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Mrinkey

Normal blood sugars & ketoacidosis!

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Mrinkey

I'm the mother of a 16 year old type 1(girl). She was in ketoacidosis last week & admitted to the hospital. She had normal to low blood sugars while still having acid in her blood. She has been home for a week now & her bg's are normal 150-180 most of the time, but she hasn't been eating that much. This morning she started gagging & her bg was at 160 & has moderate ketones. My question is should I be worried or am I jumping the gun?

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Stl-T2

I would be worried.  At least call the doctor.  If you can't reach the doctor, I'd take her to the ER to be safe.  There are other forms of metabolic acidosis than just diabetic ketoacidosis and they can be life threatening.  

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Mrinkey

Thank you Stl-T2 for your quick response... That is what I was thinking... She is in school right now and I have her friends reporting to me about how she is doing, as she isn't responding to me... They said she's doing fine, but I'm her mom & I'm worried & im generally not that worried... It's just when she had ketoacidosis in the hospital last week, she had normal to low bg's & her blood was acidic... I'm going to call her clinic now & see what they want me to do... Thank you for your advice

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NoraWI

She has been home for a week now & her bg's are normal 150-180 most of the time, but she hasn't been eating that much. This morning she started gagging & her bg was at 160 & has moderate ketones. My question is should I be worried or am I jumping the gun?

BGs 150-180 are NOT normal. Normal BGs range between 70 and 110 with occasional spikes to 140 if something very carby has been eaten. DKA is caused by a lack of insulin in the body. Has your daughter been injecting an adequate amount of basal as well as bolusing according to the number of carbohydrates she is consuming?

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Mrinkey

Yes!! She has been a type 1 diabetic for 11 years... I know what the normal range is, but that is not the range for her as she is insulin dependent. Her injected insulin is so resistance that she is also on Medformin ... I don't need to be schooled on diabetes in general & I didn't come to this forum to be treated like I know nothing... Her symptoms of DKA are not the common ones. So my concern is warranted. So your opinion isn't as important as the solution!! If your intent was to be sincere, you failed!!!!

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JohnSchroeder

I've heard of pump users getting kinks in the tubing which can quickly bring on DKA.. but that usually comes with dangerously high (400+) sugar levels.  Maybe the added metformin is keeping her BG in those lower ranges while her body is not getting any insulin?

 

What type(s) of insulin does she take?  Pump?  What was the most recent A1C?  What were the levels last week upon being admitted to the hospital with DKA?  Yeah, 150-180 are not 'normal', but at 16 neither are they cause for concern.

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NoraWI

WHOA! I did not deserve your level of aggression. You did not include any of that information in your original post. Frankly, I don't understand why you are questioning us on something this important in your daughter's health. Call her doctor or take her back to the ER! Were she my daughter, I certainly would not be looking for answers to something so important from strangers on the internet.

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Mrinkey

She was on the pump when she was little & we did have issues with her fusion sites.There were a few times she was close to DKA when she was on the pump... Now we use the novo log flex pen & she is on a lantus as her long term insulin. About 4 weeks ago her a1c was 9.8, which is the best she's had in a long time. Then when she was in the hospital she jumped up to 12.6. Yes she was admitted for dka, which literally happened before she went to bed & getting up with her in the morning & going to the ER. The reason I asked for opionions on this matter, was because her diabetes clinic did not open for another 2 hours yesterday... I didn't bring her to the ER, because we make too many frequent trips there already & we do try to prevent this, but her symptoms are way different than normal signs. I found out yesterday from her that she isn't eating at school or staying hydrated as I believe is a way to hurt herself. She has depression issues & body image issues that I think she might of figured out how she can withhold the use of insulin as a way to look better. Managing her diabetes is hard especially when she acts like she doesn't want to get better. This was the first time I have ever reached out to anyone online or personally about figuring out a way to prevent dka & wanted opinions from parents & fellow diabetics from their experiences. Nora, I am sorry for how I responded to your first message. This subject has always been a trigger for me, when I feel that I am being attacked, heck I yelled at the social worker at the hospital & I'm not confrontational, at least in person. The reason I've been so upset in general is that she isn't showing the symptoms of dka, yet she goes there anyway. I yelled at the social worker because he asked me how they could help prevent this so she doesn't end up in the hospital & my answer was that when they find a way for us to give her sugar & insulin intravenously at home to let me know... That was the only way we could get her ketones to go negative & for her electrolytes to normalize. I have always been on the defense when it has come to her diabetes, because either people in general think they understand diabetes with no prior knowledge & think they know more than me by reading low carb cook books & searching online if they even care to do that. I have had to defend my child to have the right to check her blood sugar at a restaurant, where the waitress would tell us that she needed to do her management in the bathroom. When she first started kindergarten with the after school program, they absolutely refused to help her, at 5 years old, & required her to do it herself... She was diagnosed earlier that year & we were still at the point where we as her parents had to hold her down for her injections. I ended up pulling her out of that daycare which was in her school district & took her to her old daycare which was an hour away from home & I no longer worked in that area. However they were awesome at her old daycare, because she was going there when she was diagnosed. Thank you for all of your questions to help me make the best decision based on the current issues. Her bg's were higher than normal yesterday after school, but her ketones were negative... She started to gag this morning & her bg was around 105 & had trace ketones. I did call the clinic yesterday when they opened & the triage nurses did agree that her symptoms were unusual & to just keep an eye on her (while at school), because she already misses enough school as is & her grades are suffering from it. Thank you again & I will keep you updated on what is happening & answer any questions that arise. ~ Michelle

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NoraWI

Michelle, children are difficult enough to raise without special issues such as diabetes. I raised 3 (without diabetes) and it certainly was a relief when they grew up and went on their own. Teenagers are rebellious even without the encumbrance of diabetes. I wish you the best in getting a handle on what is happening with her.

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stinastina

Michelle, I would not listen to the nurse and if you can afford it, take her to the ER. I'm a T2 and had bs #s similar to your daughters and developed dka due to my medicine. Dka happens at a metabolic level until you completely break down. The only symptom I had was feeling too tired to get up (I probably had mental confusion by that time). My doc said I had been ill for a while because I had a severely high number of acid in my blood, low potassium, low phosphate, bad anion gap and low beta hydroxybutyrate. Meanwhile, all I felt was tired. Since she is young, she may just keep going. 

 

I had the same treatment in the hospital - iv fluids, then sugar & insulin. They sent me home on lantus & novolog but so far I can't get my numbers down. I need metformin as I believe I am extremely IR.

 

Dka when your numbers are "normal" is called euglycemic dka. Does she have an endo ?

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BigMouithXXX

mrinkey, I understand your anxiety and snapping at Nora but she was correct.  She had to assume you believe 150 - 180 is normal.  

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