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[IP] Re: Diabetes Care article about DKA ???? reported in Diabetes E-News Now!

The only times we've had bad problems were when things
went wrong during the night and we weren't aware of it.
So, maybe that IS what happened to that man in the
article? Shannon has awoken vomiting, with headache,
stomach pains, large ketones (and sometimes I've even
been able to smell them), and bgs off the meter (with
the FreeStyle that is over 500)...that isn't DKA. It is
that gray area between severe ketosis and DKA. It is
"DKA on its way" unless things turn around (which we
have always been able to do within 4-6hrs) but it isn't
quite DKA yet. I made the mistake years ago of calling
it DKA, only to be corrected by the endo, who said that
most people nowadays have never seen DKA since
management of diabetes has gotten so much better. At
diagnosis, Shannon was in DKA and, these situations
we've had, as bad as they've been (and they can be
scary), are NOTHING compared to how sick she was at
diagnosis. And at diagnosis it was just MILD DKA (the
mildness or severity of it is determined by the degree
of acidosis) and she was in the ICU for it. I hope no
one here has to ever see it to know the difference.

Take care, Kerri, mom of Shannon-13 (dx 11/96, pumping
HTron 11/99, pumping Cozmo 8/03) and her 7 siblings :)

Linda said:

Does anyone here have this kind of experience? In 5
years of pumping I
have only had a few times that the pump or site
suddenly stopped
working without my knowing it, and the only ones I
didn't catch pretty
quickly were in the middle of the night.

It actually wouldn't occur to me to even call the
doctor, much less go
to the hospital, just for high blood glucose and
ketones in a situation
where the pump had stopped delivering insulin -- I
would assume that
getting insulin was the problem, and get insulin (along
with making
sure I stayed well-hydrated, and allowing that if
things didn't improve
within an hour -- which they always have -- I might
reconsider.  Mainly
in order to get an IV for hydration.)  Even though I do
tend to have
symptoms when I am ketotic (rapid breathing
particularly).  If I
thought the problem might be illness, rather than pump
or site
malfunction, I might call, though I would expect I
would be the one to
figure out the increased insulin rate.

They seem to be using DKA as synonymous with having
high blood glucose
and ketones, not as some of you on this site use it.  I
guess, though,
that it would fit the ADA definition of DKA, which is
ketoacidosis (DKA)   (KEY-toe-ass-ih-DOH-sis)
> an emergency condition in which extremely high blood
glucose levels,
> along with a severe lack of insulin, result in the
breakdown of body
> fat for energy and an accumulation of ketones in the
blood and urine.
> Signs of DKA are nausea and vomiting, stomach pain,
fruity breath odor
> and rapid breathing. Untreated DKA can lead to coma
and death.

The solution offered for this man's problem,
incidentally, was to take
60% of his basal as a Lantus injection. His A1c went up
to 7.1.

Linda Z
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