help :( partner at risk of ANOTHER DKA

[jessypoo89]

my other half was in hosp before xmas with a dka... he had very poor control... for about two weeks he was really god monitoring his sugars etc and now hes back to his careless self again!

for the last few days his sugars have been over 20 or just reading HI on the meter... hes been doing his ketones and they have normally been below 1.. i know they should be zero but it doesnt sound too bad.. anyhoo yday his ketones werte 3.3! they wer 0.4 by end of day... but he was sick this morn so i asked him to test again and they were 0.7..
is he at high risk of ending up back in hosp? or once they are back close to normal is he ok?

i hope someone can help

[kgm0612]

I can't answer your questions, Jessy, for I have never tested for Ketones and know nothing about what the numbers should be.

I'm surprised your other half didn't learn his lesson back in December when he was hospitalized with DKA. Hopefully he will find the strength to get back on track.

Karen

[Gary_W]

Ketones or not, running with your blood glucose that high increases your risks of all the bad things that potentially go with diabetes. So as well as feeling really awful in the short term, he runs the risk of diabetic complications visiting him sooner rather than later.

If you 'do' this thing properly, you can have a good life that is complication free / unlikely to suffer from complications. Doing so involves education and the will to do things in a sensible manner.

Yes, I know you could get run over by a bus tomorrow (the usual response for not taking care of yourself / stopping smoking etc). But you are less likely to get run over by a bus if you stop laying in the middle of the bus lane.

[fgummett]

I can't say if he will inevitably get DKA (characterised by high BG and ketones) or need to go to the hospital again but it looks likely with the poor control that you describe. Is he not using any insulin? I'm not quite clear what you are looking for here... unless he makes changes there is very little we can do to help...

[notme]

Sadly, not much you can do to help. The decision to take control is all up to your partner.

I hope the decision is made before another hospitalization. Good luck!

[jessypoo89]

thanks for your replies.. what i really wanted to know was IF he does take control and get his sugars down would that be the risk of a dka this time down and he should start taking control in the long term.. or if they were high is he still at risk for them to peak even if he lowers his sugars?

also from a diabetics point of view he is a 21 year old male who was diagnosed at 16 and hasnt really dealt with the life change well at all.... what would make you realise you needed to change? or what would give you the motivation to do it?
he has a 5 month old baby girl! i cant possibly see what more he needs!!!

[Gangrel]

In my mind if a 5 month old infant isn't enough to make him change, nothing will.

[BlueSky]

....... what would make you realise you needed to change? or what would give you the motivation to do it?
he has a 5 month old baby girl! i cant possibly see what more he needs!!!
Landing up in hospital with DKA normally makes people more responsible and accountable for their control. It sounds like this hasn't had the desired effect, so maybe his biggest problem is a sense of not being in control. It sounds like he is not making an effort to balance his food and insulin action, so the lack ofcontrol is not surprising. Having ketones normally means that that not enough insulin is being used, so perhaps the starting point needs to be adjusting the dose until those ketones go away. That would at least reduce the risk of another DKA. Would talking to a diabetes educator and/or a counselor help?

[notme]

It was my husband (who hides emotions) being very upset one day, that made me realize I was not just hurting myself. I changed my ways that very day and have never looked back.

[jessypoo89]

thanks... i think he does need to receive counselling as he didnt really have a very good time of it when he first got diagnosed... was accused of drugs etc and i think it just made him think that he wasnt normal! i try and tell him that if he checked his sugars and adjusted his insulin i would never have to mention it and he would feel fab and he would hardly notce the difference.. but cos he is so slack hes constantly got the likes of me and his mum and dad going JAB, SUGARS at him every meal time

[princesslinda]

Do you think he would consider participating in the forums? Sometimes, just knowing there are others having the same challenges you are facing will help you be more motivated to do what you need to do.

Also, sometimes it's easier to take advice/criticism from "faceless strangers" rather than loved ones.

I really feel for the situation you (and him) are in.

[jessypoo89]

i told him about the forum and said he might like to join... but erm well he hasnt joined :)

i feel i am at the end of my tether and i am getting very bitter towards him and the diabetes....

i am starting to feel like i know he will end up with health problems cos his diabetes isnt under control but i dont want to have to be there to deal with them.. i feel terribly guilty for feeling lke this but ateod i know it is him who needs to take control

[yannah]

wow hon, you are in a tough spot...... this sucks.

have you talked to his doctor, does he know what he will enevitably face too soon? it is not pretty at all. he is so young, but too old to be this irresponsible.

I feel bad for you. i would do some couples counceling about this, seriously. I really would., this is your issue too. and you can't control it.

come and chat whenever you want.....good luck to you and welcome to the forums.

[AngelKitty]

Hi - I just read your thread and was concerned with the ketone readings you listed and consulted my Ketone Action Guide, this is what it said:

Below 0.6 mmol/L
Readings below 0.6mmol/L are in the normal range. Follow your healthcare professional's advice before you make any changes to your diabetes medication program.

0.6 to 1.5 mmol/L
When your blood B-Ketone reading is between 0.6 and 1.5 mmol/L and your blood glucose reading is higher than 16.7 mmol/L, this may indicate the development of a problem that may require medical assistance. Following your healthcare professional's instructions.

Above 1.5 mmol/LWhen your blood B-Ketone reading is higher than 1.5 mmol/L and your blood glucose reading is higher than 16.7 mmol/L, you may be at risk of developing diabetic ketoacidosis (DKA). Contact your healthcare professional immediately for advice.

When you have high levels of ketones in your body your kidneys struggle to flush them out of your body and your potassium levels drop. High levels of ketones also alter the ph level of your blood turning it acidic and dangerous.
Unfortunately in these instances you need to be hospitalised with intra-venous fluids and potassium to help the body flush out the ketones - extra insulin may also be required to counter act the high blood glucose readings.
Hope this helps.

[Jan B]

Jessypoo,

I hope your other half decides to come here. I wish I had a magical answer. I do know that the feeling of isolation (or being different) can sometimes be overwhelming, and these forums can be very good medicine for that.

I've sinned against my body a lot during my 29 years of having T1. Mostly during my younger years. I thank God every day for life, and for keeping me safe through many bad, often rebellious, and difficult years.

21 really is young. He can get this thing together . . . with help. He also needs to help himself. I hope you can keep being a loving partner . . . but don't be his mom! Take care of that sweet child of yours.

[mell1682]

.... what would make you realise you needed to change? or what would give you the motivation to do it?
he has a 5 month old baby girl! i cant possibly see what more he needs!!!

For me, it was having children that really woke me up. Sadly I know another diabetic who was dx at 18 and he is a father of a healthy and gorgeous 3 year old daughter but he still doesn't care for it the way he should, he runs in the 400's regularly and has been hospitalized for DKA several times but he still does this to himself! Some people never realize they need to change. I hope he wakes up soon for both you and for your baby.

[sable_032592]

i had a dka back in 99 and i was scared afterwards because it was a horrible experience... my ketones were around 4 i think, but i don't remember what it was before i went into a coma... as for my blood sugar, the hospital's machine stopped at 55 and my level was 55+ (990+)...

as for your partner, if he doesn't want to learn, you can't make him, all you can do is try to introduce better things for him to eat and do, maybe you can ask people who he respects or knows or loves, maybe do an intervention of sorts... it's probably the only way to wake him up...

also, maybe if you put him in your shoes, explain to him how you feel and how you deal with his actions...

[Subby]

As for the baby girl not waking him up, it could simply make things more depressing if he is not facing this. Given a level of depression or denial, the sort of things going through the head can be "what kind of father am I, I'll be dead in 5 years" leading to even less motivation. It may not show on the outside, (denial often comes across as forced and sometimes convincing lack of interest) but I know too well how precious things can make things even more hopeless when you are being ground into the concrete over and again by bad BGs.

Does he admit there is a problem? That is the first step without which, your intuition about a poor future are likely true. Him committing to improving, having that desire, is the starting point. Even if he feels it's too hard, doesn't want to deal with it, doesn't know HOW to deal with things - some kind of tenacity to keep getting up and trying, some kind of commitment to himself to just be in for the fight, even if there are many small relapses and obstacles, needs to be there.

I think lack of education and picking up perceptions from such things a mass media and doctors who try to scare patients with a one-liner (happened to me) can really cause a lot of denial, I mean this thing is SCARY especially if you go by generatilities "You'll die young" "In a few years at this rate you'll be on a dialysis machine" "You're stuffed" "Number one killer"... if you were in some fear and denial before, you focus on the negative, and if presented to him, (quite possible given some medical people's lovely attitude to "telling it straight" or "tough love for their own good") picking up these things will push you all the way into the hole.

Let's talk about you partner for a moment. 5 years down the track and not likely good control through those years. At this stage - there is every chance that if he does change his ways (or move slowly towards control) and do some basic things to look after himself, he'll live a relatively long and happy life, albeit a life with this other partner actively involved called "diabetes". At this stage, the chances of irreversible damage to eyes, kidneys, heart, limbs, are not great - and can be checked with tests (has that been done?). At this stage, a lot of reversal of the effects on his body (that he may not be aware of) will likely occur, given stabilised blood sugars. The better his control, and getting regular checkups, the more likely complications are caught early, and are something to manage rather than destroy quality of life (ok, no one wants to hear they may get complications at some stage - but it's better than being possibly severely sick within 5 years - right?)

At 10 and 15 years of terrible control, people start lucking out a lot more. There are two things going on: the tendency for poor control to clearly lead to more complications, and also a luck of the draw. While the luck of the draw is not an easy thing to sit with by any means, playing russian roulette more often than absolutely required is not usually wise, yes? And, given a more balanced view of things, most people will naturally see the right course of action.

So, especially if your partner is not the best listener in the world, he may really be walking around with a deep sense of denial and not getting the right information that NOW he can make good and LATER he may not be in such a strong position. Or he may understand this but not be able to connect with it, may feel too weighed down by lots of proof of how he can't handle things well - to act on it.

Working out ways to crack through the denial, would be the task I would see an interested party being inolved with here. It's true that he has to take up the gauntlet himself. It's equally true that if his perception of his situation is, underneath, absolutely hopeless, and that some help from others to face fears and get better educated about the details, may be very important.

[m2jpilot]

question, my sugars have been running high, 200 or so, on insulin and working on getting it down, an hour ago I was at 588 some said I needed to go to the ER. Is that true, or should I just monitor it?

[Subby]

Quick reply about the DKA threat given better control: a diabetic engaged with their management will take however many BG tests is required during a given time to have a "handle" on BG trends. They will also have learnt that what comes first are good bg trends, what comes second is good health, good life. Not the other way around.

So, if he was to become engaged, the DKA risk only becomes an issue in such circumstances as extreme emergency leading to being cut off from insulin or being knocked out, etc (so, pretty unlikely). Given reasonable long acting dosage awareness, night times should not lead to DKA. In the normal run of things, even if his BG does spin out of control, an awareness of this coupled with tactics to regain control (such as a correct adjustment shot of insulin, and being sure not to eat, etc) will mean it's a pain and an irritation and disruptive: but not so much dangerous.

By the way, it's quite possible to have ketones showing but not be in danger or likely to lead on to DKA. DKA is caused by a certain threshold of lack of insulin in the system. Ketones can be observed with too little insulin in the system, but what is important is WHAT IS HAPPENING NOW... has a reasonable amount of insulin been administered? Are BGs going down, or going up? Trending upwards, and more action is required.

[mell1682]

As for the baby girl not waking him up, it could simply make things more depressing if he is not facing this. Given a level of depression or denial, the sort of things going through the head can be "what kind of father am I, I'll be dead in 5 years" leading to even less motivation. It may not show on the outside, (denial often comes across as forced and sometimes convincing lack of interest) but I know too well how precious things can make things even more hopeless when you are being ground into the concrete over and again by bad BGs.

You bring up a very very good point. I've had moments like this that make me wonder what I'm doing and why. If anything leads to just not caring, it's these horrible thoughts.

[Subby]

question, my sugars have been running high, 200 or so, on insulin and working on getting it down, an hour ago I was at 588 some said I needed to go to the ER. Is that true, or should I just monitor it?

Hi mj2, your message really snuck in there, you should start a new thread for something like this.

With a BG of 588, go to ER, now. Do not drive yourself. Get family or friend to take you. Let us know how you go.

[m2jpilot]

yeah.. kinda realized that after I had posted it. Reposted in the right spot. Tried to delete it from here but wasn't an option I guess. Thanks for the response though.

[Subby]

Hehe, no big problem, just concerned you get to chat about your issue, I see it's working out.

[jessypoo89]

thanks again everyone... i tried talking to him last night and said im not having a go i want to understand..'why is it that you cant just take control' he said he is still very much in denial and says he just cant accept that he is diabetic.'

i said that if he doesnt take control then he will be so ill he cant hide away in denial. and tried to say that he needs to realise he will be denying me of a partner and his daughter of a father if he isnt careful...

the thing is he knows how to adjust his insulin etc he is just bitter about his illness!

he needs counselling but he would have to go through the nhs which would prob take time and also take place during working hours and we just cant afford him to take time off... i know we cant 'afford' him to not look after himself either. its like we are stuck between a rock and a hard place!

[Subby]

Here's another idea to think about, and more possibly useful if he is somewhat accepting of the fact he is in denial and it's sinking in that he needs help.

That is, to do things to remind him how lucky he really is and that he should just get on with what he's got and harness positivity a little more. I was thinking this as I was helping sort donated food and goods for people who have lost everything including family in the recent terrible bushfires here. Being involved and close to that tragedy just knocked any feelings of self pity or complacency I might have been feeling lately about my own condition. You can't wallow in denial and self pity about being diagnosed diabetic if you open your eyes to what some people go through.

What could this mean? I'm not sure. It might seem completely out of character, but it may be something that can be done in convenient hours and soon. It might mean doing some volunteer work for people on the very edge of poverty. It might mean getting involved with a hospital and cancer patients. It could be something less obvious, but nontheless something to cut across the apathy and encourage internal re-appraisal. It would probably need to be sporadically or regularly done, for a number of weeks at least, to let things sink in.

If he already works in this kind of field, then the walls of defense are already up for whatever he comes in contact with, and something a little different may need to be found.

In some ways this sounds contrived, I know. But in other ways, it gets away from the idea of needing to be "fixed" with counselling, the sense we sometimes get of a kind of delicate intricate operation on a failing system - and gets back to a more organic idea of just getting life into perspective, which is a process we all need to go through in some way or other at various times of our life, and may be something lacking in his life at the moment.

It's also something you may be able to partake in, encourage, and go on a journey with him on, as well.

[LancetChick]

You know, there are relatively few type 1 diabetics in the general population, so having type 1 diabetes can be very isolating and lonely, no matter how many friends and family members you have, because the only people who understand are others with the same disease.

If your boyfriend were to come on this message board and post something like I can't stand to live another day in my shoes with this disease; I can't make myself go through the motions of controlling it; I feel like a complete failure, so I just don't want to think about it. A lot of us have been there! We know about failure, being judged, resenting those who advise us on a disease we know so much more about than they do, and we also know how to make it easier, and how to succeed with it, so ask him to come here and hang out with "his own kind". :)

[Bonbra]

Sorry in a bit of a rush so havent yet read everyones replies but I just wanted to say I got diabetes aged 11yrs and it has took me until the age of 31yrs to control myself. I was in complete denial that i had it and I now know that I needed some form of counselling.

My wake up call came when my friend who was the same age as me with the same complications and a mother of 2 died. We always joked that we would get through anything as we had done so many times...and that it wouldnt happen to us.

I had DKA about 30 times..ending up in hospital..intensive care etc...It didnt change me!!

I have all the complications going now, and well to be honest everyone is surprised that Im still here!

It sounds like your other half is in denial and he doesnt need to be nagged at but he really needs some form of support.

I would love him to talk to me as i know exactly what he feels and he needs to face this before the complications set in.