Kept telling myself it was the flu, but in reality it was DKA

Type 1 and LADA
1

Hello everyone!

I've been T1 for almost 2 years now (gosh, it goes quickly!) When I was first diagnosed, I was in DKA. I had all of the classic symptoms of T1, but I have to admit that the progression of the illness and feeling lousy all of the time sort of had become the norm for me.

Since my diagnosis, I have worked really hard to stay healthy (with the intent to never-ever-never-never feel like that again being one of my strongest motivators.) But everything came to a screeching halt this past weekend when I was hospitalized for severe DKA. It happened so quickly that it still amazes me. Here is a quick review of the day leading up to it:

Thursday morning: I felt great. Nothing to report. I changed my sight on the Minimed, headed off on my day around 9 am.

Thursday afternoon: By 2 pm, I all of a sudden felt like I was getting the flu. It wasn't a gradual, "Oh I think I might be coming down with something" feeling, but rather a "Wow, I'm totally sick" feeling. Stopped at a store on the way home, I remember standing in line and feeling terrible, and feeling my heart bust out of my chest. I made it home and promptly laid down to nap, thinking I could sleep this off (because I truly have no time to be sick ;) My BG were a little high, in the low 200's so I wasn't too concerned. I corrected and went to nap.

Thursday 8pm: Slept all afternoon, and woke up feeling worse. Ate some soup, took more insulin for my rising BG and laid back down. Noticed I was thirsty, so started drinking lots of water.

2 am: Woke up in a daze. I was home alone. Couldn't think straight. Felt super nauseous, vomited violently twice. Blood sugar hit mid 400's. Took lots of insulin, Laid back down because that was all I could do. I remember telling myself that I should check my pump/call my doc/ call someone/ do something. Then I went back to sleep.

6 am: After fitful sleep, BG hit high of 600. Lots more vomit. I was scared but still not thinking straight. Still home alone. Somewhere in my cloudy head I got myself to change my infusion on my pump, thinking something had to be terribly wrong because I had taken so much insulin and my BG just kept rising. Put a call into my doc, naively hoping it was just a flu/bug.

8 am: BG began to slowly come down; around 400 at this point. Vomited again (but for the last time, thankfully) Doc called and told me to go to ER NOW! Again, I was alone and knew I couldn't drive. My friend came and brought me in.

9 am: At ER, they took me right in and put me on IV, Potassium. Slept most of the time when not answering questions/giving blood. Diagnosed with DKA.

12 am: BG had fallen to around 230 average, finally admitted to floor for observation and IV.

It is helpful for me to relay what happened this way because it was all such a terrible blur. I realize now that I should have gone in when the first signs of DKA presented themselves. Honestly, this was my first experience with it in a long time- and I never expected it to happen so quickly. I just kept giving myself insulin, but it had little effect. I'm scared by my muddled mind and lack of ability to think straight. How do you handle that when you are by yourself?

I am feeling better- which is actually kinda surprising to me now when I consider how sick I was just a couple of days ago. Now that I can consider what happened to me, I'm a little disappointed in myself for not recognizing what was happening sooner. I could have sworn I was getting the flu (and two of my coworkers were really sick, so I just figured they shared it with me.) I'm a little depressed I thinkas well because I work really hard to keep the best control I can... and this was totally out of control.

Needless to say, I am seeing my Endo on the 28th, and I'm not looking forward to it. But, it has reinforced my resolve to NOT ever be that sick again.

Thanks for reading!

2

That is a really scary story. I am on MDI right now and two things worry me about pumping. First is that it can lead to scarring, but second, when the pump fails things go south fast. The pump uses rapid insulin, so if your site goes bad you can run dry in mere hours. And your story is important, your site went bad and in less than a day, BLAMMO, DKA. And I don't think they explain that to you at training and even if they do, you can be "faked" out by thinking that high blood sugars are due to being sick or that pizza pie.

I don't think DKA is inevitable. This was a learning experience. There are a number of things you could have done to avert the situation, even if you weren't thinking at the top of your game. You missed some opportunities to test. We sometimes worry about too many tests on a day when we are fine, but when things are bad you should not feel guilty about your 50 tests for the day. I think some pumpers also just do manual correction when there is any question of pump operation or when blood sugars are high enough to be "serious." Perhaps others with more experience have suggestions.

I am glad you are ok. Your story is a strong warning of some the dangers faced by us every day.

3

That's one thing that keeps me from getting a pump. Things can go bad really quickly...

what I do (I'm on MDI but this doesn't make me immune to DKA) when I notice there may be something wrong:

- test for ketones
- drink a lot of water (if I don't want to/cant', though a straw)
- not lie down or go to sleep
- test bg an hour after correction to see if it went down
- not eat anything I have to bolus for

if nothing works for a a longer period of time:
for MDI: check for air bubbled in my pen(s)
- if there is not much insulin left, refill the pen (insulin may be too old/whatever)
- add some basal to the correction (this is something I noticed helps me since I take few units of basal insulin, and if bgs are running high and there a ketones aboard I easily need more and for some reason it has a better effect than short acting insulin- but that's not for everyone!)

for pump:
in a way, something similar
- check site, and for air bubbles in the reservoir/tubing
- in necessary, refill reservoir

You probably know most of this but you'll have to remember to actually do it.
I had to learn to take situations like this more seriously too.
I hope I'll never have to get to the ER, so far I have always managed to prevent it by following these steps...

But I'm with you, a few days ago I actually caught a nasty cold and despite my bgs being pretty good before, numbers suddenly went on a crazy rollercoaster! Never in years have I woken up with a bg of 300+, it kind of shocked me how much impact a simple cold (it's not even the flu!) can have. I was lucky, no ketones. It still was a struggle to keep bgs in a save range.
In my case I knew it was the cold but I could have been wrong. I could have been fine in the evening and woken up like that, thinking it was a cold even if it was not. Sometimes diabetes fools us.

4

Not sure you're old enough to remember the Chevy Chase skit: It's a floor wax and a dessert topping!

It's possible that you have the flu or some other virus or some other infection and that sent you over the edge into DKA.

I had the chicken pox at age 19 and that put me pretty firmly into DKA despite massive insulin doses. It is not at all unusual for me for the first sign of the flu or an infection, is that my bg's are going up without any obvious reason.

5

hi. got a similar story with my son. Kinda long story so let me try to shorten it.
January 2011 john got sick like the flu his fiance took him to the ER they said he had a infection around the heart musle and it was causeing severe chest pains like a heart attack. sent him home on meds.
He was only on Metformin ER since he was considered type 2 since age 16.
Seem to get better.
Came home from college end of may.
I noticed he was drinking alot more and going to the bathroom alot. thought of DKA but didnt think to much of it cause I thought type 2 dont go through that.
August john got married. he seemed a little off like withdrawn at the ceremony. thought maybe he would pass out but he said he was just trying to not cry when he saw his bride coming toward him.
September came and john had signs of a cold ect again like in January. His wife took him to the same ER and they said he has a sinuitis. They gave him medicine for getting sick and the infection. not once checked his sugar and she told them he was diabetic. sent him home and john got worse.
about 2:am got a call john was still getting sick and the medicine wasnt working. told her what to try to settle his stomach.
about 4:30 am another call saying he was struggling to breath but his wife thought he was just dealing with the conjestion from the infection. called the ER they told her to give the medicine time to work.
7:00am April made a wise chose to take john to the ER again dispite the ER nurse saying to wait.
John was admitted in severe DKA and was hours from death. his blood sugar was 750 and his blood was so toxic all his levels were wacked out. Levels were all in danger zone. We were never told how bad it was till 24 hours later. this is all new to us. Its scary and hes so young. I'm glad we have this message board to share and inlighten each others on what we go through. my son has what seems like neuropothy after he came home from the hospital on insulin about a week after he got out. Its all the sudden and trying to understand it is hard. Do you have any symtoms of this? Praying he can heal and walk without pain soon. Thanks Kimberly

6

Not intending to hijack this thread, but wasn't your son testing his BG since he had T2? Wouldn't that have shown out of control BG?

7

I've never been a pumper and had no idea it could happen that quickly. Thanks for the timeline. I must say I'm surprised there's no alarm to indicate the insulin isn't going anywhere. Glad it turned out OK (hope you held onto a few syringes, just in case this happens again!)

8

When you say you were giving correction doses, were you doing it by bolusing through the pump? The thing that was hammered into my head when I was trained was that if I'm over 250, and ESPECIALLY if I'm feeling nauseated, is to give a correction by syringe, because it might be a bad set. I do notice that your BG started to come down when you changed your set, which confirms the notion of a bad set. But by that time, it was too late.

It might be a good idea to plan to correct by syringe if your BG ever goes above 250 for no discernable reason (i.e. if you pig out on spaghetti, and underbolus, you know that's why). Doing that will never hurt you, but CAN help you avoid DKA. I don't ever want you to experience that again! ((((Hugs!))))

9

Wow! Crazy story. Glad you pulled through it ok.

For those worried that this is what happens on a pump: First off a bad site is fairly rare. I have had maybe 5 in 6 years of pumping. This is the exact reason it is almost mandatory that you test blood glucose at least 4 times daily on a pump. Most people can go a couple of hours without insulin without much of a problem. I was suprised to find I could go about 7 hours and still not be at a point I had to go to the hospital (i had a bad infusion set I put in right before bed- BAD. Never suppose to do it right before bed for this exact reason).

Because this is a possibility I use the rule of thumb that if a blood glucose is not where I expect it to be (high for no explainable reason) I will correct and check again in an hour. If the correction hasn't moved my blood sugar lower by that point I take a shot and change the infusion set. Using this rule of thumb I have not even barely been kicking out ketones by the time I knew I had a problem (except for the above pre-bed change. In that instance I had moderate ketones and was on the verge of needing a hospital) with the infusion set.

I guess I look at it as there is no safe way to take insulin. We have all heard the stories how the fast acting got mistaken for the long acting on shots so there really is no 100% safe way to take insulin. You just use protocols to try and reduce the potential for error.

Jag- All the pump can tell you is if it is encountering resistance when it is pumping the insulin out. If the insulin is going somewhere else besides in the body the pump has no way of knowing (e.g. a bent catheter that is not under the skin).

10

Unfortunantly he was off at college and took his pills but wasnt checking reguarly. I guess he felt fine so he didnt realize it could go so bad from what we saw with type 2. at the time thats what we were told when he left for school august of 2010 it was in control. He thought he could be in control diet and exercise on his own. This was a big wake up and eyeopener. Guess moms arent so stupid. He takes better care now and is now insulin dependent. Wish they would of said type 1 in the beginning than hw would of been on insulin and understood things better. thanks yes he should of checked more. was very active at college but things happen.

11

OK, I'm glad it senses back-pressure since that should be a trivial thing to engineer in. If catheter isn't under the skin, isn't there a wet spot of insulin formed on the skin? Or is that the problem - that there is, but it sometimes isn't noticed?

12

Frightening! I was diagnosed DKA & worry about going through the horrors of that again. I thought I had the flu when the violent vomiting started. Truly stupid to have not recognized the intense thirst, constant peeing & exhaustion that preceded the head over toilet stage.

Know how you felt not being able to think. My brain was too fried from high BG to think at all.

I've never wanted a pump fearing what you went through.

Glad you're ok.

13

+1

I get a new bottle of insulin on board if the corrections don't resolve the high bg.

more ((((hugs)))) and hopes for no more DKA episodes.