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The Scary Experience of Diabetic Ketoacidosis

By Amanda Sheldon

Managing Editor

Posted:  2/19/2013 4:58 PM

Tags:

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. For more information on this topic, watch this video on Knowing The Warning Signs of DKA.

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.
 

Comments

clay witherspoon

Posted on Tue Feb 19 20:29:17 GMT 2013

Very touching and informational. i had a similar experience but i believe my symptoms were a bit different. i had gone in for a ct scan, for something i don't remember, and upon leaving my mother my niece and myself had gone to eat i remember my bs being around 150 or so. my bs runs normally high so i thought that reading was great. well we ate and left to do some shopping i wad so caught up in what we were doing i neglected to testest again. well on our way home i had to stop on the side of the road to vomit i though it was the food we had eaten not thinking about my bs being off the charts, it runs high anyway but i remember pulling into the er at the hospital and then remember waking up a day or so later in icu my case as it seems was so baffled that i had lost 24 hrs and don't remember anything that happened during that time.

Tim Lewis

Posted on Tue Feb 19 20:41:37 GMT 2013

I went through the same EXACT thing in December!! Although, the first doctor in the ER came up with the diagnosis of a muscle disorder.....?????? It was the 4th doctor that got the diagnosis right, which scares me to death!!! 13 days in the hospital, unemployed and without insurance. One of the most aggravating experiences in my life, because everything I ate and drank came right back up, and NOTHING I did would lower my blood sugar level.

Joyce Finn

Posted on Tue Feb 19 21:38:12 GMT 2013

Wish I had a pump again.

Debbie

Posted on Tue Feb 19 22:00:55 GMT 2013

My son went in to work the night shift as a CNA. His blood glucose level was 150 before he ate around 3:30 am. Within an hour, he started vomiting and by 5:30 am, they sent him home. He checked his BG at home and it was only 119 but he woke me, said he felt awful, and just wanted to go to bed. He was negative for ketones. By 9:30 am, his BG began rising though he was vomiting violently and then the diarrhea started. I said that's it, time to go to the ER. His last BG at home was over 300 and by the time we got tested at the ER it was just around 400. They hung insulin and started fluids by IV because he was already so dehydrated. They admitted him to ICU for the next day, and he spent the next two days on the med-surg floor. That was our first experience with DKA. Putting the pieces back together were easy enough yet surprising.
My son is 20. He was diagnosed as a Type 1 Diabetic the day after he graduated from high school. After the initial honeymoon phase where he was still producing some insulin and using just long acting insulin on a daily basis, he finally qualified for the pump. We thought it was an answer to prayer. His BG levels stayed in the hundreds for a few months after he got started but then something happened. He was at the age of wanting his freedom- from family, from his diabetes, from school. Everything. He stopped testing and just guestimated his carb amounts for the bolus and ate whatever he wanted, even if that meant half a package of Oreos and half a gallon of milk on top of a huge peanut butter sandwich. And sometimes he didn't eat at all. Or forgot to administer the bolus. I kept reminding him to get his bloodwork done, to make sure he got to the doctor for his appointment, and I was worried he wasn't following through on getting his supplies for his pump. He had told me to butt out, that he had control of the situation, that I needed to 'chill out' and get off his back. Well, he never got his A1C drawn so he didn't go to the doctor.

nancy joslyn

Posted on Tue Feb 19 23:03:23 GMT 2013

dka as a mother of a type 1 diabetic those are 3 letters i have to say that strike terror in my heart it strikes so fast and furious an er trip then icu waiting for blood values feeling the disease owns you

Adrianne

Posted on Wed Feb 20 00:20:18 GMT 2013

So sorry to hear this. I as well went thru this 3 years ago. I had the stomach flu and was nursing my 3 month old...a horrible combination to stir up dka for a type 1! Although the experience was scary it makes you realize you never want to get that sick ever again! To this day I stay keenly aware of everything...maybe too much but I'm proud of it!! Take care!!

Naomi

Posted on Wed Feb 20 01:35:54 GMT 2013

Thank you so much for sharing your personal stories and encouragement for Katie since she so openly shared such a difficult experience in her life. You are each so special and strong in your own unique ways!

Wendy

Posted on Wed Feb 20 05:10:40 GMT 2013

So sorry you have had to go through this. It is one of the scariest times of your life. I know....been there. Nov 2010, I had sudden onset of diabetes.....diagnosed as type 2. BS over 500. Placed on oral medication with little result...BS 300's. Added an injectable prescription medicine 2 weeks later and became sicker over the next 2 weeks. One nite ...just a month after being diagnosed as a diabetic, I was so sick that whatever conversation I had with my mom on the phone that nite had peaked her mother's intuition ....she knew something wasn't right & she came to my home to find me a lump in my bed.....so sick I could barely move. Mom took me to the ER......where they found that I was in DKA & about to slip into a coma. Spent 9 days in ICU....most of which I don't remember. Further testing showed that I was really type 1 diabetic....not type 2. But it was all very new to me....I didn't know a thing about DKA...didn't know what signs to be aware of. And who would have thought type 1 new onset at age 38. Scariest time in my life. I still shutter to this day knowing how close I was teath. All I can say is stay strong sweet girl. Katie. Education is our best prevention!! God Bless!!

Steve

Posted on Wed Feb 20 05:39:01 GMT 2013

I haven't suffered from DKA, but I recently had my blood sugars go higher and higher until they were two points short of 500, and no matter what massive doses of insulin I took, it did no good. Finally reached my doctor who suggested I try a different bottle of insulin, and that worked. I dropped 160 points in the next hour and a half. Apparently, I had some "bad insulin." DIdn't know that could ever happen but I guess it can.

Karen Graffeo

Posted on Wed Feb 20 15:39:09 GMT 2013

Thank you for sharing your story (I'm sure it was tough) and for raising awareness! I too went through a similar experience. I was in DKA for the first time since my diagnosis (about 24 years earlier) and it didn't even occur to me what was happening. My then-fiance, now-husband, tried everything he could to help me while I refused to go to the hospital. (It's funny how when you are in it, you seem to lose all sense of reason). Luckily, my mom came over and immediately insisted on calling an ambulance. In the end, it was the kick I needed to start taking better care of myself, to find a new endo (mine was terrible) and it ultimately led to me being a much more engaged patient and to finding the Diabetes Online Community. Yes, even now DKA can happen to me, but at least I know what to look for and the importance of getting help at the first signs of DKA.

Heather

Posted on Wed Feb 20 16:43:21 GMT 2013

Thank you so much for sharing this. We all like to think we are "above" such scenarios, but the truth is things can go so wrong so fast, and in the end we DO have a disease that doesn't always do what we think it should. Highs that make no sense, lows that have no reason, we just keep responding and reacting and trying to stay ahead of it. What a great reminder that at times the ONLY thing to do is to SEEK COMPETENT HELP! So glad you made it through and can live to fight another day! And yes, a good endo is worth their weight in gold, I drive almost an hour to see mine because she is WORTH it!
Take care,
Heather

Lane

Posted on Wed Feb 27 15:43:29 GMT 2013

Hi Katie! In our times together in India and Minneapolis over the past year we always had other things to talk about besides DKA, so thank you so much for sharing this eye-opening experience now. We've had our own brushes with DKA at home when various factors have combined in a "perfect storm" kind of way. Your experience serves as a reminder that you can't ever turn your back on the diabetes beast - you never know when it will bite. I was at a diabetes conference in Spain last year during which one of the presenters asserted that DKA kills more people than extreme hypoglycemia. Peril at both ends of the glycemic spectrum. Thanks again for sharing, keep well. Lane

Megan Scala

Posted on Tue Aug 06 12:52:42 GMT 2013

I went through the same thing about 3 weeks ago. I was sick for a couple of days with a virus and when I checked my sugar it was about 200 (which for me wasn't anything to go crazy about) then I became so weak I could barely get up to vomit. I stopped checking my sugars for about a day because I wasn't eating, unfortunately I also wasn't able to keep water down either. I was in so much pain, my whole body ached and I was unable to climb the stairs in my apartment. When my fiancee found me he rushed me to urgent care. They gave me fluids because my body was so dehydrated but found I was getting worse. My sugars at this point were around 550 and my acidic gap was around 23. They put me on a paramedic and sent me to the icu for a couple of days and after four days there I recovered. They also told me I was lucky to be alive. You're story was a great read!

Naomi

Posted on Tue Aug 06 15:46:10 GMT 2013

It sounds like many of you understand what Katie went through. Thanks for commenting with your own experiences and offering her reassurance and support!

Lance

Posted on Mon Feb 24 10:04:33 GMT 2014

I got diagnosed with type 1 on January 7, 2014. The doctors told me I've had it roughly since the end of September of 2013 and had no idea. In the middle of November I noticed that something wasn't quite right. I was always tired and started noticing a slight weight loss and I thought nothing of it and thought maybe I had a bug and it would go away. After hunting season got over and got my buck something didn't feel right. I didn't want to eat and had a hard time sleeping and when I finally passed out I only slept for a few hours at a time. Before Christmas I was thinner, my vision was terrible and always thirsty and constantly going to the bathroom and I still couldn't figure out what was going on. Well the last few weeks were the worst, couldn't keep anything down and was being 15+ times a day and couldn't really function at work. The day before I went to the ER I was vomiting uncontrollably and having bad abdominal pain and felt like I was going to pass out. Well early that morning my cat must've sensed something was wrong and woke me up and at that point something was terribly wrong and felt like I was going to die (not exaggerating) I went upstairs to attempt to eat something. That's when I noticed how thin I had actually gotten, a muscular 200 pounds now a 154 pound pile of skin and bone. That point I drove myself to the ER and there found out I was a diabetic. Stayed in ICU for 5 days, the nurses and doctors said it was a good thing I came in when I did because I wouldn't have lasted much longer. I'm very fortunate to be alive and healthy again I never want to go through that again in my entire life. Thought I'd share my DKA story!

Joel

Posted on Mon Feb 24 17:48:00 GMT 2014

Thank you for sharing your DKA story with us, Lance. I imagine that was a very frightening thing to experience, but glad to hear you are doing well and are healthy again!

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