DKA.

[Craig squibb]

Hello, I’ve been a diabetic for nearly 9 years and with my families help coped quite well. Unfortunately for some reason I’m now having to cope with DKA. I was hospitalised just before Christmas which was very scary for me and my parents and I’ve now had an attack this morning. I just don’t know what’s going on??. Any advice would be brilliant please?

 

[Thebearcametoo]

I’m sorry you’re struggling. Are you in hospital? The correct treatment for DKA is IV insulin and they need to keep an eye on potassium levels so it’s not something you can treat at home. Do you mean DKA or do you ‘just’ have ketones? Can you give us more information about what levels your blood glucose are, if you have ketones, what insulins you’re on etc.


If you’re getting ketones then it’s because your body isn’t getting enough insulin. This can be because of illness or other changes which mean your usual levels of insulin aren’t enough. We can give you general information about how to manage glucose levels but if you have high ketones you probably need to talk to a doctor.

 

[Craig squibb]

No I’m not in hospital luckily! This time it was different as I’ve only felt sick but not actually sick. So therefor when I put in my insulin it stayed in my body, at least not coming out through being sick.
I came home from work feeling achy and thought my glands were up. I was also frozen to the bone. Had my tea and injected like normal. Woke up through the night to have a wee but that’s quite normal. When I woke in the morning at 6 felt really weird so I took my blood level which said High. I then took my ketones level, 6.8.. obviously dangerous.
I woke my mum and we new we had to control it with my insulin 30 units of each nova rapid. This seem to work and thankfully my ketones have finally come down. It’s been worrying but my blood levels have been all over the place again. I’m not sure whether I’ve had DKA???. I assume if I was hospitalised then that would mean yes! Whats worrying my mum and me is the difference with the two attacks ?? The obvious being I haven’t been sick.

 

[Craig squibb]

Only that I felt off! I went to sleep and didn’t inject because I was just too tired. Also I didnt feel like eating anything.

 

[Thebearcametoo]

Checking your glucose levels before bed is a good idea even if you don’t eat and if you feel different to normal it’s a good idea to check them too. It may be a combination of being a little ill (your glands being up suggest that) with not correcting glucose levels before bed leading to high ketones first thing.

Do you have good info about how much insulin to give for different ketone levels?

If you’re ill even if not massively symptomatic and it’s pushing your glucose levels up then you may need to increase your boluses by 10% or so for a few days. If levels are generally higher than target over a longer period than a few days then it may be that your basal needs to go up. It can be helpful to take a look at your levels over the last 2 weeks or so to see what the pattern is.

 

[Pumper_Sue]

Only that I felt off! I went to sleep and didn’t inject because I was just too tired. Also I didnt feel like eating anything.

Did you have all of your basal insulin or did you skip just the bolus because you didn't eat?

Basal insulin must be taken even if you are unwell and not eating. If it's set at the right level/amount than you can skip meals all day if you so wish.

 

[Inka]

Only that I felt off! I went to sleep and didn’t inject because I was just too tired. Also I didnt feel like eating anything.

Do you mean you didn’t inject? Because if you didn’t that’s probably why you got ketones. If you meant test, then you should always test before bed for safety.

 

[SB2015]

Only that I felt off! I went to sleep and didn’t inject because I was just too tired. Also I didnt feel like eating anything.

Hi Craig. I am pleased that you have found the forum

i am glad that you had not needed to be in hospital, and that it was high ketones that you were dealing with at home.

As you did not inject before you went to sleep that meant that you had no basal insulin to deal with the glucose that you body is releasing to keep you ticking over. Also these high levels will make you feel awful and worse, including tired, as you develop the ketones. I have been surprised how quickly levels rise even within a short space of time with no basal insulin in us.

You mention about when you are sick your insulin would come out. As your insulin is absorbed through your skin this will not be coming out when you are sick. However the sickness can cause issues if you have already injected insulin for the carbs which then come back up. This would be more likely to cause us to go hypo, but as the glucose levels rise when we are I’ll these may well be balanced out.

Even if you don’t feel like eating it is important to check your glucose at bedtime, do any corrections that you need and make sure that your basal insulin is given.

it sounds like the most recent incident was due to lack of insulin. I hope that things settle down for you now.

 

[Kaylz]

You mention about when you are sick your insulin would come out. As your insulin is absorbed through your skin this will not be coming out when you are sick

you beat me to it! xx

 

[nonethewiser]

No I’m not in hospital luckily! This time it was different as I’ve only felt sick but not actually sick. So therefor when I put in my insulin it stayed in my body, at least not coming out through being sick.
I came home from work feeling achy and thought my glands were up. I was also frozen to the bone. Had my tea and injected like normal. Woke up through the night to have a wee but that’s quite normal. When I woke in the morning at 6 felt really weird so I took my blood level which said High. I then took my ketones level, 6.8.. obviously dangerous.
I woke my mum and we new we had to control it with my insulin 30 units of each nova rapid. This seem to work and thankfully my ketones have finally come down. It’s been worrying but my blood levels have been all over the place again. I’m not sure whether I’ve had DKA???. I assume if I was hospitalised then that would mean yes! Whats worrying my mum and me is the difference with the two attacks ?? The obvious being I haven’t been sick.

See your diabetes team & get libre 2 prescribed, device has alarms that will alert you when bg goes high or low, that way you can take preventive action in future to stop getting anywhere near high reading on bg meter.

 

[Craig squibb]

Hi all. Thanks for advice. I always do my 6 o’clock injection whether I’m feeling good or bad. I did that night with my food at 6 and then went to bed. When I woke at 12:30am my reading said hi so obviously I didnt inject anymore insulin? Should have I done? I was too ill to eat anything.(Friday)

I had a reasonable night but my blood levels are still high 20 to 25. My wee is very dark and smelly! Do you think I’m over the worse! No sickness this time so no hospital! (Saturday)

 

[Craig squibb]

Sorry got that the wrong way round, my blood level was low so I didn’t inject!

 

[Inka]

Hi all. Thanks for advice. I always do my 6 o’clock injection whether I’m feeling good or bad. I did that night with my food at 6 and then went to bed. When I woke at 12:30am my reading said hi so obviously I didnt inject anymore insulin? Should have I done? I was too ill to eat anything.(Friday)

I had a reasonable night but my blood levels are still high 20 to 25. My wee is very dark and smelly! Do you think I’m over the worse! No sickness this time so no hospital! (Saturday)

@Craig squibb It’s easier to understand what you’re describing if you say the insulin type (basal or bolus) or the insulin name (eg Novorapid, Levemir, etc etc) rather than the time you injected it. A 6pm injection could be Humalog or Lantus or anything.

Sorry got that the wrong way round, my blood level was low so I didn’t inject!

If you were low, you shouldn’t inject your bolus/fast insulin but you would still need a basal insulin. Because you said a time rather than your insulin type/name, it’s hard to follow what’s going on, and if there’s an obvious cause eg you missing a basal injection.

However, what I can see is that your blood sugar is still 20-25. That is not good and is potentially dangerous. You should be correcting that with fast-acting insulin whether you’re vomiting or not. Have you done that?

Personally, I think you should seek medical advice from 111 ASAP and explain you’ve had DKA recently.

 

[Inka]

“So therefor when I put in my insulin it stayed in my body, at least not coming out through being sick”

To be clear - this is wrong. Insulin can’t come out of your body through being sick. Insulin is injected into the area under your skin and absorbed there. Whether you vomit or not has no effect on that absorption. If insulin was a tablet you swallowed, yes throwing up would mean you might have lost the insulin, but it’s not, it’s an injection into your body and can’t be removed by vomiting because it’s not in your stomach like tablets are.

Vomiting is a sign of DKA but you do NOT have to wait till you’re vomiting to seek medical help. A person could still be seriously ill with DKA without vomiting. If your blood sugar is in the 20s you need help whether you’re vomiting or not.

“I went to sleep and didn’t inject because I was just too tired”

^^ What did you mean by this? Did you miss a basal insulin injection? Or did you mean “fingerprick blood test” rather than “inject”?

 

[Inka]

How’s your blood sugar this evening @Craig squibb ? Did you get some medical advice?

 

[everydayupsanddowns]

Sorry to hear what a tough time you have been having @Craig squibb

High ketones must have made you feel pretty grim

Do you usually inject twice a day or 4-5 times a day? Do you have just one sort of insulin (eg Novomix or Humulin 70:30) or do you have two different sorts (one slow acting/background, and one fast acting for meals)?

Hope you have managed to get your ketones down today, and have been drinking plenty of fluids.

Chin up chuck. Hopefully with the help, support and encouragement of the forum you will lick up some hints and tips to help prevent this happening again.

Ask away with any questions. We all ‘get it’ here. We know diabetes doesn’t always obey the rules, and sometimes has a mind of its own. No question will be thought ‘silly’ or too obvious. Ask away!

 

[Pumper_Sue]

Have you also changed your insulin to new cartridges just in case there is a problem with the one you are using also have you checked your pens are working correctly?

 

[Inka]

@Craig squibb I see you were online recently but your thread had slipped down the pages - how are you? Is your blood sugar behaving now?

Do let us know how you are.