I had about 10 years of diabetic symptoms - worsening eyesight, dramatic weightloss (I looked like an anorexic), thirst, frequent urination etc etc - before diagnosis. I am not sure if I was producing some insulin while I was so ill, but I really was extremely ill and had now, what I know was DKA several times - heavy legs, heavy breathing, frequent vomiting (even when I had not eaten) the “smell” which people took to be alcohol, though when I did drink my poison was vodka which does not smell! But the doctors missed it. They never tested as I had had very low glucose levels while I was growing up.
I was only accidentally diagnosed after being in hospital for 6 weeks for acute stomach pains which turned out to be a cyst on my spleen, and while they were scanning for that they discovered one on my pancreas. STILL they did not get it but when I was restless during the early hours of the morning I would walk the corridors and on several occassions I was asked where I had got the alcohol? At 3 am, just having had stomach surgery, nearest shop 2 miles away, pulling a drip stand … alcohol was the last thing on my mind!!! They had smelled ketones, but I did not know about it then.
Only when they were about to discharge me they did the test for diabetes and then came and told me I was Type 2 (based on age) and it was another two years before I was diagnosed as Type 1 after a couple of really bad DKAs (that is how I now know I was like that before!) I am sure it is only by the Grace of God that I got that far!
My hypothesized timeline if I unplugged my pump right now and try to continue my life as normal…
1-2 hours I feel like crap
4-6 hours I feel horrible and have small ketones.
12-24 hours DKA and I need emergency medical attention.
3-4 days Game over.
This brings up the interesting idea of a doomsday scenario. Where most of the world is eliminated (including your nearby pharmacies). What would you do when your bottles ran dry?
Even though it probably would not help much, I would run around (exercise) while drinking strong spirits to hopefully lower my rising BG.
Thanks for the detailed reply Jen,some I already knew but I wasn’t sure about the exact outline of DKA.
What I meant about tighter-control patients is that their body isn’t used to highs,and pretty much collapses quickly,whilst those with high blood glucose most of the time,their bodies are used to highs therefore can stand ketones for a longer while.But you said makes sense,I don’t which makes more sense though.
And your comment about DKA being the point when you no longer can treat yourself,very true I think,I’ve seen the ICU guidelines for treating DKA patients,definitely a do NOT try at home.
Thanks again,appreciate your feedback.
How soon you go into DKA depends on how much insulin you are producing. For people in their honeymoon, insulin treatment allows the remaining beta cells to recover from glucotoxicity (caused by high BGs), and once again take up some of the task, so newly diagnosed people may well be able to live a couple of months without insulin injections. But the autoimmune attack is relentless, and they eventually lose all or nearly all their beta cells, and then, as full-blown T1 diabetes sets in, they will experience just what all the people above have been saying. And natural disasters ARE extremely scary – it’s awful to be dependent on external insulin – if you can’t get more within days, it’s lights out!
Ketones and exercise (without insulin) can certainly be a bad combination. I was making the assumption that ketones had not set in yet with my doomsday scenario.
If the world ended now and all I had was the insulin left in my pump and the insulin pen I carry as backup, I would run a 50% basal rate and not bolus for anything I ate. I’d run super high and I don’t know if a 50% basal would be enough to prevent DKA, but hopefully it would! Doing that the 68 units currently in my pump and the 300 additional units in my pen would last me almost a month. Maybe by then I would find some secret stash of insulin.
'Course, there would be the problem that I don’t typically carry a month’s worth of pump supplies around nor a month’s worth of pen needles.
I would try to exercise, too, but I think stress would probably offset the effects of any exercise.
I tried to look up how fast DKA sets in for someone with Type 1, but couldn’t find written information. My pump trainer emphasized that because I use fast-acting in my insulin pump (Novolog) and don’t use long-acting basal, if my pump malfunctioned and I stopped receiving insulin, I could be in DKA as early as 4 hours later and dead within 24 hours.
But three months? Only if you have A LOT of beta cell function left.
Every time we have a natural disaster, I start thinking about having a go bag. I even wrote on my blog about that after the earthquake in Japan & TuD put it at the top of the home page as one of the featured ones. I still haven’t done it and have thought about it twice the last week. Who said third time is a charm? I have been having problems with Apidra going bad about a week after I start using a pen so I would never be able to put one in a bag even if I changed it out every time I started a new pen – I have been throwing a lot away. My Levemir is pretty sturdy so I should at least put a Levemir pen in a go bag and swap that out every time I start a new one. Having that would at least be better than having nothing!
I finally got around to making one up, Kelly and I put everything in it except my insulin my weekly med boxes and my meter remote. Those things are all in the kitchen, so I figured I could make a quick trip in there and scoop those up and put them in the bag (oh yeah and my cat, lula, but no telling where that girl could be!). The bag I prepared has a couple extra infusion sets, glucose tabs and test strips. Or at least it did till I had a delay in getting my pump supplies and used the extra sets. (the delivery comes tomorrow). It’s actually kind of nice to have the extras to use in a mini-emergency and then replace for The Big One. (Oops shouldn’t use that phrase since I live in California)!
I find that easier then continually swapping out insulin vials. I figured if I don’t have the extra seconds needed to scoop up the things in the kitchen I’m pretty much a goner anyway! Now having the presence of mind to do it is another story altogether. Repeat after me, Zoe: Emergency Bag, Insulin, Meds, Meter/remote=30 seconds. Finding Cat=10 minutes, Convincing cat to get into carrier = infinite.
Having only a basal, and even eliminating carbs will prolong your dying (don’t ask me how I know), but the end result is the same. Even though it’s not ideal, even having some Humalog or R in your kit is better than relying on a basal alone. You can have a couple of bottles of insulin and some syringes in a baggie in a quickly grabbable spot in your fridge. Keeping yourself alive in an emergency is priority number one. Hope you never experience such an emergency!
having test strips is the main thing on my list. Even if I can’t do anything about fixing the BS problem, I want to at least know where I am at! Last summer when they took me to the ER after I passed out, I really wanted my meter. I thought if I had a small bag on the door with some stuff, as long as I am not zonked out, I would take it.
You must have a bell on your cat if you can get her in 10 minutes! I can’t tell you how many hours I have spent looking for mine thinking she managed to get out. She will suddenly appear out of no where. If it happens in the middle of the day, I know she would be on my bed under the blankets. If it happens at night, I will never find her.
I am hoping it wouldn’t be longer than a week Natalie. I know it is not ideal, but better than nothing! I did think of keeping my insulin in a zip lock bag in the fridge so I could grab it, but I wanted something in one spot that would be easy to get and not having to think about getting stuff from different places. I have already had to leave twice in a hurry because of one real gas fire and one smoke from my microwave frying itself and just got out without taking anything either time.
The 10 minutes was just for “locating her”, Kelly. She does go out and over the fence, but I know her hiding places (usually anyway), now getting her to come in…that’s the infinite part. We play this “game” at night where she meows at the back door to come in then I open the door and she just sits there and looks at me - if I reach for her then she’s gone! Then after a few rounds of that she comes to the door and just strolls in as easy as pie. There is no doubt in my mind who is the one in charge here! You’ve heard the saying, “dogs have masters, cats have staff”? Yep.
But even if I didn’t get her in an emergency, she’d probably be just fine; she’s been lost for a week twice - once in Guatemala where she found a field with a very low fence, probably the only place in Guatemala the stray dogs couldn’t go.(and nearby construction workers that I think were feeding her tortillas) The other time was in the mountains in California and there was snow.
I know you separated the locating & getting her in her crate. “If” I can get my cat in my arms, them the crate isn’t too bad - she fights but I can win on that one. Finding is the hard part. When I take her to the vet, I always lock her in the bathroom after she eats breakfast so I don’t have to try and catch her. I can see my cat doing the door game if she were allowed outside. I agree with that saying - my cat is the one in charge and she doesn’t make a move unless she is the one that wants to make a move.
I am glad you were able to get her back both times she was lost. I know how scary that is. A couple months after I got my cat, she was waiting at the door when I had the dogs out and when I opened the door, she took off. One of my neighbors friends had cats and said to put some food out for her. The next night after I went to bed, my one dog started crying so I went down & opened the door. She was outside and never made an attempt to run away again.
Yeah, same here, if I can get her, I can put her in her carrying bag.It’s the “getting her” part that’s hard! I’m definitely stronger than her physically (I hate to think of it if I weren’t!). Mentally, now, I think she’s the smarter one - or at least more devious.
I’m glad you got your cat back after she ran out. The time it’s the easiest to lose them is if they’re not used to going out or when you’ve just moved somewhere new and they don’t have the scents to find their way home yet. I lost Lula’s brother, Latte that way 13 years ago!
Actually, I hope the same thing. But here in Nevada, our greatest danger is earthquakes, and if that happens, it will certainly be more than a week or two. After a major earthquake, the roads could be torn up, and there might be SO many people dead and homeless (think Haiti, although we are not nearly so large or poor as Port-au-Prince), and the hospitals might have come down, not to speak of medical personnel not being able to get there – I don’t even want to think about it. Maybe I should start stashing all my meds – the insurance companies make it hard, but it would be so nice to have a supply, just in case! I’m much less worried about refrigeration than about just having insulin at all.
I live in an earthquake risk zone and I keep a kit with extra food and supplies in it near my door, so I can grab it if there’s even “the big one” that they keep warning us about. I don’t keep insulin in there, but might start. I also make sure I always have a full insulin pen in my purse&mdah;and, until recently, carried extra test strips and enough supplies to last me at least a few days. It makes me feel much safer having that stuff nearby.
