Dka In Type 1

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If A Diabetic Person In A Remote Area Entered Dka, And Had A Vial Of Insulin But No Needles, What Other Methods Could Be Used To Provide Insulin? (type 1 Diabetes)

For those that don’t recognise the abbreviation DKA - it means Diabetic Keto-Acidosis, a serious imbalance brought on by very high blood glucose levels due to insufficient insulin, which the body uses to break down glucose in the blood to usable energy. In the absence of insulin the body begins breaking down fat for energy and releasing acids called ketones (principally acetone, just like the solvent used for nail polish remover.) This keto acid buildup starts playing havoc with the body’s systems, including the liver, the brain and the kidneys among others. If the level continues to increase, the body starts “shutting down” and one goes comatose and can eventually die. To partially answer the question, it’s reported that certain insulins can be absorbed through mucus membranes like under the tongue, the sinus walls in the nose and the anal mucosa. Opening the vial of insulin might prove to be rather tricky without breaking it, but I suppose it’s possible. Nonetheless, if the person is conscious a small amount of relief may be possible. If unconscious it’s going to be really rough, if at all possible. That person is in dire need of medical attention - quickly. Continue reading >>

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  1. Liang-Hai Sie

    Type I diabetic will develop a ketoacidotic hyperglycemic diabetic coma, and die if not getting their insulin, type 2 diabetics will have (very) high blood glucose levels, but most won’t develop a ketoacidotic hyperglycemic diabetic coma. While this isn’t good for their health, they aren’t in immediate danger of dying.

  2. Satyabrat Mahali

    Of adults with diabetes, only 14% use insulin, 13% use insulin and oral medication, 57% take oral medication only, and 16% control blood sugar with diet and exercise alone, according to the CDC.

  3. Mags Hussey

    Originally Answered: What would happen if a type 1 diabetic did not take their insulin for an extended period of time?

    A person with type 1 diabetes, depending on length of time since diagnosis, has essentially no insulin production. I say essentially nil, because studies have shown that winners of 50 year medals (surviving 50 years T1 is rare enough you get a national award, ceremony and medal), about 75% of those with the least diabetic complications have been found to have a little C-peptide production. That means their bodies still battle to keep producing beta cells (beta cells producing insulin and c-peptide being a cleavage product off insulin which is easily measurable) and their bodies immune system keep killing them off. I digress. Even those with tiny c-peptide production will die without insulin, the question is when. Days would be my estimate. C- peptide is also used a medication nowadays to prevent diabetes complications.
    I've had T1 30 years. If I omit insulin for 12 hours (background/basal and bolus) and eat regular foods, my blood glucose level would be over 33.3 mmol on the meter i.e. Unreadable. I would have very high blood ketones (which means acidic blood and cells not able to access glucose for energy so fat has broken down uncontrollably to feed the body instead causing an unwelcome acidic environment). and I would now require hospitalisation. If I took no insulin but went without food, specifically avoiding carbohydrates which drive glucose higher, I might make it to 2–3 days instead before needing hospitalidation as low carb can stop the body reaching such high blood glucose levels so quickly. But it would get to >33.3 mmol unreadable in 2–3 days regardless. Restabilisation isn't just a matter of taking insulin at that point. We are often tempted to take a giant stick of insulin to deal with ourselves but this is not advised.
    The body is too dehydrated, the blood is thick and acidic, pH as low as 6.9-7.0 (normal 7.4). Bicarbonate is low, Potassium and sodium electrolytes are imbalanced due to excess urination so hourly blood arterial gases for Co2, bicarbonate, pH and potassium are forced upon you. A saline IV perhaps with bicarbonate and /potassium is inserted depending on your blood results. An ekg is on you non stop as the potassium and sodium imbalance has wrecked your heart rhythm. Your input of fluid by IV and output by vomit (there's a lot of that) and urine is tallied up and tried to be balanced out. With the IV drip. Your kidneys might have shut down. Temporarily or permanently. It would seem obvious that The big concern is of course to lower your blood glucose, but done too rapidly or not at all and the brain tissue swells, causing brain injury, coma and death. Look up kisses for kycie, whose t1 diabetes was misdiagnosed and thus endured brain swelling and passed tragically 7 months later. This happens all too often. But it is the cause of death in 3% of known t1s. A bout of no insulin for 2–3 days whether accidental or purposeful can mean death, a stay in ICU, a week in hospital to correct slowly. It is an ugly way to die.
    There are early signs a person is not taking sufficient insulin if a person is not checking their glucose or hasn't access to a meter or is not yet diagnosed - heavy breathing, acetone breath, stomach pains, vomiting. Weight loss (I lose 3kg in one day of no insulin). Frequent urination, incessant drinking and thirst. Fatigue, lethargy, stupor, coma. Kids being out of sorts, not growing, wetting the bed, soaked diapers, moodiness in teens and adults.

    If you have diabetes, don't mess with your insulin. You dice with death but risk being brain injured, on dialysis or comatose forever.

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