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[IP] 1st DKA on pump

I started pumping 12/02/2000 and last night I had my first experience with
DKA. And like I was warned it was really fast in developing.

I went to bed at 11:30 at 107 mg/dl with the intention of getting up during
the night to check the fasting basal (my CDE and I had made some slight
adjustments in the basals on Wednesday). At 1:30 the pump woke me up with a
low reservoir warning (i.e.. less than 20 units remaining) but I wasn't
concerned because I was 140 mg/dl and I was  going to change the set in the
morning and would only use 3 or 4 units in the mean time. At 3:30 AM I was
225 mg/dl. This was a little concerning but not completely unreasonable and
I did nothing about it. At 6:55 AM I was 280 mg/dl and LARGE ketones!!!

The pump indicated that I had 17 units left in the reservoir but it was
empty and when I removed the syringe from the pump I could get only a couple
of drops out of it. Apparently I had missed 4 or 5 hours of basal but at 0.4
units/hr the pump was not able to yet detect the problem. But my body
obviously was.

I did not feel particularly good at the time but no obvious overt symptoms
ether. I did the set change and bolused for the high BG but it still took
about 7 hrs to bring the BG back down and completely eliminate the ketones.

>From this I got two lessons: 1) YES DKA can happen fast - one night is more
than enough time and 2) I need to be a bit more aggressive with the extra
insulin when this does occurs.
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