Diabetic Ketoacidosis (DKA): How Do You Know When It Is Time To Go To the Hospital?
I Have These Symptoms All the Time
If you are diabetic, and have been for a while, you develop a different sense of what feeling "normal" is and when it is time to be concerned. However, even those of us with the most keen sense of our blood sugar levels based on symptoms we experience can become desensitized to how close we are to falling into a far more dismal situation known as Diabetic Ketoacidosis otherwise known as DKA. As described by the American Diabetes Association DKA is “a serious condition that can lead to diabetic coma and even death”. The ADA goes on to explain that when your cells don’t get the level of glucose they need to produce energy, our bodies have to go elsewhere to find means, like burning fat. The problem is that when the body burns fat for energy it produces an acid called Ketones which spill into the blood stream and become very toxic to your body. A diabetic in the state of DKA is essentially being poisoned by their own body as it seeks energy it cannot get from glucose saturated blood cells as it normally would.
What does Diabetic Ketoacidosis (DKA) feel like? Does it Hurt?
Being in a state of DKA, from my experience, starts of rather mundane and usual and eventually becomes quite a surreal and alarming ordeal. For me, Diabetic Ketoacidosis began on a day no different than many others I had been having lately. I had gotten sloppy with my insulin doses and hadn’t been taking my blood glucose levels nearly often enough. I would take insulin based on what carbs I thought I was eating and when I was not eating, based on how I felt. I truly doing it all wrong, not because I don’t know what I need to do but because I had fallen into a bad habit of snacking constantly which makes it difficult to test correctly and almost impossible to give yourself the right dose of insulin. This on top of the fact that I was eating poorly helped propel the situation. It was early December and everyone was bringing their favorite cookies and sweets in pre-holiday glee. Co-workers went out of their way to bring in doughnuts for all to share and I indulged myself knowing it wasn’t good for me but I was in the “spirit of the season”. Fast forward to later that evening. I at dinner with my family as I normally do with my family and we did the normal routine of getting my 10 month old twins and 4 year old son bathed and ready for bed. My wife was also preparing for a business trip she was leaving for the following morning to the western coast of the United States. I could feel that my blood sugars were high. My mouth was drier than usual, I was urinating more frequently than normal, and I generally just felt a bit “off”. So, what did I do? I gave myself a max insulin dose of 25 units from my insulin pump due to my blood glucose level coming in at around 450 mg/ml which is very high but not so high that I didn’t think I couldn’t bring it down.
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Through the night, I was getting up quite often to go to the bathroom and subsequently downing as much fluid as I could. Obviously my dose of insulin didn’t bring my glucose levels down enough. I tested it again and instead of a number, the meter simply read “high”. Yikes! I better give myself another 25 units… Two hours go by, I test again, the meter still read “high” I decided that I’d wait and give the insulin more time to kick in. At this time, I was more tired than anything do to constantly getting up to go to the bathroom but I didn’t feel like I was “sick”. A couple hours go by and my wife wakes me up to say goodbye and leaves for California. I took my blood sugar again and it was 445. Phew! Finally it is coming down. I go back to sleep until I hear my alarm go off at about 6am. I wake up and feel oddly lethargic. I felt like I could hardly move and every attempt to do so was of great effort. I was tired. I’ll just hit the snooze button and sleep a little longer before I get the kids ready for daycare. The alarm goes off again. This time, I knew I was in trouble. I could hardly manage to get out of bed. The pure thought of getting the kids up and ready was exhausting. I didn’t know how I was going to do it. I also knew that I wasn’t going to be able to care for them during the day. I had to get them to daycare, come back and get myself feeling better.
I manage to get the kids dressed and with the help of our cleaning lady, who I had forgotten was coming that day, got them downstairs and into my car. During this time I was so thirsty that I gulped down 16 oz of water and then almost instantly had to run to the sink to vomit. My body was rejecting the consumption of any more fluid. I am still thinking I must have some kind of bug and check my blood sugar again to find it hasn’t changed much. I took a bath, which felt great, but also nearly caused me to drown due to falling asleep. The next thing I know, my in-laws are peaking into my bedroom to find me barely lucid and unable to move. They arrived because my wife didn’t like how I sounded via text message and asked them to check on me. It was time for an ambulance. I hardly remember the ride to the hospital and most of the next 2 of the 4 days of hospitalizations. I was truly near the end. My blood sugar as measured at the hospital was nearly 1000 and I began having irregular heartbeats which apparently is one of the final stages before diabetic coma and death.
When It Is Time to Go To the Hospital (DKA)
Hopefully my story above provides some of you to know what not to do when you are experiencing potential signs of Diabetic Ketoacidosis (DKA). I clearly did not know when it was time to get serious and go to the hospital. Honestly, as i got more and more sick, i became less able to make any decisions let alone going to the hospital. So what can someone do to determine when it is time? Below is a list of things to have/ do if you are diabetic.
Glucose Monitor: This seems like a no brainer and that every diabetic should have one. The key is, USE IT! Don't get lazy like I did and only use it to see how high your blood sugars are, use it to keep them from getting out of control. Doing so should help you stay healthy and see if you have an upward glucose trend to be concerned about.
Ketostix: Ketostix are an inexpensive and easy way to determine if there are levels of ketones in your system. You simply pee on the ketostix and compare the color the end of the stick turns to the legend on the box to determine if you have ANY ketones in your urine. If there is any more than a trace, it is probably time to call your doctor, especially when coupled with other symptoms of high blood sugar. You should test for ketones in your urine any time your blood glucose level is 250 or more and also periodically to keep check.
Diabetic Identification: Whatever you need to do to identify yourself as an insulin dependent diabetic that can be easily found by medical staff is essential. Some people get medic alert bracelets. The cool kids even get something tattooed permanently on their person to leave no doubt and to never leave home without it.
See your endocrinologist regularly: Just do it, Enough Said. Really. Yes I am talking to you.
Don't be afraid to tell someone you feel sick: Many times others won't understand how sick you can get from high blood sugar until it is too late and you are already out of control and almost dying. Don't be afraid to ask someone to take you to the hospital or call an ambulance. Diabetic Ketoacidosis is very serious and you should take it seriously.
© 2014 Peter Leeper
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