Recovering From Dka

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Transitioning Safely From Intravenous To Subcutaneous Insulin

Current Diabetes Reports Authors Kathryn Evans Kreider, Lillian F. Lien Abstract The transition from intravenous (IV) to subcutaneous (SQ) insulin in the hospitalized patient with diabetes or hyperglycemia is a key step in patient care. This review article suggests a stepwise approach to the transition in order to promote safety and euglycemia. Important components of the transition include evaluating the patient and clinical situation for appropriateness, recognizing factors that influence a safe transition, calculation of proper SQ insulin doses, and deciding the appropriate type of SQ insulin. This article addresses other clinical situations including the management of patients previously on insulin pumps and recommendations for patients requiring glucocorticoids and enteral tube feedings. The use of institutional and computerized protocols is discussed. Further research is needed regarding the transition management of subgroups of patients such as those with type 1 diabetes and end-stage renal disease. Introduction Intravenous (IV) insulin is used in the hospitalized patient to control blood sugars for patients with and without diabetes who may exhibit uncontrolled hyperglycemi Continue reading >>

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Popular Questions

  1. Shama

    I was diagnosed as t1 four weeks ago. I was admitted to hospital with BGLs of 19 and ketones were 5.5, so I was DKA.
    I spent 24 hours in emergency while they brought down my ketones to zero then spent another 8 days in hospital getting stabilised and learning how to inject insulin etc.
    My question is: how long does it take to fully recover from DKA? I went back to work yesterday and was exhausted after 7 hours (including a short lunchbreak). I deliberately didn't do very much; just got through my backlog of emails and did a bit of reading. When I got home, I perked up a bit after dinner. Today, it was the same at work but tonight I am SO tired I can barely walk and I can't do *anything* other than sit and watch tv. I can't keep doing this. I need to be able to function at least a bit in the evenings, and this is without me doing my usual job of answering complex (and long) phone calls and emails. Is this normal??
    I wasn't in a coma (I walked into emergency). I lost 3kg in the fortnight before I was admitted despite eating heaps, and lost more weight before that. I had a lot of muscle pain and muscle cramps before diagnosis, and couldn't walk up a hill without having to stop all the time to catch my breath. (plus the classic insatiable thirst and peeing heaps)
    When I first got out of hospital I basically just tried to get on with normal life and started exercising, ie a 20 minute walk most days. Then I carried lots of heavy boxes (long story) over several days. I was fine at the time then lost some stamina late last week. The DE (after I'd done all this exercise, not before!) said now was not the time to hit the gym, just as a throwaway comment. I didn't ask her to elaborate but did scale back my daily walks a bit.
    I'm going to ring the DE or endo tomorrow to see if this is normal and if I need more time before going back to work (I'm not driving yet, hubby can't afford to take time off to pick me up early each day and the bus home involves two 15 minute walks each end and a 45 minute bus ride). But I would like to know other people's experiences with DKA recovery, particularly if it was a pre-diagnosis one with several weeks of symptoms.
    Thanks in advance :)

  2. Magenta76

    Hi Shama, sucks that you have to be here, but glad that you found us!!
    I, unfortunately, have a LOT of experience with DKA's... (something like 9 or 10 in 13 years of diagnosis) Each of them the recovery time has been different.
    My diagnosis, I have no idea what my level of ketones was, I know my BSL was 30something, and I was incredibly ill, and weighed something ridiculous like 50kgs.... with hindsight I was probably presenting symptoms at least 2 or 3 months before I was diagnosed.
    After my diagnosis, I took the probably set standard, month off. I went back to work as a chef after that, I don't really remember what it felt like, I was 22 so I probably was not too bad. I think we all would have different recovery times to anything and everything, so I don't think anyone could give you a straight answer on how long it will take for your body to go back to "normal". Talk to your HP's but take it day by day would be the best bet. Not really helpful, I know, but can't say any more than that.
    My last DKA was extremely severe. We're talking coma, organ failure type stuff. That was 18 months ago. My body is still recuperating from that one. I know that for me, each time I have a DKA, the whole episode is worse, and I take longer each time to get better. I just wish I discovered and knew about all the triggers for me. Stress is a large factor for about half of mine, which unfortunately means that when I get the all clear to work again, I have to change my career.
    Good luck with everything, and I hope you are feeling better soon. Try not to overdo it. Your body would still be adjusting. Let it. :)

  3. tantan

    Hi Shama,
    I have a similar story to you. I was diagnosed about 4 years ago, with ++++ ketones (whatever that means), a BGL of 32.7, and weight loss of 9kg in the preceding 3 and a half weeks. My understanding is that DKA involves the body basically chewing up fat because the lack of insulin means it can't access the glucose in your body, even if you're eating lots of it! So a lot of that weight loss is coming from storage (and we all need some fat storage for normal functioning! :-) ). At the end of the day, it will take a body awhile to replenish those stores, work properly again, and get back to the state it was at prior to diagnosis (and prior to the weeks leading up to diagnosis).
    I can't remember how long it took me to recover fully. I was diagnosed several weeks before Christmas, which was a massively busy time at the company where I was working. The doctor at the hospital gave me a medical certificate for at least a week off, but I actually only took about two days. However, I only worked shorter days for at least a week, maybe two, once I went back. I wasn't allowed to drive, so my co-worker would pick me up in the morning on her way to work, and my husband would pick me up in the afternoon when he finished at his work (which was always about 1-2 hours earlier than my usual finishing time). I found that I felt better in the mornings, so that worked for me.
    I think the best one can do for one's body after something like DKA is to eat healthily and get plenty of sleep!
    All the best!

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