Unpleasant Diabetes DKA experience

There was an unpleasant experience with DKA for a relative and disappointed with health care providers. Almost like caution, warning for others. of potential negligence and malpractice.

A hospital advised that a grandparent was on last few days and any family should meet asap. Grandchild came over from Europe, who was T1 Diabetic, celiac, mid 20s female. Apparently grandparent lasted well over 2 few days infact eventually few months. Grand child visiting hospital every day and after 11th day complained about nausea and feeling unwell. She was taken into a day clinic, Doctor was told of T1, he said she’ll be fine and will recover in 24 hours and prescribed antibiotic and something for nausea and told her to drink lots of Gatorade. No blood or urine test taken. Next day morning, she was found unconscious and rushed to hospital, ambulance confirmed she had sugar reading of 36 max their meter could read. In emergency they confirmed she had DKA and later in that day/eve put her in ICU. Begs the question why the clinic doctor had not sensed anything to DKA 16 hours earlier. The doctors in ICU were seem to be hypothesizing what the trigger was and were claiming on a foreign trigger from another continent. Sugar reading was at 50 and then it would come to 35 and then it go back up to 50. Almost like they were experimenting. Eventually disease control results came back to a family of cold virus, no foreign trigger, but possibly norovirus and the doctors were so coy about exactly what it was. It was so suspicious about what the cause was. Almost like they were trying to hide an HAI, hospital acquired infection. They spent 6 days on the recovery when the average DKA recovery is a few days and she got severe scarring. Sadly, even after 4 years since this incident, she has never been normal and has had continuos gastro problems, affecting her normal life, cannot not work, gets tired quickly and is seeing specialists to try to help her.

Bottomline, T1s should be very weary of hospitals and unclean places and even health care personnel like doctors.

Wow, that is scary. I have to ask, was she testing her blood sugar on her own?

She was taking here own sugar readings, it was high near 10 when she went into the doctor’s clinic, he seem to shrug it off, that she can manage it.

Unless I compute wrong, that is only 180? (factor of 18 - yes)? In which case if this is a diagnosed T1 on proper insulin regimen than I would tend to agree that a 180 should be able to be easily handled. Simply bolus some insulin.

I assume there had to be something else going on or else I have simply misunderstood the entire situation.

Yes that seems the way to go Tim. But isn’t that what DKA is , that insulin becomes ineffective and sugar accumulates in the blood. Apparently all the symptoms of DKA were there but the clinic doctor did not diagnose and detect. This was her first case of DKA so she may not be aware of the ongoing but surely it should have crossed the Doctor’s mind ?

Strictly speaking in regards to T1, AFAIK, it would not be expected for “insulin to become ineffective”.

However it is very common to have high blood sugars due to not enough insulin. For whatever reason. The immediate solution is to bolus more insulin and check with a meter in 2 hrs to confirm BG is starting to respond.

For a T1 to have DKA at 180 would (in my opinion) be quite odd. Without additional factors at play, this would not be something I would consider.

It certainly sounds like there is more to the story.

DKA sucks. I’ve had it twice.

High blood sugar alone isn’t going to get you to DKA. Ketones have to be high too. Search here for a discussion regarding the ketogenic diet–I ask about DKA and get some great info.

Additionally, while things may have changed since my diagnosis in 1993, I was told back then not to worry about ketones until I hit 240. Thus a 180 while under the weather would not cause me to think DKA absent something else we aren’t thinking of.

The lingering gastro issues could be the celiac. Also I’m unsure where scarring would come from with DKA. Both times I had it, I was around her age, in burnout/denial, got something flu-like and quit taking insulin altogether, due to a combination of burnout and not being able to keep food down. Is it possible there was more going on with her self care than she’s letting on? Not trying to be accusatory, everybody goes through that stage. Just asking because I know where I was when it happened to me.

Celiac is not enough to cause the DKA at 180. In fact, Celiac would tend to be the opposite. Uncontrolled (or poorly managed) Celiac will cause the body to be unable to properly digest food and absorb nutrients. Carbs (in additional to many other aspect of food) will pass through the digestive track.

Well managed Celiac should be a non-issue as relates to this thread.

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Something like 70+ % of all Americans die in hospitals. Moral of the story stay the heck away from hospitals.

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Amen!!! And, for the most part, the older the patient, the less quality care is rendered!:stuck_out_tongue_closed_eyes:

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Amen indeed Joedy, I could not believe my ears when I heard the nurse say this at the same time as bedside sitting with a dying parent and the relative suffering from DKA ICU in same hospital, she said “give me a gun and I’ll put all these old people out of their suffering”. Yeah right no one should see any one suffer but one does not not need to hear such words even if they don’t mean it. But then what do these people actually do and don’t do for old people when they are not being watched.

I agree there are Doctors and nurses and then there are Doctors and nurses and hospitals and hospitals. Best I can see is preventative medicine and stay away from HAI infested hospitals

Agreed Tim, it would not be Celiac. The culprit was the intensity of the infection that triggered the DKAand once Ketones get started, the right treatment is required, IV to detox while feeding Insulin to being sugar down. Insulin on it’s own is useless and meaningless.

I completely disagree with this statement.

However it is clear there is more to the story and critical elements that have been left out are quite likely highly relevant.

thanks auntlisa re- the ketogenic diet. This is good information. Is this recommended for T1s as deterrent on normal practice ? as one never knows when and where the trigger DKA can come, mostly it is an infection or severe illness.

what do you disagree with ? If someone gets DKA, they can self manage with just insulin injections even though they may have fallen unconscious at the point. what else could there be. what triggers DKA ?, Really intrigued. Horrible experience for anyone so if there is something avoidable, really like to know ?

I really don’t know much about the ketogenic diet. I was only suggesting the thread because I brought up my perception of the dangers of ketones and received some good feedback.

While the main issue back then for the grandchild was not celiac, I believe it highly possible that the GI issues that remain today, are celiac rather than the previous DKA.

I also agree with Tim that there is more to the DKA issue that we in this thread, probably you included, don’t realize. Flulike symptoms and a reading of 180 just are not enough to logically predict that the reading will more than triple in 16 hours. When I had DKA they were happy to bring me DOWN to the 220’s. I really don’t think from what you’ve told us that the clinic doc did anything wrong.

I deal with DKA patients in the Emergency Department almost daily and a large percent are DKA because they stop taking there insulin, aren’t controlling their diet and go over the top. These type of patient usually need insulin, as well as an insulin drip for a day or two. We stop insulin drips when they reach 200 and monitor their glucose readings and provider insulin as needed with those readings. Other DKA patients have issues of the flu, vomiting, diarrhea and/or infections that take more intense treatment , antibolotics, insulin drips, ABG monitoring so bicarb can be given to correct acidosis. These patients can remain in ICU for several days. It can be a difficult balance stopping the insulin at 200 then sometimes restarting insulin drip because, IM, or IV insulin corrections are not enough. As other people have states there is more to the story that we didn’t know. And I agree that the clinic doc did anything wrong with the information given. I don’t even check my ketones until 240 per my Endo.

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