I am type 1. Even though I’ve read about it I feel like I don’t fully understand dka, please help me out. It’s caused by lack of insulin? So as long as I have my pump on and running properly I’ll be safe?
II’m type one as well and I’ve been on the pump and needles as well. I’ve been in DKA more than 5 times and I’m only 22 years old. DKA is when you have too much glucose in your blood for a period of time and your blood cells either aren’t responding to insulin (insulin resistance) or you just aren’t giving enough insulin or any at all. With the insulin pump, it’s easier to stay out of DKA as you have a constant rate of insulin in you at all times.
I’ve been pretty lucky in that I’ve only gone into DKA twice. Once was when I was diagnosed, and the second time was when I had a nasty stomach flu and couldn’t keep any fluids down or get my blood sugar into a range that would show up on the meter. (Ah, good times.)
DKA is a little more complicated, more complicated even than what I am describing, and there are some who are much more susceptible to DKA than others.
with no insulin or way to little insulin, the cells in your body starve. Literally. This triggers your body to start burning fat and sometimes muscle. When fats are metabolized (in this case turned into usable sugar), the byproduct is “ketones”. ketones are not “bad” in fact, if you are trying to lose those extra 5 pounds, your ketones will signal weight loss.
What is bad is the “diabetic acidosis” part of DKA. Essentially, when these cells are all starving, and you are converting large amounts of fats to usable energy, in the presence of very high blood sugar, a “runaway” buildup acids and ketones can be life threatening. DKA almost always requires IV fluids and careful monitoring to correct the pH and dilute the ketones and get blood chemistry back under control.
there are more thorough explanations on the web.
pumping actually increases chances of DKA. For those that fall into DKA very rapidly, a pump “occlusion” (clog) where you don’t get any fast-acting insulin, can leave you without enough insulin in 4 hours. Whereas a shot of lantus is going to work much much longer. For some people who are very sensitive, a good strategy is to inject some portion of their static basal as lantus (or other long acting) and just pump the rest.
dehydration, forgetting a bolus or basal, massive fast carb intake, pump occlusion, diabulimia, all add or intensify the probability of DKA.
cheers, hope this helps
Hi @goatleg, the answer to both your questions could be both “yes” and “no”.
DKA is not something real simple to define and there can be differing causes. The explanation @Joe provided does give a very good summary. Do not call a “high” glucose level, or several high readings in a row, DKA; DKA occurs with acetone or acidosis poisoning and can even occur without [extremely] high glucose readings.
The only time I had significant “DKA” was 62 years ago as a 15 y/o when I refused to admit that anything was wrong with me even when weight was dropping off me, and I ate, drank and peed constantly. Fast forward [over many ups and downs] to three years ago this month when I was hospitalized for 9 days and my BG readings were staying for days above 500 mg/dl and during that time, I did not experience DKA. One possible reason I avoided DKA at that time was because I continued infusing sufficient insulin to manage foods I ate and refrained from all exercise - although I did take a 15 mile bike ride the day before I was admitted to hospital; turns out my high BG was caused by blood and urinary tract infections that took 32 days of IV antibiotic to clear up.
Interesting, this is the first time I found another T1D that had their only DKD 62 years ago, just like me. Only difference, I was 5 at the time (not that it matters).
Anyway, DKA is complex, but keeping bg in realistically healthy levels is the best thing we can do. I;ve never heard of DKA happening below 300 or even 400 levels.
Yes, DKA is fairly unlikely when getting enough insulin to feed your body’s cells if you have something different raising levels, such as your infection.
Ted, I was 15 when I was in DKA - of course in those days it wasn’t called
“DKA”; I was diagnosed with diabetes on my 16th birthday after I had denied for months that anything was wrong with me even as I was loosing weight and couldn’t stop eating.
I was in DKA at diagnosis. BG was only 380, never have been higher than that. So, I think lack of insulin is more causal for DKA than high BG.