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!
[…] I figured out what put me in the hospital. […]
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?