will get DKA if you disconnect your pump and forget about it.
Thanks for this explanation of what exactly DKA is. I thought it was anytime you spilled the highest number of ketones shown in your urine ( say the darkest color) for over two times… spread hours apart on more than one day. I thought that was DKA . Since the times I had that situation and was able to treat it at home successfully, I guess I averted the DKA ( And this was all pre-pump).
According to your definitionJen, I guess I have only had DKA twice in 43 years: Once because I had pnuemonia, and another time because of a raging urinary tract infection. I was hospitalized for the DKA and pnuemonia back in the 80"s. I was Treated in the ER with a slow insulin drip, electrolyte replacement and antibiotics… and then sent home the later in the same day when I had DKA from the urinary tract infection. I think that was mid-90’s or so . I was on MDI with NPH and regular insulin.
Never had DKA while on the pump. High blood sugars of 350+ due to pump / infusion set malfunctions can be expected, but I always carry a syringe and another infusion set with me at all times… and I can bolus my way back to normalcy in 3-5 hours. I also have a CGMS and a 'sick day" basal as well as a plan of action now, which I did Not have in earlier years… I guess that is how I have avoided DKA
Since I use Apidra in my pump and it leaves your system quickly, I ASSUME I WOULD BE ABLE TO SURVIVE ABOUT A WEEKOR SO?maybe longer, maybe if I ate nothing but nuts and lettuce , cheese, lean meats, drank a lot of water? I am not sure…
Will not even attempt to surmise a definite how long?… Not exactly for ME to say how long I could survive;
God is able.
God Bless
Brunetta
Thanks for the informative discussion! My “plan” for when my pump breaks, which it did last summer, is to go to the drugstore and buy some insulin until they send another one. I think I hit 280 in there while I was pumpless (as I was 20 minutes away running, like 10 miles to “kick off” marathon training and probably blew 10 minutes running by Walgreens for some NPH) but I immediately pounded a bunch of insulin with the syringes from the garage and, when it didn’t work, hit a vein, which worked. And then I ate for a while as shot #1 started working too. I drank a lot of water, which I usually do when I drift > 150 but I didn’t bother checking for ketones and just figured when my BG was normalized, I’d get cleaned out.
Or give fast acting insulin ( same as in your pump ) every 3 hours …and finger poke , finger poke …acidrock, I have good news …we now have a printer with scanner, so I don’t have to type( 2 fingers ) that page ever again …just scan and voila:) !!
Modern technology is a blessing …and NO I don’t want to reach DKA …I plan not to try
Thinking back, I need to make a correction. Years later two times I was obviously in DKA while I was in the ER but I did not go to the ER because of DKA. I went once for a kidney infection and the second trip was due to blood poisoning due to a kidney infection. I was more concerned about running to the can every ten minutes, 2 male Nurses competing to see who could complete the Better i.v setup on both of my arms(the Lad on the right won hands down), the different antibiotics that were not working on me and the Drs. messing around with my steroid dose for RA.
Otherwise through the years, I had many HI meter reading which is at least 33.3mmol/L(600mg/dl) advanced DKA which I Successfully treated by myself at home. I believe DKA
starts at bgl’s over 17.0mmol/L(300mg/dl) give or take depending on the Person.
Here is the link for DKA criteria in the U.S.
http://spectrum.diabetesjournals.org/content/15/1/28/T1.large.jpg