Diabetic Ketoacidosis (DKA) is a very serious complication of diabetes. DKA is dangerous and can also be life threatening if not treated quickly. It occurs when there is a high blood glucose level and a lack of insulin, often during illness or when insulin has been omitted.
This article has been written for GlucoMen by Angela Allison, the mother of Claudia.
Angela is the founder of the "Diabetes Power" website.
Claudia was diagnosed with Type 1 Diabetes in 2008.
In the past, Claudia has had colds, she has been treated for swine flu and sickness, yet we have always managed her condition and illness at home. She never had ketone readings of more than 1.0, which have gone within a couple of hours. We have always used a blood ketone meter as I feel when managing Type 1 diabetes you need the most accurate information in order to keep your child healthy.
One Monday morning during the summer holiday's Claudia got up and said she felt unwell. Her blood glucose (BG) reading was 15. I gave her a correction. She had a ketone reading of 0.6. The previous day her blood glucose readings had been fantastic all day, so I really didn't think it was anything serious.
Suddenly Claudia started being sick, she couldn't even keep water down. I looked at her and thought something isn't right. So I called our Diabetes Nurse. She said that l should check for ketones again, even though her BG was now below 10. The ketone reading was 3.0. This was a huge increase from 0.6. The Diabetes Nurse said to take her to the hospital to get her checked out.
So off to hospital we went. We checked in to A&E and waited. We were seen by a lovely nurse, by this point Claudia had a ketone reading of 3.5 and had been sick again. Her heart rate was faster than it should have been. This was all in the space of 1.5 hours.
The doctor inserted a cannula and put a drip up. We were taken to the children's ward. Claudia was very brave, she opted to have the cannula put straight in rather than waiting for the numbing cream to work. I was so proud. They took blood and sent them to the lab for analysis.
On the ward, a registrar came over to talk to us, he had her blood results. Although her BG had never gone above 16, the ketones were up to 5.8 and her blood was "acidic", basically she was in DKA (Diabetic Ketoacidosis).
Her pump was disconnected and she was given dextrose and insulin etc via IV infusion. She was put on hourly observation, which included, checking her pupils, reflexes, BG, temperature & blood pressure. She was also hooked up to a heart monitor. Her heart rate was a little faster than it should have been. I was awake all night as I was checking her blood ketones every hour.
It brought back lots of memories of when she was first diagnosed. Claudia was in DKA at diagnosis and spent a couple of days in the hospital high dependency unit (HDU).
My thoughts were:
- What happened?
- What did I do wrong?
- Why did I not see this coming?
- She shouldn't have to go through this?
In reality it has been a bit of a wakeup call for a number of reasons:
You can have "normal BG readings" and still be in DKA. Sickness can come on very quickly and there is nothing you can do to prevent it. No matter how well controlled your diabetes is, it can happen to you/your child. Sickness & dehydration are a dreadful combination for someone with Type 1 diabetes. A blood glucose and ketone meters is vital. We use the GlucoMen LX PLUS for blood glucose and blood ketone tests.
I always check for ketones at the first sign of illness or if Claudia has a BG of 14 or above.
For most patients, DKA is not well understood and in some cases not discussed at all with their healthcare team. This can have terrible consequences as it makes prevention very difficult. Below is a real life experience from a mother with a daughter who has Type 1 diabetes.
We feel it is important to highlight the seriousness of DKA and to encourage people with insulin treated diabetes to discuss how to avoid it with their healthcare professional.