There are a few things, but what I think it comes down to is mistakenly using expired insulin that had actually expired (unlike expired insulin that actually has some punch left). In the grand scheme of things, bad insulin from the vial comes very late in the troubleshooting game. I almost implicitly trust that insulin from the vial (that hasn’t been abused) is good and will work – don’t you? This stuff was also fresh out of the box and only a few hours out of the refrigerator.
When I started writing this post I planned on going into all of the details on how this happened to me, and what mistakes I made along the way. But I don’t want to do that. I don’t feel like opening up to even the best intended criticisms right now.
It is easy to say what someone else should have done, but something very different to work through it on yourself while spilling major ketones, fighting mid-300 blood sugars, and puking up any drop of liquid you drink.
Besides, once you’re through a problem you can always see what you should have done differently. There’s that 20/20 hindsight thing again.
The one thing that keeps coming to the surface for me is that I simply did not have time to react to anything. The ketones crept up on me in my sleep, and before I realized what was happening, it was already too late. The moment I woke up that morning I was hospital bound, and there was nothing more I could do about it.
It took about eighteen hours of nearly eight times my normal hourly insulin doses, and countless bags of IV fluids (including a dextrose mix and potassium) to get back to normal. They checked my blood sugar every hour, and did blood draws every two hours. I was so dehydrated that often times they couldn’t get blood from anywhere besides veins in my knuckles. That was one of the most painful things I have ever experienced in my life. The acid imbalance in my body was so bad that they didn’t even let me drink water until damn near 12 hours into my stay.
I am back at home now, and I am feeling pretty good, although very worn out. I’m sure it will take me a few days to feel 100% better, and I plan on taking it easy for a while. I sure do appreciate all of you that checked in on me, sent e-mails, tweeted, called, all of that. It made my stay that much easier to tolerate. Thank you!
last nov I was diagnois with dka and I do not understand it at all. I also was diagnois with high blood pressure and anemia.they just told me and put me on two types of insulin. never they explain it to me. I glad you are feeling better. keep a smile on your facce and hod your head up high and the lord will take care of you
Absolutely corrrect. Correct the serum pH without bottoming out glucose
The purpose of the dextrose is to keep the BG from dropping while receiving insulin. When the BG hits ~250, the ketones are still present usually, and so you still need a good bit of insulin to clear the ketones. At 250 though, if you don’t supplement with dextrose, you can potentially bottom out. Also, if the BG drops to rapidly there is a risk (greater in children than adults) of cerebral edema (brain swelling). Keeping the glucose slightly above normal helps prevent that to some degree as well.
Hi Anne,
You know, I’m not really sure. I think it might have something to do with them trying to get some energy back into me. Up until this point I hadn’t eaten in a long time (more than 24 hours?) and my body is metabolizing fat stores and other energy, creating more ketones in the process.
Or, maybe it is so they can keep the insulin going without me dropping too low. But like you ask, why don’t they just reduce the insulin?
As usual, more questions than answers. What else is new, right?
I’m just curious. Why do they give you dextrose?? Doesn’t that just make it worse? Couldn’t they leave out the dextrose and give you less insulin? Or do they want to give you more insulin and hence, need to give you the dextrose?
Scott
I don’t know how I missed this post. I’m so sorry you went thought this my friend. I hope by now you’re feeling WAY better. Thanks for the heads-up on looking at the expiration dates. This is not something I always do.
Kevin/Scott,
Ever since this post I have been looking at my insulin expiration date, I never have in the past.
Funny thing is when you open the box, it is on the part that I usually rip off.
What a way to start a morning, buddy! So glad you made it out of the rabbit hole!
Sorry this happened, Scott.
I hope you’re feeling better by now.
And yes, I too totally take insulin from a vial for granted. Sharing this experience might be helpful to us and move the insulin check higher up the troubleshooting ladder.
Congrats on the new job, too!
God, what a miserable experience. I’m so sorry you had to go through that. And who doesn’t use “expired” insulin?!?
Oh Scott, that really sucks!! But give yourself a big pat on the back for going to the ER as soon as you did. Being stubborn and trying to fix it yourself would have made things much worse. Good for you for recognizing the “point of no return”!!
((HUGS)) I was just thinking about you today….and then read THIS!! ACK! So glad you are on the mend! Think SLEEP, WATER……REST!! We love you Scott!
So very sorry to hear about this. I hope you feel better very soon.
Mel
UGH, what a horrible experience. So glad you are feeling better and out of of there.It’s no one’s fault, there is absolutely nothing you can do sometimes(been there, done that). It’s like a steamroller.
Hope you are back to 100% soon.
So so sorry Scoot — that just plain sucks. I ended up in the ICU with DKA once and I pretty much thought I was dying. Give yourself plenty of time to recover. All the best.
I remember my first bout with DKA. I was in college at the time, and managed to use massive doses of insulin and oral water to get through it (cause I didn’t recognize it at the time). I remember leaving work early because I felt like “a butt full of crap in a bladder full of urine.” (Apologies if I offend anyone.) Thankfully, I’ve only had to deal with it one other time, and that time I was at the hospital (which is when I figured out that the first time was DKA). That’s in 12 years though, so I better not have any more for 15 years. But hey, by then they’ll have found the cure, right? 🙂
So glad you are feeling better. DKA sucks. Hospitals suck. The knuckles? Ouuuch. Take care, rest, watch bad daytime television.
Scott Thanks for the additional information!
I am a new reader and so relieved to find another Diabetic who experiences this. On Sunday my BG (which I refer to as BS) was “HI” we all know what that means. But as you said, I was able to pull myself out of it (I rarely go to the hospital). I do not vomit when it is over 300 (which is almost daily).
I am glad you were successful on Symlin. I could not get past the first 3 days of nausea and I quit taking it. What dose did you start with – did you then increase the dose and if so, what amount. How did you get it into the pump?
Many thanks for your blog. I am just begining my blog over at world press called Jan’s a Diabetic.
I will read you again soon
Thanks everyone, you are all so kind.
Anonymous & Rachel – DKA happens when for whatever reason your insulin isn’t working right. Either delivery problems or bad insulin, or maybe an illness has you very resistant to it. The body needs energy, but without the insulin it can’t get it from your blood sugar. It starts burning fat and other energy sources, but it’s not a clean burn. It leaves behind ketones as a bi-product of that conversion process.
This happens to all of us when we are burning fat, maybe from exercise or whatever, but with DKA it is a massive amount, creating a lot of ketones, which upsets the bodies acid balance for those of us with diabetes.
That buildup is not something that usually happens in a couple hours, but as I experienced, can happen overnight. If you are able to drink water and fix your insulin supply issue, you can pull yourself out of it. Drinking water will flush the ketones out of your body, and fixing your insulin problems will help your body stop creating more ketones. You usually need much more insulin because ketones make you very resistant to your insulin.
In my case the acid imbalance of my body was so unbalanced that when I tried to drink water I would vomit. As soon as you start puking plain old water, you need to get help. You won’t be able to pull out of it yourself.
I hope that answers some questions. Please let me know if anyone has any others.
I saw your high comment count and wondered what is going on with Scott! This was a hard read. So sorry you had the bad experience. Hope today finds you much improved. Nobody wants this kind of drama, but with diabetes, well, there can be plenty of drama! Diabetes doesn’t care if you’re famous, good looking, have important places to be or just need a good long rest. No good time for this sort of thing. Glad to hear the hospital got you what you needed when you needed it.
Here’s hoping you’re back at all the things you love!
thanks for sharing your horrendous experience. until now i honestly did not know dka is so bad.
eeks, i’m so glad to hear/see that you’re okay, scott! i had a major pod and cgm fail last week and was scared out of my mind that i was going to land in the hospital. dka is no fun!
Scott:
Hope you are felling better.
Nothing quite like DKA. Sucks when it happens, but very glad to hear you were well cared for.
I too experienced a bad bottle recently.
Hope you mend quickly. Drink lots of fluids.
drew
Your knuckles? Really? That sounds awful. And they had to do that more than once? That is too much. Too much.
Glad you’re home and feeling better. Damn insulin.
I am so sorry you had to go through that, Scott! I hope that you’re feeling better now.
I just want you to know that you’ve inspired me to go through all the insulin that I have in my fridge and remove all the bottles that could potentially be old. It’s simply not worth it!
It’s so scary! We all try our best to manage this condition and then something like this happens!!! I always worry about nights at home because I’m afraid that something is going to happen to Tristan while I’m sleeping.
I do have a question… why wouldn’t they let you drink water? Tristan’s team always told us that when he has ketones he has to drink water.
I’m really glad that you are feeling better. I’m sure that it was a horrible experience. Hang in there, take good care of yourself! You are an inspiration to a lot of us!
No judgment from me, friend.* I am so sorry you had to go through that and I hope you are feeling better ASAP.
*After all, I am the person who got “too busy” running around after my toddler one day and forgot to test for about five hours. I went from a 250 fasting to 574 in that period of time due to a bum pump site( that I didn’t catch because I wasn’t testing). I didn’t clue into my situation until I was praying to the porcelain god. It’s that easy, it’s that fast, and it’s that sucky.
sending healing thoughts your way…..
Please, please give some details, Scott. I am Type 1, diagnosed three years ago and do not understand DKA at all, so any light you could shed would be helpful.
So glad you feel better.
Oh Scott, what a nightmare. Glad you’re feeling better.
Ax
ugh, sounds horrible. Made me shudder to think. I am so glad you’re okay.
Oh no, I’m so sorry this happened to you. AND I thank you for having the moxy to share your experience. It is a horrible thing thing to go through it and an awesome thing to come here and remind us of how very quickly it can happen to any one of us. I’m so glad you are home and on the mend. Please take care =)
Glad you are past this and telling the tale from the other side.
Scott,
I am glad you are all better.
Karen
Scott, I’m so glad you are home and on the other side of such a horrendous ride. I’m so very sorry you had to go through it, and there is absolutely NO judgement from any of us who know what it is to live with diabetes over the long haul. Please rest up, and give your body and spirit the time they deserve to recharge.
Sucks
All the best bro.
Oh Scott, I’m sorry! I’m glad you’re back home and takin’ it easy. Take care. Stay strong.
L.
Wow, DKA stinks. I’ve been through it once (twice if you include my initial diagnosis) and I remember that experience vividly (it was Thanksgiving day in 1979, I remember spending most of the day in the hospital, ruining what could have been a good holiday) and how gross it feels. Of course, on the other hand, hypos account for about 2% of all deaths in people with type 1, and perhaps others, too, when motor vehicle accidents and machinery accidents are involved. It’s a very fine line to walk, and sometimes, it works better in theory than it does in reality. Anyway, I’m glad you’re feeling better. Just remember: there’s no place for guilt in this!!
glad to hear you are feeling better after such a horrible experience!
Hope you’re feeling better, bro. Damn broken pancreas }:-(
Scott, I am so glad you are feeling better. I can’t even begin to imagine how scary that must have been for you. There are obviously alot of people who care about you here wishing you well. So take it easy and get better.
wow..glad you’re ok…
Glad everything is ok now Scott… you did what you had to do and i’m real glad you did that… take care my friend…
I’m glad everything is okay, Scott. I’ve had my time with severe hypo’s, but it’s not a blame game. You do the best you can! Sometimes the enemy doesn’t want to play nice. Get lots of rest and relaxation. This can take a lot out of you. Jennifer
Glad you’re home. Take care and feel better.
Sorry to hear that you had to go through this experience, Scott. I’ve got the T-Shirt too, and remember only too clearly how horrific it is to go through.
Without even having to hear all the exact circumstances, I can tell you that there is absolutely NO criticism that can be leveled at you. One of the cruelest ironies of diabetes is that at the very times we most need all of our wits and problem solving skills – when we are very high or very low – all of our cognitive abilities dessert us. And as you point out, the retroscope, and the outside eye, are both wonderful tools but ones we don’t get until after the event. Whatever happened, whatever the cause, it’s down to diabetes. Damn diabetes.
(And it’s a really low blow when it sneaks up on us while we sleep!)
I’m so glad you went to the hospital and got the care you needed, and most of all that you’re home again. Take it easy, and feel a hundred percent better soon. Hugs from across the pond.
Scottie-
Bro. I am so happy you made it to the hospital and back home:) honestly, that’s all that matters at this point:) Btw, I’m catching Scott up on all of the meet-ups:) it’s pretty cool.
Oh for pity damn sake, Scott. Terrible. Just Terrible. I have had 2 episodes in my 35 years and both left me completely wiped out for a couple of weeks afterward. My doc said it was like being forced to run a marathon without training.
I remember getting pure potassium iv in my hand and it felt like hot oil. Oh sh-t. That is just the pits. Glad you are home.
Glad to hear you are doing better. It’s tough to try and figure out any BG problem, and in hindsight it always takes me waaay too long before I hit the “maybe this is the insulin’s fault, not mine” part of the checklist – one of the major suckage points of D is that there is no easy way to tell how good your insulin is.. if I were slightly more cynical I would say they don’t have an easy test for insulin potency b/c then we could all see how inconsistent it is in terms of shelf life and batch to batch…
(((hugs!))) And eight times your insulin rate??? scary!!! Be well! (can I get any more punctuation into this line?)
glad your better scott.only a perfect d would criticize anything you have done.you are in my thoughts my friend and please please dont be hard on yourself!remember that there are only a million things we have to be aware of and remember and thats in the first hour we awaken.forgive yourself.i do
Scott, I am so, so sorry that happened to you. Rest up, feel better, and don’t blame yourself. You’re fantastic. Diabetes is lame and unpredictable and impossible to get right all the time.
DKA = The Worst.
I am glad you are home and for some reason that first picture really got to me. I hate diabetes dude, especially when it hurts my friends.
I admire your thoughts and writings so much…
SO happy you are home again! … when I read knuckles I winced..ouch!
Big hugs bro!
((hugs)) Dbro! Glad you are home and better!
So so SO glad you’re feeling better.
I cannot imagine how scary that was, to have no control over your own body like that.
I’m glad that you’re home and better Scott – it sounds incredibly scary. Hugs to you!