Why is DKA a bigger threat with the pump?

[Adinsmom]

Hi, Happy day after Thanksgiving. :) We had a busy day yesterday. But the most informative part of the day was seeing dh's Aunt's Minimed 722 pump. I never knew she wore a pump or had diabetes until just recently. :o She is very sweet but quirky and eccentric. She just upgraded to the 722 and absolutely loves it. She showed me her infusion site and it is alot smaller then I thought it would be. I am not sure what I had envisioned but it is not as intimidating seeing it up close. Dh came in when he saw her showing me the pump and listened while I asked some questions. We would have talked more but Thanksgiving festivities and kids didn't allow an in depth discussion. She is hoping her insurance will cover the cgm next year. She was able to try it for a month and her numbers were "spot on".

She had an "episode" last month where she was taken to the hospital. The details are sketchy but from what I can understand she was in DKA, hallucinating and her bg was 1120. I have read about DKA occuring quicker on the pump. Why? I am assuming it is because there is no long term insulin. How fast of an onset can it be?

[karonray]

My son uses the same pump that your aunt does. He was getting no insulin for , i guess, atleast 5 hours becuase the site fell out while he was sleeping. I woke up at 4 in the morning to him puking and his number off the meter. High ketones and High numbers do not make a good combination. This was the second time that it had happen in less than 2 months. It has also happened to lesser degrees several times.

There is no back ground insulin so you can very quickly go in to D.K.A. He is 13 and hormones are just messing with us badly. We have to be very careful. I have upped his basal rates and am just tryign to keep him out of the hospital when this happens. Lots of water and insulin to bring down the ketones. His daily total of insulin is somewhere between 50-75 units, on days that we have issues with ketones that can go up to 125-150 units.

It is very scary and can happen quickly. Also it is not something that is commonly thought of when starting a pump, you think everything is going to be great all the time. If you are looking into the pump this is not scare you but to inform you that it can happen and just be prepared.

P.S.
When in doubt go to the hospital.

[Amy C.]

If the insulin delivery with a pump stops and it is not noticed, DKA can set in. Based on my son's experience, his sugar accelerates after about 5 hours of no delivery. It is slowly rising until then. I would guess that once the last delivery has worn off, the sugar sky-rockets.

We were instructed to change out the set and insulin after two readings of over 300 (the first without ketones) and give a shot. So far, this has worked.

As long as you test fairly often, you can catch the high readings.

[selketine]

If the infusion set or site goes bad or the pump malfunctions and doesn't deliver insulin then you can have a problem quickly - within 3-5 hours. That would be ketones and sick but not necessarily a hospital trip. I think it would take longer (or combined with another factor like illness) to warrant a hospital trip.

I have no experience with older diabetic kids but I think especially with young kids (like William's age) that it is necessary to test them at least 1x during the night just in case there is a problem with no delivery of insulin. I don't think William would wake up until he was rather sick and it would be a disaster to have his pump fail just after bedtime and not realize it until the next morning (8+ hours with no insulin).

[EmmasMom]

This is something you need to be aware of with the pump, and yes it's because of only having fast acting insulin.
BUT... as long as you test regularly and inspect the site daily you are unlikely to have any serious ketone problems as a direct result of pumping. Most people actually have fewer episodes of DKA when pumping, and better control overall. You just have to pay close attention to your sites and any unexplained highs. (This is why people who don't test regularly are not good candidates for pumping)

We have only had one instance where Emma wasn't getting insulin, and it was because I hadn't properly re-attached her site after a bath. (day 3 on the pump) She was 400 at a 10pm test, I corrected and retested in 1.5 hours and she was 550 :eek:. I prepared to change her site and found the tubing unhooked and pumping insulin into her diaper. I hooked her back up bolused and she was back in range by her 2 am test. Even after 4 hours w/o insulin she only had trace ketones.
Since I test many times a day, and never go more than 6 hours at night, it would be virtually impossible for Emma to go into DKA without my knowledge.

[Adinsmom]

Thanks everyone.

There were a chain of events leading up to dh's Aunt's DKA. She had a touch of food poisoning, site change problems, she doesn't remember checking her bg's, and no one is sure how long they left her alone without checking up on her. That was about all I could understand from what everyone was arguing about. She didn't blame the pump at all she loves the 722 and pumping in general.

[Ellen]

See this answer too at from Ask The Team at CWD

http://www.childrenwithdiabetes.com/dteam/2006-11/d_0d_ebe.htm