Dka

[pookey]

Hi I hope you can help me. My 20 year old daughter is type 1 and has been for 10 years - recently her alcohol consumption has got out of control and she has had very severe 'hangovers' for the past 5 weekends. anyway,this weekend she was violently sick for a good few hours before i clicked that it was dka - her bloods hovered on 12 all day - but she was sipping lucozade. got her to a n e she did not lose consciousness but was in a bad way. due to poor management in hospital - they kept disconnecting her from insulin when she had a hypo and forgetting to plug her back in - she went into dka 2 more times. she started on the pump 8 months ago and up to this always had good control. she was in hospital for 4 days and returned home on wednesday. i am still worried about her as, although she appears to be recovering, (she is eating now) - she is still really exhausted and needs to have regular naps - she also gets dizzy spells and needs to stop what she is doing. she has never had a crisis like this, not even at diagnosis so it has knocked both of us for 6. please can anyone advise on recovery periods after dka...im really worried that some permanent danage has been done.
Thank you

PS alcohol issues have been addressed...!!

 

[Robster65]

Hi pookey. I've never suffered dka but with BGs at 12, I wouldn't have thought the effects would be down to that.

Is her drinking a very recent thing or is she just more open about it now ?

For anyone, excessive consumption is damaging, but if she's not taking care of her diabetes also, it can be fatal.

Rob

 

[Northerner]

Very sorry to hear about your daughter's DKA and it's particularly bad that she got such poor treatment in hospital - I hope she/you are taking things further so that they 'review their procedures' or whatever words they use these days

I was in DKA when diagnosed and it was horrible, so I can't imagine how it must have been to just be recovering then back into it through negligence. I was in hospital for 8 days recovering and was under the weather for several weeks afterwards, but I did fully recover and apart from the fact I now have diabetes I am as fit as a fiddle. I hope that your daughter feel much better soon and gets back her previous good control - she certainly has a huge incentive, staying out of that hospital! 😱 Good luck to you all.

 

[pookey]

Hi pookey. I've never suffered dka but with BGs at 12, I wouldn't have thought the effects would be down to that.

Is her drinking a very recent thing or is she just more open about it now ?

For anyone, excessive consumption is damaging, but if she's not taking care of her diabetes also, it can be fatal.

Rob

Thanks Rob - no she has only recently started on spirits - she mainly stuck to lager. only very recently has she felt it was ok to get bladdered at the weekend by binge drinking and then vomitting the next day. she has learned her lesson, i think.
My biggest worry is that i suppose i expected her to be back to normal...just concerned that she is still unwell - bloods and keytones all back to normal -
we do have appt with specialist diavetic consultant on tuesday thou....

 

[Robster65]

The hormone that signals the liver to push out glucose is called glucagon. If it's produced in excess (such as in a severe hypo) it can make you feel nauseous and dizzy.

I wonder if she's swinging high to low while her body tries to balance and making her feel queezy. She could do with testing at least half a dozen times a day before and 2 hours after meals to make sure she's not going too high or low.

Rob

 

[Ellie Jones]

At first I thought perhaps she's didn't inject her insulin while out drinking but she's on the pump..

Has she's gone into DKA and her current levels are around 12mmol/l it would be wise to still be checking for ketones in her urine as her body could still be creating them if she's spiking after meals, and this will make her feel yulk, and should be practising sick day rules and drinking plenty of fluid..

As her dizzy spells might be an effect from dehydration and she's lost some of her balancing fluid from her ear canals, or their again it might be that she's got an ear infection which would could explain why her BG remains higher than normal.. So I think a visit to her GP to have the dizzy spells checked out is called for..

Has she checked her pump to ensure that it's delivering correct dosages etc? It may be with her little adventure with the wrong side of drinking she may had banged the pump!

Once you've ruled out any dka lag, underlying infections having an effect then it maybe she has to go through a process of redoing her pump management as the DKA might have knocked it all out..

My friend son did similar to your daughter, learnt the hard way that drinking and diabetes doesn't mix well, 3 days in hospital DKA after a weekend of drinking with his mate and not taking his insulin.. So don't be to harsh..

P.S

From a diabetic who used to like a tipple or more and doesn't drink anymore.. One a night out you can join in the drunken frolicks of your mates even being stoned cooled sober, good thing is you still enjoy yourself you re-frame from making some of the stupid decisions one often makes while under the influence and you wake up in the morning after a brilliant night out without the hangover... Oh and yes your mates do get used to the idea you don't drink when they realise that you'll still enjoying yourself etc.

 

[Pumper_Sue]

Thanks Rob - no she has only recently started on spirits - she mainly stuck to lager. only very recently has she felt it was ok to get bladdered at the weekend by binge drinking and then vomitting the next day. she has learned her lesson, i think.
My biggest worry is that i suppose i expected her to be back to normal...just concerned that she is still unwell - bloods and keytones all back to normal -
we do have appt with specialist diavetic consultant on tuesday thou....

I was going to suggest perhaps a few blood tests wouldn't come amiss. Did they check her liver function by any chance?
It could be just a bug she has picked up that's making her feel so unwell now.
Is your daughter actually using her pump correctly? If not after this her consultant might pull the plug on it so be warned.

 

[trophywench]

Well Pookey - I guess the evil alcohol monster is always there trying to tempt us when we are that age - or younger! - and you just have to try these things for yourself, don't you, no matter what the voice of mother or dad is saying in the back of your head !

Could it be - and I dunno cos I've never had it (must be luck cos I certainly got paralytic a few times years ago) - alcohol poisoning? I mean how long does that take to get over? Bearing in mind the after effects of either a hypo or DKA feel very much like a hangover, it may be difficult to tell what is causing what.

Finally, one of the difficulties where DKA plus alcohol are concerned when your BG then goes low is that alcohol reduces your BG too so it must be quite difficult to treat when it's together. Is it the insulin, or the alcohol?

 

[pookey]

Thank you all so much.

Daugbter had all tests in hospital and they came back normal. she has very good averages 7 and below - the 12 was on the day she was sick and in fact only rose to 14 just before hospital - when we arrived she was 19!!!

I think the pump stopped working when she was out drinking and only when it was disconnected in resus did it appear to have stopped working (no beeps etc...)??? we have been to clinic yesterday for the pump to be over-hauled and quite right the consultant will consider removing it from her.

Also - she has had a few spikes in the past 24 hours last night she went from 8 to 18 in a short space of time then down to 8 again after 3 hours. she is a very good tester but the spikes may be the reason for the tired/dizzy spells.

thank you all for the advice

 

[Robster65]

Wild swings will knock you flat every time.

Assuming the pump is operatign fine now, she could do with trying to stabilise at a slightly higher level to avoid risk of hypos and replenish the liver glycogen for at least 24 hours.

Also important of course to avoid the highs but not to panic about getting BGs down to 4s or even 5s. When she feels better, she can then readjust to normal range. Unless she's been given advice by a doctor/nurse to do otherwise.

I did also winder about alcohol poisoning. My brother had it when he was in his late teens. Just the once. I learned from his mistake. 🙄

Rob