Hi - admitted to hospital with DKA

[spoon363]

Hi,

New to to forum so wanted to say hello
I'm 41 and started noticing weight loss from last October, overall lost about three stone without trying Jan this year. Around October I also started getting up regularly during the night to pee. Taste went funny and I was thirsty all the time. 3 weeks ago I went to the GP and he diagnosed me with Diabetic Ketoacidocis and I was admitted to hospital immediately for 7 nights. They were very concerned about me and had me on the emergency ward for 2 nights before being moved to a diabetic ward as I wasn't responding well to treatmemt at first. I'm home now and trying to get used to the new routine of taking insulin injections 4 times a day. Having daily hypos and feel like Ive got no idea of what I'm doing but. Very frustrating that they've not confirmed it as T1 yet, but they think it probably is because of I had DKA. At least I have an appointment with a nurse on Tuesday even if it is just a telephone one.

 

[Tdm]

I'm sorry you had such an introduction to diabetes. It is very stressfull and confusing at first, but it does get better.
And you are in the right place for help!
Are you on set doses of insulin per meal? Are you carb counting? When do you hypo? If you let us know we can give you the best advice of how to avoid your hypos

If you are regularly going low and don't want to adjust your insulin/don't feel confident to do that yet, then eat extra with the meal. So, say you ate 40 carbs at dinner, and took 3 units of insulin, then needed 10 carbs of jellybabys to treat hypos, then next meal eat 50 carbs with the 3 units of insulin and see how that works out.

do you have a libre monitor yet? If not, ask when you will get one or similar like dexcom. A continous glucose monitor will warn you when you start going low and is a game changer, allowing you to outsource some of your diabetes vigilence.

 

[spoon363]

Thanks for the reply. I havent been told to carb count, just to have carbs with each main meal. Im on 15 units of Lispro with meals, and 54 units of Degludec taken at midday. Hypos are usually happening around 11:30am and then sometimes on the afternoon or evening but generally waking up with BS around 4.5-4.8. Dietician on Friday said to reduce the breakfast dose of Lispro to 13 units and the Degludec to 52 although it hasnt made much difference yet. Really annoying and frustrating when I want to drive somewhere. Currently I dont feel confident going back to work with my BS all over the place at the moment. I'm currently testing around 7 or 8 times a day due to hypos/wanting to drive and tbh its a bit overwhelming. Currently all I have is finger prick monitor to test with.

 

[Inka]

I’d be wanting to wake with a slightly higher blood sugar than that @spoon363 It also sounds like your Humalog (?) is too high if you’re hypo’ing so much. We’re not allowed to advise on doses but if it was me, I’d be reducing the doses. Better to be slightly high than risk going too low.

 

[Lily123]

Welcome to the forum

The degludec you are on (Common name Tresiba?) will take a few days for any changes in dose to “bed in” and make a difference

 

[spoon363]

I’d be wanting to wake with a slightly higher blood sugar than that @spoon363 It also sounds like your Humalog (?) is too high if you’re hypo’ing so much. We’re not allowed to advise on doses but if it was me, I’d be reducing the doses. Better to be slightly high than risk going too low.

Yes. Thats my thoughts on it as well not sure how long things take to kick in once theyve been changed.

 

[spoon363]

Welcome to the forum

The degludec you are on (Common name Tresiba?) will take a few days for any changes in dose to “bed in” and make a difference

Thank you. From what I understand Im on quite a high dose.

 

[Lily123]

Everyone needs what they need - it will take a while for you to find the right amount for you

 

[SB2015]

Welcome to the forum @spoon363 but I am sorry that you have needed to join.
you have been with rough the mill with your route here and it is understandably quite overwhelming at this stage. There is so much to learn very quickly At the start but it does get easier.

Your team will work with you to adjust your doses, to work out what you personally need. This will vary depending on what you choose to eat, and there need be no limitations on that. We each have to be able to find out the amount of carbs that we are choosing to eat and then your team will enable you to work out the amount of insulin needed. So a familiarity with carbs will be useful, and it is surprising how quickly you learn The carb values of what you normally eat.

Our insulin needs are dependent not on,y on the food we eat, but also the amount of exercise, so we are taught how to make adjustments for that. Think back to learning to drive. It seemed a lot to take on board at the start then much of it becomes automatic. So it is with managing T1.

There is loads of experience to tap into on here, so just ask any questions that arise. Nothing is considered silly. Just ask.

 

[spoon363]

Thank you all for kind replies.

 

[everydayupsanddowns]

Goodness what a rough ride you’ve had @spoon363

Glad you have found us. It can be so helpful to have a friendly space to ask questions, or simply let off steam with any frustrations that arise.

Sorry to hear about the regular hypos too. Even ‘mild’ ones can be really unpleasant and very disruptive. And if they are happening fairly regularly for you is does sound like your doses may still be too high (or that you aren’t eating quite enough carbohydrate to match them). It’s all about trying to find that elusive balance 🙂

When my doses need tweaking I personally tend to aim for roughly 10% increase or reduction which seems to be enough to make a difference, but not too drastic.

If you’d like an overview of the principles of carb counting, there’s a page here that gives an introduction

The nuts and bolts of carb counting

When you live with type 1 diabetes, carb counting is a great way of managing your blood sugar or glucose levels. It can give you more freedom and flexibility in what you eat when you're preparing meals at home, grabbing food on the go or eating out. Carb counting does take some time and effort...

www.diabetes.org.uk

Good luck! And keep asking questions

 

[Proud to be erratic]

Good Morning @spoon363 and welcome.

About Degludec (=Tresiba):
As @Lily123 has said Degludec insulin is more widely known as Tresiba. Tresiba is a basal (or background) insulin, intended to provide insulin in the background for glucose that your body gets WITHOUT any food being eaten. Your liver acts as the body's reserve store for glucose and can (does) release this stored energy source in response to all sorts of normal metabolic stimulants and at all sorts of different times of the day and night.

Tresiba has a much longer lasting profile than most of the other basal insulins - typically lasting 40 hours. This means that an injection of Tresiba today is topping up yesterday's injection. One immediate consequence of that is that it is considered less flexible than other background insulins and dose changes might typically take up to 3 days to take full effect.

I'm on Tresiba and it suits my lifestyle very well; I don't have routine days. I like having one less insulin to take per day. Because it lasts so long the timing of when I take it is not at all critical and I moved my daily basal to first thing after I get out of bed; my target time is 8am. But it can be at 0630 for a rare but really early start, or midday if I've had a major lie in (equally rare). It took a little while to find my optimum basal dose and I have to adjust that from time to time, since our body's needs change with the seasons (or illness or various other things) but (like the driving analogy) this becomes fairly routine as you learn how to manage your Diabetes.

Our background insulin needs vary across any 24 hour period, so Tresiba can't be optimised to cover day and night. So I steadily optimised to ensure hypo free nights and manage each day as it happens with my bolus, or quick acting, insulin - and of course whatever I eat. Your Tresiba dose does sound quite high, now at 52 units. I take only 9 units daily. BUT (as @Lily123 said) we need what we need and this highlights how different we can each be.

Most other basal insulins have much shorter profiles and some people using those quicker basals often take 2 basal injections daily; also some people even change the basal amount they take each time. This works for them; I just find it easier to have a single daily long lasting basal and thus only need to juggle with the other 3+ times bolus insulin doses. There are numerous permutations of multiple daily insulin regimes! Tresiba as your basal is a little different but will have been chosen, with its longevity, to suit your medical circumstances.

My bolus, or relatively quick acting insulin, is NovoRapid; you have Lispro. Your medical team will guide you through the whole process of doses and dose changes. Currently you are on fixed basal and bolus doses; in time you will find you take full ownership of your insulin treatment regime and be making your own decisions about how much insulin you need. But there's a lot to learn in what feels like a frighteningly short time.

The Hospital will have made their best estimate of what insulins you need before your discharge, knowing about your unique medical circumstances, but without the confirmed T1 diagnosis; they won't necessarily be able to get the doses spot on straightaway and will need your feedback to help them help you to adjust your doses. You can contribute by keeping a diary or log of your finger prick readings, your meals and an estimate of exercise or activity - at whatever time these things occur.

I've tried to spell this out and apologies if it is too basic, or confusing with too much info. Good luck.

 

[spoon363]

Good Morning @spoon363 and welcome.

About Degludec (=Tresiba):
As @Lily123 has said Degludec insulin is more widely known as Tresiba. Tresiba is a basal (or background) insulin, intended to provide insulin in the background for glucose that your body gets WITHOUT any food being eaten. Your liver acts as the body's reserve store for glucose and can (does) release this stored energy source in response to all sorts of normal metabolic stimulants and at all sorts of different times of the day and night.

Tresiba has a much longer lasting profile than most of the other basal insulins - typically lasting 40 hours. This means that an injection of Tresiba today is topping up yesterday's injection. One immediate consequence of that is that it is considered less flexible than other background insulins and dose changes might typically take up to 3 days to take full effect.

I'm on Tresiba and it suits my lifestyle very well; I don't have routine days. I like having one less insulin to take per day. Because it lasts so long the timing of when I take it is not at all critical and I moved my daily basal to first thing after I get out of bed; my target time is 8am. But it can be at 0630 for a rare but really early start, or midday if I've had a major lie in (equally rare). It took a little while to find my optimum basal dose and I have to adjust that from time to time, since our body's needs change with the seasons (or illness or various other things) but (like the driving analogy) this becomes fairly routine as you learn how to manage your Diabetes.

Our background insulin needs vary across any 24 hour period, so Tresiba can't be optimised to cover day and night. So I steadily optimised to ensure hypo free nights and manage each day as it happens with my bolus, or quick acting, insulin - and of course whatever I eat. Your Tresiba dose does sound quite high, now at 52 units. I take only 9 units daily. BUT (as @Lily123 said) we need what we need and this highlights how different we can each be.

Most other basal insulins have much shorter profiles and some people using those quicker basals often take 2 basal injections daily; also some people even change the basal amount they take each time. This works for them; I just find it easier to have a single daily long lasting basal and thus only need to juggle with the other 3+ times bolus insulin doses. There are numerous permutations of multiple daily insulin regimes! Tresiba as your basal is a little different but will have been chosen, with its longevity, to suit your medical circumstances.

My bolus, or relatively quick acting insulin, is NovoRapid; you have Lispro. Your medical team will guide you through the whole process of doses and dose changes. Currently you are on fixed basal and bolus doses; in time you will find you take full ownership of your insulin treatment regime and be making your own decisions about how much insulin you need. But there's a lot to learn in what feels like a frighteningly short time.

The Hospital will have made their best estimate of what insulins you need before your discharge, knowing about your unique medical circumstances, but without the confirmed T1 diagnosis; they won't necessarily be able to get the doses spot on straightaway and will need your feedback to help them help you to adjust your doses. You can contribute by keeping a diary or log of your finger prick readings, your meals and an estimate of exercise or activity - at whatever time these things occur.

I've tried to spell this out and apologies if it is too basic, or confusing with too much info. Good luck.

Thank your detailed reply. Ive just taken the dog for a walk and got in and realised I was having a hypo. Tested and BS 2.6 was and this is only an hour after breakfast. Pre breakfast I was 4.1 when I woke up. Was feeling fine before hand as well

 

[everydayupsanddowns]

Thank your detailed reply. Ive just taken the dog for a walk and got in and realised I was having a hypo. Tested and BS 2.6 was and this is only an hour after breakfast. Pre breakfast I was 4.1 when I woke up. Was feeling fine before hand as well

Sorry to hear about your hypo this morning @spoon363

Guideline waking targets for T1 are 5.0 or higher, because waking in the 4s may mean you’ve had a nocturnal hypo without realising it.

May be worth considering a further reduction to your Tresiba doser and/or discussing it with your DSN?

 

[spoon363]

Sorry to hear about your hypo this morning @spoon363

Guideline waking targets for T1 are 5.0 or higher, because waking in the 4s may mean you’ve had a nocturnal hypo without realising it.

May be worth considering a further reduction to your Tresiba doser and/or discussing it with your DSN?

Just spoke to the dietician and theyve reduced my Tresiba dose to 50 and the Lumjev to 10 for breakfast and lunch. Hopefully the DSN can help tomorrow as well. No way do I feel ready to go back to work next week with my BS all over thr place.

 

[Proud to be erratic]

Thank your detailed reply. Ive just taken the dog for a walk and got in and realised I was having a hypo. Tested and BS 2.6 was and this is only an hour after breakfast. Pre breakfast I was 4.1 when I woke up. Was feeling fine before hand as well

Exercise, like dog walking rather than high activity circuit training(!), does steadily affect (lower) one's BG. I always (ALWAYS) have hypo response treatments with me - every coat pocket and in every room, even the cloakroom!

Until you get provided with a continuous glucose monitor, such as Libre 2, you have only 2 ways of knowing when you might be going hypo: a luckily timed finger prick OR your own internal hypo awareness symptoms; the latter is often too late to pre-empt the hypo, but can let you keep it as a shallow and fleeting hypo.

The normal hypo response treatments are things like Dextrose (which I don't like), jelly babies, fruit pastilles and other high glucose sweets such as Haribos. The recommended response is based on a rule of 15: test, take 15 gm of high glucose, eg 3x JBs, wait 15 minutes, test and repeat if necessary.

Often the hypo makes us panicky and craving food - any food. I only found out late last year that any other food taken within that 15+ minute high glucose moment DILUTES the benefit of that high glucose; so the response is slowed. Then after 15 mins you haven't fully started to recover - but meanwhile you've taken extra carbs, for the craving, which are going to metabolise and eventually need insulin PLUS the next response of 15gms of high glucose. The accumulated consequence can be akin to getting on a roller coaster of low to high (more insulin) then back to low. Getting off the roller coaster is hard.

So, you already know that hypos are unpleasant; but you also know that while they can be dangerous they usually aren't. They are just very unpleasant. Try your utmost to stay calm, take the 1st response, sit and be as inactive as you possibly can, resist the urge to eat more and wait the full 15 mins (a bit more if you can).

I have 15 +/- gm packages of high glucose carbs; little containers of only 3x JBs - to stop me from taking a 4th! During the pre-Halloween period I found the mini packs of Haribos in bulk packages at ridiculously cheap prices, for "trick or treats". JBs we're typically 50p+ per 100gms; 42 bags of mini pack Haribos were c.20p per 100gms in Aldi and the mini packs are between 14-18 gms of carbs. Perfectly packed, easy to have in every pocket and nook or cranny! But need to be out of reach of the dog or small grandchildren!

 

[Proud to be erratic]

Just to add that high glucose treatment is relatively short lived in your digestive system. I have medium carb content options, such as plain(ish) biscuits [oaties, digestives, cheese flavoured, etc] of 6-10 gm carbs in handy places and usually follow up a hypo after recovery is confirmed with a simple biscuit to help consolidate that recovery. I avoid chocolate with this post recovery option; while the carb content may be appropriate the fat content slows down the digestion and defeats the purpose of getting some relatively immediate follo-on to the basic recovery.

There are NO hard rules with diabetes. Time is a great help in learning about how you respond to different circumstances and what does and doesn't work for you. Also, don't assume that because something worked once, it will always work. This is partly because there are so many variables at play in one's daily living and body responses. So repeated successes are better learning opportunities than one-offs. I used to refer to trial and error, but now I like a forum member's more positive suggestion of "trial and learning". That fits with the reality that D is a marathon to be managed steadily.

 

[Inka]

Thank your detailed reply. Ive just taken the dog for a walk and got in and realised I was having a hypo. Tested and BS 2.6 was and this is only an hour after breakfast. Pre breakfast I was 4.1 when I woke up. Was feeling fine before hand as well

I often eat a small carb snack before dog-walking, depending on what my blood sugar is. If you’re able, you could also test your blood sugar mid-walk and see if you need to eat/have glucose.

I’m glad they’ve reduced your insulin. Do be extra-cautious and don’t be afraid to test as often as you need to.

 

[helli]

Exercise, like dog walking rather than high activity circuit training(!), does steadily affect (lower) one's BG.

The affect of exercise on one’s blood sugar is very dependent on the type of exercise and the person doing the exercise.
Walking the dog would only affect mine if I was walking very fast for more than 30 minutes (levels would go down) or walking up a steep hill against the wind on a rainy day (levels would go up). A normal dog walk ambling around a flat playing field for 20 minutes or so would have No effect for me.
I suspect this is because of my fitness level. However, it does highlight that the blood sugar reaction could change if, for example, the person with diabetes did more exercise and became fitter (or was restricted from exercise for some reason and became less fit).

Often the hypo makes us panicky and craving food - any food.

Again, this is dependent on the person having the hypo. One of my symptoms of high blood sugar is that I am incredibly hungry. And one of the challenges I have treating a hypo is that I never want to eat.

I appreciate you mentioned that hypos ”often” make us want to eat but please take care to understand (and express) that we are all different.

If I was newly diagnosed, your comments could be misleading for me: I could take carbs before my dog walk and then think i was having a hypo because I felt hungry.

 

[mark king]

Welcome to the Forum @spoon363.
I'm a long time T1 and I find my Blood Sugars [BS] drop through the night by 4 - 6 units. The simple fix for me is to take a small snack 1 x Digestive before bed trying to wake in the range of 5 -10, the Digestives have a carb value of 10g. Similarly when doing exercise [playing badminton/golf] I sip Lucozade, but I'd be lost without my Libre2 sensor or similar.
A big plus for me is that The L2 has alarms which will warn if I'm going hypo plus directional arrows to show if your BS is going up/dwn or staying level.
Make your DN aware of your fluctuations in BS and ask for a sensor as they are available on the NHS but they were only available for T1's I think.
Certainly I would stress that you have "poor hypo awareness" as that should be a trigger for them to issue one to you.

It is a little overwhelming at the beginning but with the correct guidance and the available medical kit you will become in charge of you Diabetes.

Keep updating back to here and ask any further questions you may have and remember we are all different so what works for one may not work for all i.e. I only need 1 Digestive biscuit pre-sleep but someone else may require 2 or more.

Best