You can purge ketones on your own, you shouldn’t need a hospital unless you reach a “point of no return”. For me, that point is vomiting. If I reach that point, it goes downhill fast. That’s why I was worried about your other posts! But it’s different if the vomiting is from illness, not the ketones. High ketones + vomiting = hospital. Vomiting + low/no ketones = normal sick day regime, unless it worsens. And yes, most likely hospital. DKA is critical and life threatening, not something your run of the mill clinic is able to handle.
It seems like they stopped teaching diabetics to manage ketones on our own in the last few decades. You need insulin to purge the ketones. LOTS of insulin. It’s not just about delivering enough insulin to manage BG anymore, but rather you continue to deliver excess insulin after your BG comes down until the ketones are out of your system, and manage the extra insulin with increased carbs to keep your BG up. Ketoacidosis is really hard on electrolytes, too, especially potassium. For all of us who have been hospitalized with DKA, that’s what is in the IV bag to make it burn like the fires of hell. IV potassium is really caustic. You don’t want that, so best to supplement electrolytes early and often.
When I was a child, the routine was 2 units of humulin-R and a tablespoon of Coke syrup every 15 minutes until urine ketones were down to “trace”, and as much Pedialyte as I could handle in between syrup/insulin doses. The coke syrup was available in the pharmacy, and the same stuff they dilute to make the beverage, but full strength for this purpose. It was foul stuff and more torturous than the DKA! I think it was intentional so they weren’t rewarding the irresponsible child with tasty sugary treats when I got sick.
Now I prefer coconut water to treat ketones, since it’s both high in sugar and potassium. I basically sugar surf. I set my pump to my 150% sick day profile, but that doesn’t count as excess insulin, that’s just the insulin I need to manage BG when I’m ill, have ketones, or are otherwise insulin resistant. Then I use the extended bolus feature, and deliver quite a large bolus, extended over 2 hours (because that’s all my pump allows anymore). I keep a bottle of coconut water with me throughout that time and drink as much as I need as often as I need it to keep my sugar up.
I like the dehydrated coconut water powder. I can mix it up a little more potent for sick days than I would for normal drinking. Plus it’s shelf stable and doesn’t take up a lot of space. This is the one I buy:
Wilderness Poets Coconut Water Powder - Freeze Dried - Instant Mix (32 Ounce) https://a.co/d/eAp3ynO
It looks like a lot of money, but I get it on subscribe and save and it works out to be $3.35 per liter. That’s less than the grocery store (~3.79/L), and way more convenient.
The big thing to remember is that insulin is dangerous! You have to have to fast acting carb at the ready, and you need to have an emergency plan in place… Even if that’s glucagon, friends or family to check on you, or 911. You can’t just deliver excess insulin irresponsibly.