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DKA question

Discussion in 'Parents of Children with Type 1' started by Artgirl, Aug 7, 2016.

  1. Artgirl

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    A few questions about Dka. Does a few high sugars mean you can get into dka? Does key tones in the urine mean dka soon?she does not have any right now. How long does it take to go into dka? Please don't beat me up for asking these questions, I'm just curious as i am dealing with a very defiant teen right now. ..her Ac1 is 6 a few weeks ago but has a few high sugars due to careless care and i get worried.Thanks!
     
  2. wilf

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    Are you still using Lantus and Humolog? If so then DKA is highly unlikely, because she will always have the Lantus working. With an A1C of 6 she is also clearly still producing some insulin of her own, even further reducing chances of DKA.

    That having been said, if she gets stuck high for an extended period and gets dehydrated and has large urine ketones then you could have problems. But I don't think you're there. Also you can get a meter that measures blood ketones, which is way better because you are dealing with real-time information. Using the urine to measure blood sugars or ketones is very old school - get a meter. :cwds:
     
  3. Artgirl

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    Hi, yes she is still on Lantus and Humolog. She definitely takes her Lantus daily, I make sure of it. With that being said I don't find the Lanntus keeps her sugars from going high but it does a great job of protecting her overnight and making sure she doesn't get low. When she does go high I have her take a correction dose immediately. Thank you for suggesting the blood ketone checker, we have always and only used the strips that were recommended by the hospital. Teen years are hard and adding type 1 diabetes to the mix is even harder. She insists on taking care of diabetes her way, which is not the way they taught us. She will be 18 in 8 months and apparently if she doesn't want me at her appointments she can do so. Scary thought! Thanks again!
     
  4. rgcainmd

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    Lantus, and all other insulins for that matter, lower BG and therefore do not protect one from going low overnight (or any other time). The only exception is if one is experiencing reactive hypoglycemia prior to diagnosis and treatment with insulin. Since your daughter is clearly no longer experiencing reactive hypoglycemia, you are quite mistaken if you believe your daughter is somehow being "protected" from lows by Lantus. I do hope you are continuing to check your daughter's BG overnight if she isn't already using a CGM. You really should read the Ragnar Hanas book which covers basic concepts such as this.
     
  5. sarahspins

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    An isolated high that is treated is really not much risk of DKA.... even an extreme high. Things happen, and NO ONE is perfect. Even as an adult I unintentionally miss boluses sometimes (usually due to just not hitting the last "confirm" screen on my pump), you just correct when you realize the mistake and move on.. and that is no different on a pump or MDI.

    DKA can still happen on long-acting insulin, but it actually takes quite a bit of missed boluses and not correcting high BG's to happen, or illness. Pumpers are at a higher risk of DKA without doing those things "wrong" because without long-acting insulin in your system, DKA can actually occur much faster.

    Ketones also don't immediately mean DKA either... all ketones mean is that the body is burning fat, which can happen for a number of totally normal and not dangerous reasons.
     
  6. samson

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    As a side note, no one has satisfactorily explained to me why diabetics go into DKA but people with functioning pancreases simply go into ketosis. Or why someone who is off their pump and exercising can have normal BGs but be on their way to DKA.
     
  7. wilf

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    A Type 1 who is off their pump and exercising is on their way to DKA, because in a matter of hours there will be NO insulin in their system - and this lack of insulin will rapidly precipitate the conditions that lead directly to DKA.
     
  8. sarahspins

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    In the very simplest if terms, it's because the body needs insulin to clear ketones.. if you can't make your own, or you don't inject any, it starts a cascade of problems, which is what leads to DKA. Basically the body thinks it's "starving" because it can't use the fuel available (because of no insulin), and works super hard to make sure there is adequate fuel available, even though that is actually not the problem.

    Everyone's bodies actually work this way when you exersize... you deplete the available glucose in your blood, so the liver starts to release some stored glucose and you also burn fat for energy which releases ketones, but the non-diabetic body is able to produce insulin and use those ketones for energy without any kind of intervention. This is also why sometimes the same exact workout for a T1 can result in a low BG, or a 300 - it depends on many factors, and not all of them are under direct control.
     
  9. samson

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    Why is insulin needed to break down ketones? That's the part I still don't fully understand.
     
  10. sarahspins

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    Why is insulin needed for the body to use glucose? It's just how it works....
     

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