About a year ago I "forgot" to reconnect my pump after changing clothes. I happened to test just before changing and had been at 5.1 (92 mg/dl). Five hours later when I began to feel sick I realized something was "missing." I hadn't had anything to eat, but in that time my blood sugar had gone up to 21.5 (387 mg/dl) and when I tested ketones it went to the darkest colour on the strip.
This was when I was taking Humalog and it kind of scares me that things might happen even faster now that I'm using Apidra.
I definitely wouldn't last three months. I'm not even sure I would last a week. I think two or three days is more like it. I am pretty sure that if I went to bed without my pump and slept for 8-9 hours I would be in DKA when I woke up.
I've done that too, Jen. I don't disconnect my pump to get dressed because I use the 43 inch tubing so I can get dressed with the pump on the bed (which is why I like the longer tubing), but I do disconnect to take baths and once I disconnected, took my bath and then went to bolus for my meal. Luckily I got the "what's wrong with this picture?" and went and got it. But then I haven't been on insulin for nearly long as you, and since I will be decidedly ancient if I live long enough to "catch up" I'm sure my incidents of forgetting will grow exponentially! A sense of humor is definitely a good thing with D ...as with life!
I'd side up with Zoe on the 3days time span being the average.
But I also believe that the tighter your control is,the faster DKA's onset is.When I was on lantus and my A1C is 8.9 at best I forget my lantus and feeling tired and dizzy only after a day or so.Now pumping,when I go past 200 I'm so tired and spent and I feel worse by the minute.
I'm just curious,how do you DEFINE ketoacidosis?Is it when the ketones are past a certain number?,or when you throw up?Or when you pass out?,I'm really interested in knowing the answer since it's been on my mind for as long as I can remember.
DKA is when there are so many ketones in your bloodstream that it starts to affect the pH level of your blood.
Ketones doesn't automatically mean DKA, but it does mean you're headed for it if you don't intervene.
True DKA you can't treat at home because your electrolytes and such are all out of balance. But lots of us have headed off near-DKA at home, which is why things like sick day guidelines exist.
Also, I would think the opposite of what you say would be true: the worse your control, the easier it is to go into DKA. If you have an average blood sugar of 300 and are spilling small amounts of ketones regularly and something goes wrong, you'd already be in the beginning stages so it wouldn't be hard to go the rest of the way to full-blown DKA. If you have an average blood sugar of 150 and aren't spilling ketones, it would take something much bigger (or a bunch of small things) going wrong to get to DKA—plus, you'd probably notice how crappy you felt before being there and do something about it.
Those of us on the pump are at higher risk of DKA (and will get there much faster) compared to those on Lantus or Levemir because there is no long-acting insulin in our system. If you forget a Lantus shot you've still got residual Lantus from the previous day floating around in your system, which will slow down DKA. If you get disconnected from your pump, you don't have any long-acting insulin for a backup. DKA only develops when there is literally almost zero insulin in your bloodstream. You won't get DKA if you eat candy and don't bolus for it (although you'll have super high blood sugars), but you will get DKA if you disconnect your pump and forget about it.
Thanks for this explanation of what exactly DKA is. I thought it was anytime you spilled the highest number of ketones shown in your urine ( say the darkest color) for over two times.. spread hours apart on more than one day. I thought that was DKA . Since the times I had that situation and was able to treat it at home successfully, I guess I averted the DKA ( And this was all pre-pump).
According to your definitionJen,, I guess I have only had DKA twice in 43 years: Once because I had pnuemonia, and another time because of a raging urinary tract infection. I was hospitalized for the DKA and pnuemonia back in the 80"s. I was Treated in the ER with a slow insulin drip, electrolyte replacement and antibiotics... and then sent home the later in the same day when I had DKA from the urinary tract infection. I think that was mid-90's or so . I was on MDI with NPH and regular insulin.
Never had DKA while on the pump. High blood sugars of 350+ due to pump / infusion set malfunctions can be expected, but I always carry a syringe and another infusion set with me at all times..... and I can bolus my way back to normalcy in 3-5 hours. I also have a CGMS and a 'sick day" basal as well as a plan of action now, which I did Not have in earlier years.. I guess that is how I have avoided DKA
Since I use Apidra in my pump and it leaves your system quickly, I ASSUME I WOULD BE ABLE TO SURVIVE ABOUT A WEEKOR SO?maybe longer, maybe if I ate nothing but nuts and lettuce , cheese, lean meats, drank a lot of water? I am not sure..
Will not even attempt to surmise a definite how long?.. Not exactly for ME to say how long I could survive; God is able.
Thanks for the detailed reply Jen,some I already knew but I wasn't sure about the exact outline of DKA.
What I meant about tighter-control patients is that their body isn't used to highs,and pretty much collapses quickly,whilst those with high blood glucose most of the time,their bodies are used to highs therefore can stand ketones for a longer while.But you said makes sense,I don't which makes more sense though.
And your comment about DKA being the point when you no longer can treat yourself,very true I think,I've seen the ICU guidelines for treating DKA patients,definitely a do NOT try at home.
Thanks again,appreciate your feedback.
Thanks for the informative discussion! My "plan" for when my pump breaks, which it did last summer, is to go to the drugstore and buy some insulin until they send another one. I think I hit 280 in there while I was pumpless (as I was 20 minutes away running, like 10 miles to "kick off" marathon training and probably blew 10 minutes running by Walgreens for some NPH) but I immediately pounded a bunch of insulin with the syringes from the garage and, when it didn't work, hit a vein, which worked. And then I ate for a while as shot #1 started working too. I drank a lot of water, which I usually do when I drift > 150 but I didn't bother checking for ketones and just figured when my BG was normalized, I'd get cleaned out.
Or give fast acting insulin ( same as in your pump ) every 3 hours ...and finger poke , finger poke ..acidrock, I have good news ...we now have a printer with scanner, so I don't have to type( 2 fingers ) that page ever again ...just scan and voila:) !!
Modern technology is a blessing ...and NO I don't want to reach DKA ...I plan not to try
I had about 10 years of diabetic symptoms - worsening eyesight, dramatic weightloss (I looked like an anorexic), thirst, frequent urination etc etc - before diagnosis. I am not sure if I was producing some insulin while I was so ill, but I really was extremely ill and had now, what I know was DKA several times - heavy legs, heavy breathing, frequent vomiting (even when I had not eaten) the "smell" which people took to be alcohol, though when I did drink my poison was vodka which does not smell! But the doctors missed it. They never tested as I had had very low glucose levels while I was growing up.
I was only accidentally diagnosed after being in hospital for 6 weeks for acute stomach pains which turned out to be a cyst on my spleen, and while they were scanning for that they discovered one on my pancreas. STILL they did not get it but when I was restless during the early hours of the morning I would walk the corridors and on several occassions I was asked where I had got the alcohol? At 3 am, just having had stomach surgery, nearest shop 2 miles away, pulling a drip stand .... alcohol was the last thing on my mind!!! They had smelled ketones, but I did not know about it then.
Only when they were about to discharge me they did the test for diabetes and then came and told me I was Type 2 (based on age) and it was another two years before I was diagnosed as Type 1 after a couple of really bad DKAs (that is how I now know I was like that before!) I am sure it is only by the Grace of God that I got that far!
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