Husband had a DKA episode.

[aurorae0222]

Over the weekend, I learned what diabetic ketoacidosis (DKA) is for the first time in my and it was scary.

My husband is Type 1 diabetic and on Saturday, we were at our friends home for and all the sudden he started to feel ill. Said he wasn’t feeling well and so we went home.

I asked him to test his BS which was a bit high. He vomited a few times and then napped on and off; something want quite right. He missed breakfast and couldn’t stomach lunch.

I went out to run errands and when I got back it started to get worse. We both chalked it up as a stomach bug.

I made some soup for dinner and he couldn’t take much. He seemed confused. We checked his BS again, this time it was 29 mmol! I got so scared I insisted on taking to him then local A&E. he was like it’s okay but I insisted. Thank god I did.

The nurse did a preliminary assessment all the sudden yelled “we have a DKA”. I didn’t know what it was but I knew it was serious based on how they rushed him into a room. The rest was a blur. I could see them working on him, which is really terrifying as I didn’t know what was going. I could see a nurse squeezing the last bits of fluid from the IV bag. After a while a doctor told me what happened and said that my husband was “extremely” ill as that they needed to take him to intensive care.

He is stable now but I feel really guilty. I should have taken it more seriously instead of thing it’s just a stomach bug. I didn’t know even what it was. I asked the doctor and she said one of the telltale signs was a fruity, sweet door on a persons breath. She said that, confusion and nausea/vomiting are all things to look for. It was right there in front of me.

I have been doing a lot of reading on the internet and this thing is really scary.

Would love to hear about your experience with it.

That sounds so scary. My husband is also type 1 diabetic. The strange thing is, this weekend he has also had extremely high BS. Measuring in the 20s. He is always so careful that this is extremely unusual. He is wondering if there is a problem with the batch of insulin he is using at the moment and has switched to a new batch. Could it be something similar that caused your husband’s issues. I’m just crossing my fingers that tomorrow with the new batch my husband will be back to normal.

Did the hospital tell you what could cause this to happen? I hope your husband recovers quickly.

Your husband should attend an education course for Type 1 diabetics such as DAFNE. (Dose Adjustment for Normal Eating.) In it they will educate him about DKA. There is a session that the spouse can attend which teaches about how to prevent or minimise DKA.

Sending some I had a pretty horrible DKA 2 years ago and ended up in intensive care! Was pretty horrible! I had the flu and an infection that had caused it. Also didn’t help that I had been misdiagnosed as type 2 at the time.
Has he got a ketone monitor for later when you get home and if he gets poorly again? Now that you are both aware you will both know what to look out for x

@ChessIsASport supposedly it was caused by a bladder infection of all things. My husband takes basal insulin called Lantus but I know he was having trouble stabilizing on a bio-similar called Basaglar; had to almost double the dose to get the same effect.

@Goldensunnydays81 doctor said that he has to get a ketone kit/strips; I am going to pick one up today.

@TenLittleToes thanks for the info. I will make it a priority to learn more. I am still kicking myself for it happening. Although it was a bladder infection I keep on thinking I am somewhat responsible-not monitoring his diet, baking sweets, allowing him to eat greasy burgers and munching on bad snacks thanks in a large part to my sweet tooth.

Op, it is not your fault. You don’t plan ahead for infections. You handled it well and took him to a & e, when he needed it. Well done for not backing down and insisting on him getting medical help. DKA is scary but an infection caused it, not his diet. Don’t blame yourself, but arm yourself with information just in case you need it. If your dh hasn’t done a dafne course or equivalent, then I would recommend it highly to.

If you getting ketones tests, ask for blood test one. They cost considerably more but he can get it on prescription. You test for it same way you test glucose level. I’m a type 1 diabetic

Sounds scary! I was only diagnosed just under 2 years ago and was in DKA. I felt like I was going to die even before I knew what it was.
Don't beat yourself up- sounds like you did the right thing.

Has your husband got a libre?

Please don't beat yourself up. My oldest son (20) is type 1 diagnosed aged 8. Sometimes this can happen and you have no control. My son has been doing the Dafne clinic and found it really helpful. He also recently started using the Libre Sensor, which is is much better at picking up going high or low than the finger pricking method. My son was going too low and unfortunately it resulted in him having 2 hypo seizures last year. Thankfully since he started with the new Libre sensor, there have been none. Anyways I hope your husband makes a speedy recovery and can come home soon 🤗

What did your Dh do when he tested and it was 29? How much extra insulin did he give?

I am on a pump and occasionally have very high blood sugars that make me vomit.

I can be 8-11 one minute, and think not only is that a bit higher then I'd like, but I can also feel/bet that I will continue to go high so give a tiny bit extra, but then within minutes it can rapidly increase to the high 20's. But I change the pump, Aldo inject with an old fashioned syringe and then crawl into bed and test every 1/2 hour or hour until it comes back down.

Was your Dh monitoring the blood sugars whilst you were away doing tasks? You can't just leave it. It's never going to come back down if it's own accord. You have to make it. Monitor it.

Unfortunately coming down takes an age, which is very frustrating. You can fly up quickly, but coming back down takes forever.

I always try and deal with my diabetes as a first point of call, ie getting my blood sugar down as the first priority, before worrying if it's an infection or virus or something else that's causing it.

Does that all help? Make sense.

Does he have a diabetic team/ nurse to talk this through with?

We had a consult at his bedside. They are suggesting an insulin pump and continuous monitoring device Libre Freestyle. He is hesitant and I can see why - right now they are suggesting it and not saying it’s a requirement.

He didn’t have an insulin device in the past; it was mealtime insulin Huma (?) and Lantus. They are recommending we go to the class that everyone mentioned and at the very least to carry a keystone kit.

Its a lot to learn but I am in; its a scary thing and I want to be prepare if it happens again. In intensive care for at least another two days. Going to speak to a endocrinologist tomorrow. Glad my baby is not nursing anymore it would be even tougher to manage but she is on solids so makes it a bit easier.

Thanks for the support and encouragement. Appreciate it.

Definitely not your fault. It can happen to T1 diabetics no matter how good your control is, especially if you have an infection.

I’d definitely learn more about libre and pump. They can really revolutionise diabetes management. The Libre means less finger pricks.

I’ve always been told to test for Ketones if my blood sugar is above 13 and won’t come down and when I’m sick.

fruity, sweet door on a persons breath

Smells like pear drops! Good instincts on insisting going to hospital. Hope hubby is home soon

I'm type 1 and was in DKA when diagnosed. Honestly felt like I was going to die and was admitted to intensive care. My DSN put me on the local DAFNE course within the month, very informative, push for you and dh to go on one. Download sick day rules from Diabetes UK website. It's not your fault, DKA can come on very suddenly when ill. Great you've now got a ketone meter, if in doubt always check for ketones.
I hope your dh is recovering well, all the best.

Hopefully you’ve been given something similar but here’s a link to sick day rules published by TREND which is a diabetes specialist nurse professional group trend-uk.org/wp-content/uploads/2018/03/A5_T1Illness_TREND_FINAL.pdf

If he hasn't already, ask to go onto a Freestyle Libre, it's a small sensor Stuka on one arm, then you can scan it for BM using the suppled sensor or mobile phone. You can also see daily/weekly/month data so can deal accurately with Hyperglycaemia and Hypoglycaemia.

I had DKA that landed me in intensive care and, like you, my husband felt terrible for not spotting it and getting me help sooner. But I don't blame him at all, and I'm sure your husband doesn't either. It is not your fault!!

He will likely be fine soon, although it took me a while to feel properly OK. I felt very tired and went off lots of food. He might feel a bit mentally shaky too as it's a bit of a shock to think you've had a brush with something potentially life threatening.

Sending you both good thoughts and fingers crossed for a speedy recovery

Glad he's on the mend, it is. DKA is scary and you can't be complacent with T1.
Somebody above has linked the sick day rules, your husband needs to take a look. The higher your BG is the harder it is to bring it down and the usual ratio doesn't always work. So if he usually gives 1 unit to drop his BG by 3mmol, if his BG is in the 20's, that ratio might not work.
Why is he reluctant re the pump and the libre?
They are both fantastic pieces of technology which help enormously.
Come back if you want info on either of them, I use both (bionic woman!)

Glad he's on the mend, it is. DKA is scary and you can't be complacent with T1.
Somebody above has linked the sick day rules, your husband needs to take a look. The higher your BG is the harder it is to bring it down and the usual ratio doesn't always work. So if he usually gives 1 unit to drop his BG by 3mmol, if his BG is in the 20's, that ratio might not work.
Why is he reluctant re the pump and the libre?
They are both fantastic pieces of technology which help enormously.
Come back if you want info on either of them, I use both (bionic woman!)

DD (10) is T1. We have one meter that can test both blood glucose and ketones - just uses different strips. We've had to test ketones a few times, but luckily never DKA.

As well as the libre mentioned above, we have a miaomiao which is a little device that connects to the libre and sends data via Bluetooth to a phone. You can set alarms on it to go off when you are going high/low so that you can act before the problems set in. It is AMAZING. It is also possible for others to follow glucose levels remotely. This could allow you to be an extra set of eyes for your DH?

There's certainly plenty to learn! Hope all goes well.

Typed a long post and lost it but it’s not your fault. Everyone diagnosed with diabetes should be educated about ketoacidosis and given the supplies to enable testing.

My son was born with the opposite of T1 (hyperinsulinism) but now has Ketotic hypoglycaemia which can cause non-diabetic ketoacidosis. I buy my own ketone strips as our blood sugar monitor (freestyle optium) tests both.

Personally I’d bite their hand off for a CGM - I believe the new libre is meant to be a cgm more like dexcom but not sure if it’s out yet?

• My son was born with the opposite of T1 (hyperinsulinism) but now has Ketotic hypoglycaemia which can cause non-diabetic ketoacidosis. I buy my own ketone strips as our blood sugar monitor (freestyle optium) tests both.

Personally I’d bite their hand off for a CGM - I believe the new libre is meant to be a cgm more like dexcom but not sure if it’s out yet?*

You're amazing for dealing with all that. @SinkGirl

Not heard of the libre supporting CGMS, DP had an appointment last week and told her upgrade options are Medtronic or Tandem as only these support CGMS and NHS-funded. The DSN said CGMS criteria is "a bloody nightmare" and really narrow.

Oh not at all - it was tough at first (two month in nicu and feeding every couple of hours without fail as a baby) but he was very stable on medication and was able to come off it at 18 months, we were very lucky compared to lots of cases of HI. We were also really lucky he was already in nicu so it was picked up very quickly as they just could not maintain his sugars even on IV dextrose. He’s so much better than he was.

He has some brain damage and a visual impairment which may or may not be related plus autism (his twin has had no health issues but is autistic as well). So far (touch wood) no further endocrine issues.

For a good while we were considering self funding a dexcom because he was having lots of hypos in the night and first thing but fortunately things have been much better the last six months.

The libre isn't classed as a pure CGM @SimplySteveRedux but a 'flash monitoring system' it can be turned into a CGM unofficially with a device appalled a Miao Miao, which I have and a PP mentioned. You can find the NICE guidance online easily enough, the main criteria being T1 and testing 8 times a day so if hes's not currently averaging 8 tell him to get them up to 8 and see his consultant.
It's authorised via consultant initially then prescribed via GP afterwards.
It's been a long long battle to get it funded and thankfully the clinical director of diabetes stepped in , & change the criteria so each CCG couldn't continue pissing about writing their own version of it.

If he's being offered the pump, I would take it. Changed my life :)

Has he been diabetic long OP? The dafne course is brilliant and he should bite their hand off if they're offering a pump. The libre is fantastic too and has completely revolutionised the way I manage my diabetes.

I think dka is also something all diabetics have at least once in their lifetime. I've had it twice. Once when I was diagnosed and once when I had an awful d&v bug. Fortunately although serious both times it was caught early enough that I "just" needed a hospital stay not not intensive care.

Be kind to yourself. Diabetes is a unfun journey that affects the whole family regardless of who has the diagnosis