The scary experience of diabetic ketoacidosis
Today, we're excited to share with you another guest blog from Katie Janowiak, who works for the Medtronic Foundation, our company's philanthropic arm. When she first told me her story about food poisoning and Diabetic Ketoacidosis (DKA), I knew others could benefit from hearing it as well. Thanks Katie for your openness and allowing us to share your scary story so that the LOOP community can learn from it.
Throughout this past year, I've had the honor of sharing with you, the amazing LOOP community, my personal journey and the often humorous sequence of events that is my life with T1. Humor is, after all, the best (and cheapest) therapy. Allow me to pause today to share with you the down and dirty of what it feels like to have something that is not the slightest bit humorous: diabetic ketoacidosis.
You are hot. You are freezing. You are confused. You are blacked out but coherent. You go to talk but words fail you. Time flies and goes in slow motion simultaneously. You will likely smell and look like death. In my instance, this was brought on by the combination of excessive vomiting and dehydration caused by food poisoning and the diabetic ketoacidosis that followed after my body had gone through so much.
In hindsight, I was lucky, my husband knew that I had food poisoning because I began vomiting after our meal. But I had never prepped him on diabetic ketoacidosis and the symptoms (because DKA was for those other diabetics.)
Upon finding me in our living room with a bowl of blood and bile by my side (no, I am not exaggerating), he got me into the car and took me to emergency care. It was 5:30 p.m. - and I thought it was 11:00 a.m.
The series of events that led up to my stay in the ICU began innocently enough. It was a warm summer night and my husband and I walked up to a local restaurant. Prior to the walk, I tested at 132. Before eating, I was sitting at a pretty 101. I ordered a turkey burger without the bun with a side of veggies and a baked potato and bolused accordingly.
Later that evening, the revenge of food poisoning ensued. Testing my blood revealed a 500+ reading. While out of the ordinary, it certainly has happened to me before - I changed my infusion set, and opened a new bottle of insulin just to cover my bases. I corrective bolused the crap out of my 500+ reading and even did an additional manual injection. Tired, and at this point with a terrible stomachache, I attempted to down some water and find a comfy place to lay down.
Feeling terrible, and expending all of my energy and focus on controlling my vomiting, it didn't dawn on me the havoc my dangerously elevated sugars and dehydration from vomiting were ravaging on my body.
You see, in this moment, and in the 14 hours that followed, I did the one thing I never (ever) thought I, of all people, would do: I stopped thinking about my diabetes. I work for Medtronic, for crying out loud, and I forgot about my diabetes!?
I knew somewhere in my consciousness that I should be checking for ketones, but I kept telling myself "next time I get up to the bathroom, I will"...and making mental reminders to yourself when you are as sick as I was is all but a lost cause. My blood sugar often goes high when sick, and as I'd never (in my 15 years of being diabetic) ever faced so much as trace amounts of ketones, the concept that my blood was effectively poisoning me was foreign.
The series of events that follow, I recall like an out of body experience. Clutching a stainless steel mixing bowl, with a wet towel wrapped around my neck and an oversized t-shirt, I collapsed to the floor in the ER. Thankfully, I vomited shortly after entering, which prompted the care team to triage me in advance of the full waiting room. Triage led to taking some blood work...and taking some blood work led to an influx of frazzled nurses and frantic doctors surrounding me.
I recall hearing my husband being told that I could be in the hospital for months. I remember being told the drug they were administering was reserved typically for cardiac arrest patients. I remember someone gasping and saying my blood had the acidity of a battery. I remember the nurse telling my husband to go to the chapel. I remember the doctor saying, had we waited 30 minutes more, I would be in a coma. I remember waking up in the ICU with a doctor telling me I was lucky to be alive. I remember my amazing endocrinologist coming to visit me. More than a year later, these moments still bring tears to my eyes to think about, and I suspect they will for years to come.
Until I was admitted into the ICU, I was unaware that I was going through life-threatening DKA. To be completely honest, DKA wasn't even on my radar as something that could happen to me.
At that time, had I been the reader of this blog, I would likely be scoffing and judging the writer. I would assure myself this isn't relevant to me. He/She must not control their diabetes well. You'd have to be stupid to not see those warning signs. My husband/parent/fill in the blank would know what to do. I was wrong. I made a mistake.
While I could not have prevented contracting food poisoning, I could have prevented the near-death experience that followed, had I done the diabetic stop-drop-roll (test for ketones - call your doctor - seek help), or had I prepared my husband to do the same. Yes, DKA can be avoided. Yes, symptoms of DKA can be masked by the illness that is causing it (in my case, food poisoning.) And, perhaps most importantly, YES - We are only human in the end. We will make mistakes. Even those who feel fully prepared to handle such an incident should review with their loved ones the proper steps to take. I share with you humbly in hopes that someone, somewhere is able to relate and perhaps spare themselves or a loved one from a similar experience.
IMPORTANT SAFETY INFORMATION
- Medtronic Diabetes insulin infusion pumps, continuous glucose monitoring systems and associated components are limited to sale by or on the order of a physician and should only be used under the direction of a healthcare professional familiar with the risks associated with the use of these systems. - Successful operation of the insulin infusion pumps and/or continuous glucose monitoring systems requires adequate vision and hearing to recognize alerts and alarms.
Medtronic Diabetes Insulin Infusion Pumps
- Insulin pump therapy is not recommended for individuals who are unable or unwilling to perform a minimum of four blood glucose tests per day. - Insulin pumps use rapid-acting insulin. If your insulin delivery is interrupted for any reason, you must be prepared to replace the missed insulin immediately.
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Blog comments
I've had close smelling like death problems since I was 10 at the time I had frequent blackouts and severe headaches when I woke up. I have highs and lows all the time. But never thought that I might be a diabetic. When I was in sixth grade I vomited multiple times almost every day never saw a doctor for it. What you said above - You are hot. You are freezing. You are confused. You are blacked out but coherent. You go to talk but words fail you. Time flies and goes in slow motion simultaneously. You will likely smell and look like death. Describes my entire life the last 18 years. I am just now at 28 years old seeking medical advice from a doctor. What exactly do I need to be tested for to prove that I have this.
Hello,
I seen one or two similar situations my mom was feeling bad a few days ago, and she didn't want to go to the Er due to Corona. So she rested and I went to take her food and drinks, not that she didnt have she said she could barely walk. At the point when she said that I said ma, you should go to the ER. She said no let me rest if I dont feel better by tomorrow which was yesterday than I will go. So the next day came and I went over to find her still in bed, she had drank everything a whole gallon of water. But I noticed her breathing was labored. She was barely talking to me but she did tell me to get her red pants. I immediately call 911. Now one day in the Er and she is mumbling words, with ng tube . But she went in speaking. I dont know what to do cant see her. Her breathing is good she is stable. I'm so scared and crying every second.
I’ve experienced dka, but never to this extreme. I do commend you on sharing your story. It helps others to realize they are not the only ones going through such difficult times. Sharing the proper steps with loved ones is a vitally important thing!
I have a question. 3 years ago I had been in the er because I felt terrible. I had a blood sugar of 1029, yes I said 1029. They said I should of been in a coma. I was freezing cold and throwing up. I had diarrhea and was dizzy and confused. After waiting for what seemed to be hours, I got mad and walked out of the hospital. The next day I received a call from my doctor that the hospital had contacted him saying I possibly had DKA and he wanted me to report to the hospital. I didnt go.
Fast fwd to now. Ive had an amputation of my toe, Ive had boils that were so bad they ended up requiring surgery and in the last month Ive started developing what are called Bum blisters. Blisters that resemble a blister from a burn. They just kind of magically appear. Needless to say, I've been in and out of the hospital a lot.
My question is two part. First, could all of these problems be related to damage caused by not having the DKA treated 3 years ago, and secondly is it possible that I still have DKA and it has gone unnoticed despite having been in and out of the hospital dozens of times? I have almost all of the symptoms listed in this article. Vomiting, cold chills, diarrhea which I've had for 3 years nonstop, dizziness and confusion. Also, if I do still have it, how would I go about getting it diagnosed when I've ben in the hospital and they haven't caught it?
Richard, I'm sorry to hear about your experience. These are good questions for your healthcare team. They can run the necessary tests and background to provide you with the appropriate diagnosis. Good luck to you.
I think this is one of the most significant information for me. And i’m glad reading your article. Thank for sharing!
I have a 10yr old granddaughter who was diagnosed T1 at 5yrs old. She has a pump now and is very good at counting carbs and managing her T1 though she is carefully monitored by family members. Of late she has had ketones that were not controlled at home and had to go to the hospital in order to control them. She just called me and told me she is throwing up everything she tries to eat or drink again. This happened two weeks ago also, which prompted the last visit to Childrens Hospital where she was diagnosed and they know everything about her T1. She also just told me that her Dr. said it could be her hormones causing this imbalance in her body. She hasn't started her menstrual cycle yet but is pubescent in other areas . Does this sound correct or even feasible? Any input would be gratefully accepted. Thank you, Laurie & Nevaeh
Hi there, Laurie. Everyone's individual needs and experiences will vary, but your daughter's healthcare team will have the most insight into her ongoing needs, based on her individual circumstances. I encourage you to continue working with her healthcare team for more information regarding medical advice.
Back .on 10th October 2002 I lost my dad due to a carehome he went into for rest bite that's a short stay to give my mom a break from looking after him so as she could get the home tidied up etc , well I took my dads death pretty bad I stopped eating and was only drinking fizzy pop , if not eating I did not do my insulin as I thought with it being fast acting it would be dangerous to take it , I went from the date my dad passed to 12th march 2003 I went to hospital after stomach pains and throwing up they checked me said I was blocked gave me a bullet as I call them up the back side that made me go and sent me back home which still did not tell me why I was throwing up , on the 14th march 2003 I got up went to the bathroom and threw up dark green bile , something must of clicked inside me as I don't remember any of this my husband told me what happened , he said I shouted to get an ambulance and hurry , he said it did not even sound like my voice who shouted it it sounded like a males voice , he said I got to the hospital and they saw state of me and took my finger test and it was high so my took bloods and when they came back they stated they were moving me onto a unit , my husband said he would come and see me next day as it was after visiting time and they had got me settled in , somewhere after 1am on the 15th march my alarm went off by my bed they came and revived me then rushed me to the nurses station just outside the ward so they could keep an eye on me , when I came around I had tubes on both arms a tube going across my nose and heart patches all over my chest , I new I had died and been revived and Sarah one of the nurses didn't hold it from me either she told me they they revived me twice as I was not holding steady the first time and I am very lucky to be alive , I had to have potassium sorbate tablets as I had took all the potassium out of my body band meds to fight an infection I had , but what I went through over those months leading up to that time I would not wish on no one , I had an infection in my kidneys and I was in that much pain the doctor had to keep coming in to see me and giving me pxxxxxxx injections , no matter what I did even breathe it hurt me so I tried to stay still , I drunk pop with a straw so I did not have to move and only moved to go to the toilet as I had no choice but to , until those 2 days I was rushed to hospital that last one being that fatal day , anyhow my husband came into see me that day I had died and they had revived me and I had all the tubes etc on me ,he went to walk by me and I said where are you going and he looked towards me and his knees gave up a nurse ran to his aid , he said what the hell happened I only left her here last night , I said to the nurse let me explain better it comes from me but you stay here so he knows I am speaking the truth , she said come over here to your wife let her explain , so I said love when you brought me in last night I was dying , I did not wan,t you to see me go through that so my subconscious mind told me to get an ambulance , just after 1am this morning I died these nurses raced to my bed and got my heart going again although it took 2 attempts to keep it steady at this point tears were racing down my husbands face , I held his hand through what I was telling him and I said as soon as they got me revived they brought me here and let me sleep but I have had to have all these tubes on me as I have infection in my kidneys and I have no potassium in my body as the fizzy pop removed it all by the looks of it , all a sudden I saw a hog food cart and said to the person what have you got nice on there he started reading the things he had and a nurse said she can not eat anything , then from behind her a doctor said if she's ready to eat she can eat , I sat there and ate a bowl of soup with a cob , a main meal and some rice pudding , my hubby said that's the first thing you've ate in months love , I said I don't know when I woke up after I died and they revived me I felt hungry and livelier , I can eat now but I could not before that happened , I still don't understand why that is does any of you know that answer , I never felt hungry before I died but once they revived me and I smelt food I was hungry.
If anyone can explain this it would be appreachiated .
I went home 4 days later , I rung my hubby saying guess whose coming home , I am sure our next door neighbour at that time added a rocket to his little car because he was there within 45 minutes of the phone going down and they were driving the nurses crazy so lthey would let me go earlier than what I should be released out lol.
My husband said I nearly lost her I just want her back in my arms , the nurse said it's only 1 hour you have to wait , so our friend next door starts singing , doctor comes to him and asks if he could stop singing , he said yes when I was released doctor got hold of my doctor and said you have problems with an impatient husband and an impatient friend come and sort it out can you hear that in the background he said ok , he came up took one look at my hubby and said to the nurse to get my meds ready and send me home with my Hubby and friend , see my doctor was my dads doctor so he new my hubby had lost my dad and could of lost me , my hubby walked up to the doctor and said thank you for saving her life doc , Bryan would be happy knowing you saved his little girl , he said it was a shame I could not save Bryan he was a good man , he said take care of her I don't want to see her back in here again not with DKA it's too dangerous , my hubby said don't worry she won't be back.
Im having bad tummy ache headaches im type w mh sugar reading is 10.2 is that high
Hi there, Kathleen. This is a good conversation to have with your healthcare team. Blood sugar levels and their effect on your health varies by person. I encourage you to schedule an appointment to discuss any health concerns you may have.
The first 2 years after diagnosis I didnt take insulin, every once in awhile my mom would give me some so I wasnt a complete zombie! And like clockwork 3 weeks go by no insulin, DKA, 1 week ICU, 3 weeks no insulin and so on and so forth for 2 years. Then there was a Dr. who I saw in the ICU and he told me I've never been around a patient with an A1C this high (20.2) without prepping them for autopsy! I guess I needed that reality to smack me right in the face for me to cooperate! Now I hate the feeling of high blood sugar when that was just life before! I'm not great at controlling my sugar but I try and that's better than what I was doing before when I felt like a walking sickness 3/4 of the year and the other 1/4 was spent with the hospital trying to cure said sickness! That's no life to live I hate hate hate needles but to have to take injections or feel like you're about to die every waking second of your life? I think I'll take the injections! It'll save your life!
I’m currently in hospital reading this story and these comments. I ate something bad a couple days ago and that started my bout with dka. I had to spend a whole day taking in fluids and electrolytes to start my recovery. It took me 5 IV bags and 24 hours just to get out of the icu. Now I’m chilling in my hospital bed in the ER waiting to move to a normal room for more monitoring and recovery.
I was just discharged from 3 days in the hospital for DKA. I’ve had t1 diabetes for over 40 years and never had dka. Before admission my bs was hovering around 230 and the bolusing was bringing it down. Then 36 hours of vomiting and extreme dehydration. Bs shot up to 370. Went to the ER, was put on an iv drip with “medicine”, deluted insulin, and potassium. Probably electrolytes too but not sure. So, my chemistry came back into line but have to say some of the nurses were not well educated on t1 and pumps. Since the wouldn’t let me use my pump to deliver insulin, I was reliant on their “schedule” for injections. My bs would climb to 390 (per my CGM) but they refused to test my sugar or give me insulin to bring it down because I “wasn’t due for a finger stick for another 2 hours. Yet they kept urging me to eat when I was that high. Made no sense. I had to beg them for lispro. Then they told me I should use Lantus in addition to my pump. I had to explain how the pump is designed to work. Finally I was discharged and am back on my pump and able to micro bolus to my heart’s content.
I do have to say I still don’t know what triggered the dka to begin with but it’s damn terrifying to have your body chemistry get so dangerously out of wack so quickly.
Just keep going Maria! Take good care of yourself. Hopefully you're journey has gotten easier since your post. Diabetes does suck but just make sure to keep loving yourself in the process & never give up when things get tough. Praying for you hun.
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