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I first met Danie on twitter a short while ago and was immediately moved by the story of her experience with diabetic ketoacidosis (DKA) and the effects that it had on her.

 

Here is Danie’s own True Story:

Previous to this diabetic ketoacidosis episode, Danie’s overall control was good, with no high blood glucose readings (previous to that morning) for weeks. Danie never snacked on sweets or sugar based products but it came on due to a bout of viral gastroenteritis, hence it being such a quick process. There were no warning signs and was totally unavoidable.


It was my first experience of DKA; in fact it was my first experience of ketones! Having had viral gastroenteritis presenting in the early hours of Saturday morning, I thought that I was handling things rather well. My BG was stable, between 4-7mmols/L (72- 126 mg/dl) despite no food and only water being taken. Tuesday changed everything.

 

 

 

Waking up at 05:30am I was incredibly ill, head interference and lights swam across my vision as I stood and headed for the bathroom. Sickness consumed me and I felt weak, calling from the bathroom, I asked Mum to bring my BG meter. Taking one look at me she thought that I was having an ‘hypo’ and was looking to treat me with dextrose, due to my appearance.  I was jaundiced, sweaty, exhausted and confused but I refused, I needed to test first just to make sure. I tested at 26.8mmols/L (482.4 mg/dl). Bring me water! Bolus insulin! Don’t panic! I did all of these and took to my bed to play the waiting game.


That game didn’t last long, up came the water and back came the interference (something I cannot explain) a headache started and I tested, again. I tested at 28.2mmols/L (507.6 mg/dl). I felt shocking and found my way downstairs as Mum went to leave for work, she took a look at me and stopped, guided me to the table and brought my blood ketones tester  and it was 5.5mmols/L that’s 4mmols/L ABOVE severe. I was in trouble and I knew it.

 

Three steps needed to be taken and quick:


1. Humalog emergency pen injection – 6u.
2. TBR (Temporary Basal Rate) of 130% for four hours.
3. Attend ER/A&E – contact DSN team to let them know what’s happening.

As well as this, I needed to drink, drink and drink water, keep awake and try not to start vomiting, again. Avoiding sleep whilst in DKA is vital even if you feel overwhelmingly tired. It was an incredibly quick process – developing ketones – and a very dangerous line to walk as a person with Diabetes

 

A&E was an hour away and with a lift from a family friend, Mum and I made it quickly and smoothly. Triage was a blur and within 10 minutes I was being cannulised, having bloods drawn and blood gases taken, each hand and arm aching with pain after several attempts had been made. My DSN arrived in double quick time bringing along one of my Consultants with her. Blood results were checked and rechecked, arrangements were made and kind words said. I knew that I was in good hands and with the promise of an early morning check, I didn’t feel so bad, soon this would be all over, 24 hours and I could go home and be the picture of health!


IV lines quickly came along with my Consultants orders and fluids pushed through my cannula at an alarming rate. ECG’s were printed neatly, blood pressure, Sp02 and heart rate recorded (all high and rapid) and soon I was on my way to the ward. A&E was fantastic, calm, quick and regulated... a smooth journey.  I wish that I could say that for the rest of my stay…

 

Initially the ward was good, water brought, baselines asked, BG taken and a once over by the Doctor and Student on shift. Abdominal examinations and chest sounds were done twice and X-Ray’s organised for later. A sliding scale was set up and my pump removed, relinquishing my control was a scary moment but it had to be done and I knew it. More fluids were pushed through and then a slower bag put up over 4 hours. My BG was to be taken hourly, Ketones in urine to be tested (they don’t work with blood ketones) regularly and pain to be monitored and this did happen for most of the morning & afternoon. However as the day wore on, I gradually had less and less visits and at one point I had four hours of no BG testing and no Ketone testing! I did them myself; I needed know how things were going! Considering I was in with Viral Gastroenteritis and DKA.  Not having these basic needs fulfilled and recorded was shocking and I told them so – much to their horror! All of the staff were nice, smiley and showed false concern but lacked common sense at times, a most favourable and valuable characteristic required in nursing.

 

 

After four X-Rays on my chest and abdomen, food was served – a tuna sandwich and cheese with crackers. Fair enough, nothing wrong with trying food after having none for a very long time, I sat up and opened the sandwich. My mouth was dreadful, on the first bite pain seared through my gums and over the roof of my mouth, trailing down the throat. I quickly tried to swallow it away, downing a glass of water to gain relief but it took more glasses than just that. To describe it I can only suggest that it was like having knives jutting into every surface of my mouth and throat, scraping tender skin away and drying all in its path. This pain was in a league of its own and halted me from trying food again until hours later.
Fluids and glucose IV’s started to be alternated come 11pm and my hands became sore, irritated by the glucose passing through them in such purity. I was not to get any relief through the night nor sleep and at 11:30, when my Mum was asked to leave until the morning I cried, who wants to be alone in such discomfort and no trust in the staff looking after them? Roll on Wednesday, only a few hours away…


“There is a place. Like no place on Earth. A land full of wonder, mystery, and danger! Some say to survive it: You need to be as mad as a hatter.” – The Mad Hatter

 

After a long night on a hot ward with no sleep, 06:30am came around and another BG test. 2.7mmols/L (48.6 mg/dl) this time, how did I not feel that?  I instinctively reacted and treated myself with a pineapple juice box recovering with a nice and stable 7.7mmols/L (138.6 mg/dl) only for the Nurse to arrive again and put another glucose IV up despite being in safe limits again. Not their best decision! An hour later arrived all too soon and as I had expected, a raised BG came along with it. Here my angel arrives in the form of my DSN, she suggested all IV lines could be taken down and reattachment to the pump be made – Hurrah! Control would soon be mine again, or so I thought! She was to consult my Doctor and ask for discharge, the ward nurse however suggested the Consultant (a diabetes specialist himself) doing the ward round would see me and handle it from there. OK so I didn’t mind who discharged me so long as it was done. At this point the healthcare assistant came through declaring an input/output chart needed to be filled in hourly – shouldn’t this have been in place since my admission? Yes, she herself was disgusted and I suggested that they wouldn’t gain much from it now considering I had spent most of the night up and down to the bathroom, tripping over my fluid lines as I went. There was no doubt about it, I was definitely hydrated now.


Three hours later and no sign of being seen or hint of a discharge letter and I rang my buzzer to request all lines taking down and to be seen. The staff nurse came and unbelievably she told me she would have to get in touch with MY consultant as he had to see me. This all could have been done 3 hours ago! Whilst they waited they put up another glucose IV, ignoring my requests to hold off, having a headache and tiredness from being kept hyperglycaemic over the last three hours. It was incredulous to say the least. My Consultant came quickly along with my DSN again, who was infuriated at the lack of care I had received; they discharged me immediately requesting all lines down ASAP and pump therapy to be recommenced. Finally!

 

 

My time in hospital was a little short of 36 hours but it seemed a lifetime, I came home and had no sense of time or day. Surely it wasn’t only yesterday that this nightmare started?  I realise my experience was mild in comparison to some others and I am very lucky to have recognised the signs and symptoms myself whilst still able to function and react. All in all I had 100mls of insulin through a sliding scale, 5000-6000mls of fluids and 1500mls of glucose in just 24 hours.


I have found a new respect for my Diabetes since this experience, I haven’t always given it credit for severity and that has, as I found out last week, been a very dangerous path to take. After never having complications, ketones or a hospital admission since diagnosis, I had become somewhat complacent and this was a timely reminder that sometimes as a person with Diabetes I can be more vulnerable in times of illness and that is not something to be ashamed of!”

 

DKA is a serious complication of Type 1 (primarily, HONK for Type 2) and action should be taken swiftly. Know the signs and be DKA aware, you may just save a life!


Danie can be found at:

http://www.thedaniediaries.com/ 

http://sugarcoateddanie.com/

twitter:  @DanieLouize

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