I think it has been ages since I have posted my own topic. Early Sat morning I went from 100 bg to 325 with high ketones by 10 am or so. I woke up, saw my dex and couldn’t believe it. I immediately tested bg and ketones which were 3,8. I did a 2 unit injection and increased basal. I became violently nauseous directly after and we headed immediately to the hospital. I didn’t think I was going to make it on even a 10 minute car ride there so I took some zofran first and it helped very quickly which surprised me. I was very dazed and out of it so I don’t know how I managed to do all of this to be honest.
When we got there they rushed me through and started me on more zofran & iv fluids right away. I think one of the docs was pretty surprised when my blood work showed very high ketones even though I told him I tested for them etc… he also started in about how rare it is for adults to get type one. By that point my bg had started dropping and was at 270 or so maybe I think…he agreed with me that bg levels don’t have to be super high with high ketones/dka and each person is different. The anion gap was ok and the ph was also ok as far as I know, I haven’t seen the lab results yet, so it wasn’t full dka I guess what you would call pre dka but they had to admit me to treat me to flush out ketones and treat severe dehydration etc and find a probable cause for this like infection. I was there for about 24 hours and ketones appeared to be close to normal last night already.
I had had a stomach bug on and off for a few days and that could have been part of it. It didn’t seem severe enough to cause this and I’ve been sicker and had no problems with ketones before since my original diagnosis dka.
There was no pump malfunction or lack of insulin from my pump although I still wonder if something is going on with it because I’ve been having terrible trouble with my bg crashing with almost every meal and then going high.
I had started feeling ill the Thursday before I think and had bad runs… then went to constipation/runs= I thought I might have mild food poisoning. I had drastically lowered carbs to take small boluses to try to stop bg crashing. And I remember the night before drinking some juice because bg was dropping and then eating some chicken and veggies but I felt so nauseous I could hardly get started eating so think now I was already getting ketones then.
I drink a lot of water so I’m surprised by how dehydrated I was apparently, they gave me 5-6 bags of fluid total while I was there and that seems to have worked along with the zofran.
I think my ketone meter saved me because they said it was very good that I came in right away before things got much worse. I knew when I had that dka type nausea things were bad. I recommend getting the ketone blood meter. This really saved me. I’m using it now to monitor ketones as I recover and I’m surprised how much they are fluctuating but still in a low range now.
While I was in the hospital my bg were overall much more stable, partly due to the fluids I think and to not moving around too much. I will write more about the overall hospital care later, some of which was great and some not great.
I’m still not sure how this happened so rapidly and I wonder if anyone else has had something like this happen too and what you think caused it or were there multiple causes? I was also under a lot of stress leading up to this. I’m still pretty out of it from everything- I’ll be resting up and taking good care for a while and trying to figure out how to avoid this happening again.
I’m sorry to hear about your experience. It does sound like you were right on top of it, but still I’m sure the whole thing was horrible.
You can become dehydrated even though you drink water if you lose electrolytes. This can happen with vomiting and the runs as well. Do you think that might have happened? Being dehydrated (and being sick) can cause you to become insulin resistant and at higher risk of DKA.
And why do you think a ketone meter is so much better than the urine strips? Is it because it is more accurate?
I’m sorry you experienced that. Hope you feel better soon! I’ve had the ketone meter for years and love it. It’s so much more accurate the the urine strips for catching problems as they develop. I keep one in my bag with my backup pump supplies.
Not 100% on topic, but . . . I’ve been pondering the idea of a ketone meter for a couple of years now. How many brands are there, and does anyone have a particular recommendation, either pro or con?
Have you been tested for Gastropersis (slow emptying of stomach )? Sounds like what I went through when I found out that I had this alful complication. Makes diabetes much harder to control. I’ve had diabetes for 55 years and gastropersis for 18 years. The last 18 years has been a real challenge. Hope you get better soon.
I used the Precision Xtra in the past and now use the Precision Neo. I’ve heard the Precision brand of ketone strips (which both meters use) are ridiculously expensive in the US, though—I think I heard $100 for 10 strips or something like that. I get 30 strips (three boxes) for $90. Since I only check ketones a few times a year when I’m suspicious of bad pump sites, those three boxes usually last me about two years.
You can go online and get a Precision X-tra meter for FREE, but like others have said, the strips are mucho dinero. But how often do you use them? For my daughter, hardly ever…
I did a little checking. Typical online prices are in the $50 to $70 range for ten strips. That’s not cheap, but as mentioned above, they wouldn’t be used very often—one hopes.
Meee, I don’t have any experience with a situation like this. But I did want to write a note of support and I hope that you are doing much better! That was a scare! I am also glad that you are so on top of things…you were able to catch a bad situation early on and avert a worse situation, due to your knowledge, awareness, and the right testing equipment.
It was pretty terrifying. I’m glad I was able to do everything I did. I’m still not feeling that great so I will try to reply more later to everyone. I use the precision xtra. I bought it on sale at walmart thinking I would probably never use it but I’m so glad I did have it and ordered the test strips. I will try to order a free one now for my purse to carry with me.
I also keep remembering what a nurse said to me when I was diagnosed- if there is any sign of diabetic emergency go to the hospital right away because it is always better to go earlier than later.
I don’t remember how much the strips were. I think I got them from the mail order and there was a larger copay than normal maybe. I prefer the meter because it’s more accurate than the ketostix but I have those too. A number for your ketones can tell you how much trouble you’re in vs just the different colors for levels.
There are instructions for what levels are normal and what is dka: 1.6 I think with bg above 300 = dka. I wasn’t in complete dka though even though I had 320 bg and much higher ketones at 3.8, because my anion gap was normal and I still don’t know what the ph was yet. But I would guess I was pretty close from the violent nausea that started when I woke up. I was in dka before with a pretty low number- early dka at 279 and severe dka at 363 with a ph of 1.5 and blood gas of 5. I don’t know what my ketone levels were then numerically, they were very high on the ketostix.
I would also try to keep some zofran on hand to take because it will help you to be able to function and do what you need to do if this happens to you.
I looked at statistics for type 2 dka around the time I was diagnosed and found only one site with any information on this. It said out of 100,000 people who are admitted for dka in the US each year, 75% are type 1 and 25% are type 2. So relatively it is pretty rare but it can happen. One patient in the er with me and then the icu also was type 2 in dka and kidney failure. It can happen with other severe illnesses and infections, dehydration etc.
I don’t feel like I’m completely out of the woods here and they should have kept me for another day because the night I was released after dinner my bg spiked to 250 and ketones were 1.6 so I was scared I would have go back to the hospital. But I managed to get it to 190 and ketones dropped then. My ketones are fluctuating and seem to go up and down with getting more dehydrated and bg rising etc. I still feel sick and had more upsets today… I followed up with an endo at the hospital today and she said to try increasing my basal for a while because I’m still sick, I’m just scared of what happens when I eat and crash because that happened again today when I was at my gp, my bg started crashing at 160 about an hour after eating. I treated with 4g and it stabilized, but then it spiked later which is typical and I am wondering if this could be a combo of gastroparesis and ibs together.
One thing I really can’t believe is how much more stable I was with iv fluid- so it really seems to depend on hydration for me, at least for this event anyway. Another thing that I think probably helped keep me stable was that I wasn’t really moving around too much.
I wouldn’t swear to it, but I’ve gathered it’s fairly low. DKA was mentioned to me once or twice along the way, but really only as something that could happen when my BGs went super high when I was sick or something. According to this it’s rare, and is usually preceded by a pretty serious event of some sort.
I’ve never been given anything for testing for ketones, or encouraged to test for ketones even when sick.
I’d also suspect it depends upon the individual. For someone like myself who still produces considerable insulin, but who is super insulin-resistant, it might not be as much of an issue. For a T2 who produces little to no insulin of their own for whatever reason, I’d guess that it’s a higher risk?
Hi Meee: Thanks for the update; I am glad you are doing somewhat better. Keep it under observation!
Regarding DKA in Type 2s, remember that some percentage of those “Type 2s” are probably misdiagnosed Type 1s. But yes, DKA in Type 2s can happen with illness.
Yes I’m sure some of those are misdiagnosed. The type 2 patient I mentioned was a long term type 2 who was probably not misdiagnosed, but I guess you never know for sure. thanks
