Hi. This is my first post. Sorry it runs a bit long.
T1 for 25yrs. Diagnosed at 8. NPH + R MDI for 1st 15yrs. Things got much better after I swithced from NPH to Lente. Since then, I've been prescribed and injected almost every kind of synthetic insulin, until I started pumping with a Medtronic Paradigm about 3yrs ago. Also prescribed ACE inhibitors, glucophage and amaryl in conjunction with insulin.
A1Cs 6-7 as a kid. 7-9 since adolescence. No complications to this day, and I have remained generally athletic and healthy.
I have had many severe lows, but never experienced DKA until the events described here. I have had severe highs at various points from sickness, bent cannulas, bad batch of insulin, etc. Over the years, I have been 500 - 600 on a few occasions, but just took more insulin and was okay.
I lost my insurance and have been pretty broke, recently. I was in Mexico (best man at my friend's wedding). I bought a bottle of Humulin R at a pharmacy. It seemed legit. Not expired and the seal was intact. I pumped it for a couple weeks, and it worked fine. I just waited a little longer between bolus and eating.
When I got home, I still had some Apidra left over, but wanted to finish the bottle of R. One night after dinner I was up to 500. I took a corrective bolus. Then I threw up. I went to sleep. In the morning, my BS was down to about 170, but I threw up again. Then I was perfectly fine. I figured it must've been something I ate.
About a week later, I woke up feeling bad. My BS was 377. I threw up. bolused, drank water, threw up again. Back down to 300, threw up, bolused, threw up, back to 370. Sometimes, I slept between cycles.
I began to suspect DKA and looked on the internet. I have no insurance and no $. Also, the emergency room situation here is not good. My wife asked if I wanted an ambulance. Instead, I asked her to go to the drug store for urine test strips, potassium pills and gatorade. The urine test confirmed High Ketones. I kept trowing up every couple of hours, bolusing R, and started injecting 5 units at a time of Apidra. I had saved an old box of syriges.
In a few hours, my ketones were negative, and BS returned to normal. The ordeal had lasted the entire day. I threw out the rest of the R, and am back to pumping my Apidra reserves. I am left with some questions: My BS was high, but not that high. The R seemed to work fine, stop working, and then start working again. Have I developed an allergy or resistence to Humulin R, while on Apidra? Anyone had similar experiences?
These were the first shot I'd taken in 3 years (since pumping). I took it in the shoulder, and it seemed to help a lot. I see why he no longer mentions IV. Great piece of diabetic trivia.
Since I've been pumping, I try to rotate as much as possible. The stomach is the only site that works well for me, though. I used Medtronic CGM for a while. It was pretty bad. I noticed other people here post similar complaints. Also, doesn't leave much real estate for pumping. I still disagree with Bernstein about MDI vs. pump, though. I remember some other strange practices, too, like testing the backs of your fingers, and taking the temperature of your bath water.
The problem with DKA is that it makes you resistant to insulin. It also takes a long time to get rid of the ketones that build up in your blood. If you are chronically in ketosis a little, then it does not take much to push you over the edge,
It is impossible to manage your sugars properly while in DKA. I'm only glad you got it together rather quickly. This has happened to me only when I have had my cannula come out without me knowing it,
There is a failsafe way to prevent it. If you take small doses of Lantus even while on a pump, you will not enter into DKA. Even if your cannula comes out etc,
You just need to deduct it from your basal insulin on your pump.
( my total basal insulin is about 22 units per day) I will inject 10 Lantus and use my basal on my pump to deliver the rest. I just reduce by 50%.
I did this the times I had DKA because it was too difficult to recover without it.
I've been monitoring Ketones every day, since. All negative. My BS did spike very high the first times I was able to hold down food, though.
Interesting Lantus technique. I'm kind of surprised someone will give you a Lantus prescription, while on the pump. I took Lantus 2x/day for a while. Sounds like a pain, but I can understand why. I haven't been trusting my pump as much since the incident.
I was having problems at infusion sites, about a year earlier. It turned out that I'd mistakenly gotten a box with 9mm cannulas, instead of the 6's that I normally get. I called Medtronic, and was able to exchange them.
I checked now, and realized that they sent me a few boxes of 9's again! This likely explains why I went into DKA. I called and explained the situation to Medtronic. I had a full order of 9's + another box that had been mixed in with a previous order of 6's. They insisted that I was supposed to be getting 9's. They also insisted that I couldn't return the box from the older order. Eventually, they gave in, but it was unpleasant.
I keep lantus on hand in case i have pump troubles.Some times I just switch off if I need a pump break for a few days. My doctor was the one who suggested using it along side my pump for DKA. As long as you account for it, It should be ok.
I don't understand why the different cannula sizes matter that much.
There is not much insulin in 3 mm of tube.
Although you should have the right ones, they should send you free ones.
Also little known factoid. If you go to a pharmacy in California and you tell them you are insulin dependent, they will sell you insulin with no prescription. I did this while I was without insurance for 3 months.
The cannula size makes a lot of difference, because I do not have much fat on my body. The first time they sent 9's, I was getting highs. I pulled out the cannula, and it had bent in half under my skin. Same thing the next time. Sometimes I get No Delivery errors, sometimes not. I think that even if the cannula doesn't bend, it may get clogged if it's stuck in muscle tissue. Haven't had this problem with 6's. I've been cutting 3mm off of the tips of the ones that they won't replace.
Maybe consider the sillouette they are 8 mm and they go in on an angle almost parallel to your skin. I have not had one clog or bend with humalog or novolog. The only trouble is when they come out without me knowing, That happens with all of them though.
I think Animas calls them Comfort.
Thanks. I just got samples of 6mm Sure - T's. I'll give the Sillouettes a shot if they're no good. I hate the feeling of not trusting your pump.
All good ideas. You do not mention looking at your resevoir. Could you have potentially had a large air bubble/s? Depending on how much insulin you take it may not have to even be that large of a bubble to develop ketones. Having multiple bubbles you worked through by continually bolusing it could possibly explain why the R worked, stopped, and then worked again??
Good point, but not in my case. My pump trainer said that I didn't have to worry about bubbles on the top, because they'd come out while filling my tubing. I think that's potentially dangerous advice.
I mixed N+R in a syringe for 15 years, careful to remove bubbles. I do the same when filling my resevoirs.
Just tried the Sure-T cannulas for the first time. I am much more confident with them compared to the Quick-sets. Better adhesion, and you can really see the needle going in and check that they are still in, withoup pulling the whole thing out. I should have been informed that there were other infusion sets, when I started pumping. I also should have been allowed to try other pumps and CGMs. I do not think I will be going back to that endo.
Thanks to everyone who posted here. I learned a lot of valuable information.