3. If you use an insulin pump, change your pump’s cartridge, tubing, and infusion set, using a fresh vial of insulin.
Failure to correct the problem could result in ketoacidosis in just a few hours.
Symptoms and Treatment of DKA
Everyone with diabetes who uses insulin should have a way to test for ketones. You can perform ketone testing by way of a urine dipstick or a fingerstick blood sample. (See Chapter 10 for ketone testing supply options.) Positive ketones are indicated by either urine testing that indicates small or more ketones (>15 mg/dl) or blood testing that indicates the presence of ß-Hydroxybutyrate (>0.5 mmol/l). Be sure to have fresh ketone testing supplies on hand at all times, including when you travel.
The presence of ketones in the blood is referred to as ketosis; the presence of ketones in the urine is ketonuria.
Ketosis and ketonuria are usually, but not always, accompanied by elevated blood sugar, thirst, and excessive urination.
This is a precursor to the more severe state of DKA.
Symptoms of DKA are more pronounced.
With DKA, you are likely to be nauseated or vomiting.
Your breathing may be very deep, and you could have a fruity odor on your breath as your lungs try to eliminate ketones when you exhale.
You will likely be dehydrated from all the urination, which is a result of the very high blood sugars.
This will give you dry skin, intense thirst, and a dry mouth.
Your vision may also be blurry; headache and muscle aches are common.
Call your doctor immediately if you have ketones in your blood or urine or if you are experiencing these types of symptoms.
Although fluids and insulin are the preferred form of treatment for ketosis, DKA is not something that you can treat on your own.
The severe dehydration that accompanies DKA usually keeps insulin from absorbing properly from below the skin, and vomiting may limit your ability to consume and absorb fluids.
Treatment of DKA almost always requires a visit to a hospital emergency department for intravenous administration of insulin, water, and electrolytes.
The acidity of your blood will have to be monitored very carefully at the hospital to prevent coma or death.
The length of your hospital stay will vary depending on the severity of the DKA, but expect to be there for at least a day or two.
There are a few things that you can do on your own prior to hospitalization. Try to eat light, easy-to-digest carbohydrates and drink at least eight ounces of liquid per hour. Diluted orange juice is a good choice because it replaces fluids as well as potassium that is lost with excess urination. Check your blood sugar and ketones every couple hours, and report the information to your doctor.
Remember: they don’t call it “insulin-dependent” diabetes for nothing. We depend on insulin to stay alive. DKA causes more than 80 percent of hospital inpatient admissions for people with type 1 diabetes. Practice the preventive measures described above, and stay in close contact with your health care team at the first signs of trouble. Diabetes management is truly a team effort!
LOSING WEIGHT SAFELY WHEN YOU TAKE INSULIN
There are good ways and not so good ways to accomplish just about anything. Anyone with diabetes can lose weight if they stop taking their insulin (or take less than they should), but that would only lead to serious health problems that are far worse than anything caused by carrying a few unwanted pounds. Diabulimia , a form of bulimia in which a person takes less than prescribed doses of insulin in order to lose weight, is extremely dangerous and usually requires intervention by a skilled mental health professional.
Also, there is nothing magical about very-low-carb diets when it comes to weight loss.
Very-low-carb diets are challenging to follow over the long term and come with downsides as well: lack of energy, reduced stamina, potential for unhealthy cholesterol levels, and blood sugar increases from protein intake, just to name a few.
Research has shown that just about any reasonable diet plan can result in some weight loss if you pay closer attention to what you eat and strike a favorable caloric balance.
The key is to find a plan that you can follow long term.
For those taking insulin, there is another caveat: you must find a way to lower your insulin doses
without sacrificing blood sugar control if you want to lose weight and keep it off. Remember: insulin promotes the uptake of fuel by the body’s cells, including fat cells. Less insulin means less fat storage.
Ways to Cut Back on Basal Insulin
• reduce overall stress levels
• minimize high-fat foods
• increase daily walking or other physical activity
• increase muscle mass
• take metformin
• take an SGLT-2 inhibitor
Ways to Cut Back on Bolus Insulin
• reduce carb portions
• increase fiber intake
• exercise after meals
• reduce snack frequency
• use Symlin or a GLP-1 receptor agonist
Hypoglycemia can stand in the way of your weight-loss efforts. Lows are a sign that you have taken more insulin than you need. Most lows force us to consume calories we would not have had otherwise, and overtreatment of lows can really jack up caloric intake. If you are working to lose weight and experience more than one low blood sugar per week at about the same time of day, cut back on the insulin dose that is working at that time.
CHAPTER HIGHLIGHTS
• Hypoglycemia is a major limiting factor in intensive diabetes control.
• Mild and moderate lows should be self-treatable. Severe hypoglycemia requires glucagon or intravenous dextrose.
• Proper treatment of lows should be customized to the individual and the situation.
• Loss of hypoglycemia symptoms (hypoglycemia unawareness) can be reversed by preventing lows for several weeks.
• Implement strategies to prevent hypoglycemia if you are experiencing more than a few lows per week.
• Taking bolus insulin earlier and/or applying strategies to slow the digestion of your meals can help minimize after-meal blood sugar spikes.
• A complete lack of insulin in the body can lead to diabetic ketoacidosis (DKA).
• Checking for ketones at the first sign of unexplained high blood sugar, and administering insulin and fluids if ketones are present can help prevent DKA.
Think Like a Pancreas
TEN
Resources for Everything and Anything Diabetes
It takes every kind of people
To make what life’s about.
Every kind of people
To make the world go ’round.
, Robert Palmer, “Every Kinda People”
Giving Support, Getting Support
F eeling the ups and downs of blood sugar swings. Handling the incessant responsibilities of managing a chronic disease. Trying to make sense out of a highly imperfect science. And facing the grim reality that, despite all your best efforts, serious health problems may be in your future.
Living with diabetes can be a frustrating, frightening, and sometimes lonely experience. If you have ever felt the need to reach out to someone who understands how you feel (someone who has
been there ), support networks may be just the answer. Even if you don’t feel the need to receive support yourself, the act of giving support to others is worth its weight in gold. Nothing will make you feel better and enrich your life more than helping others.
Opportunities for giving and getting support are widespread: both in person and online. And the beauty of it is that you can find groups that are general and diverse or highly specialized and tailored to your particular interests.
For an in-person type of support group, a good place to start is at your local hospital or diabetes treatment center.
If there is a diabetes association office near you, they probably have a list of support groups in your area.
If nothing exists near you, or if what exists fails to meet your needs, consider starting a group of your own.
If face-to-face groups are not feasible because of space, distance, or your desire for confidentiality, consider joining or starting an online chat room or group.
It truly takes a village to manage diabetes, so don’t hesitate to create one!
Resources are not limited to mutual support programs. There is also an assortment of clinical networks, apps, associations, websites, blogs, and product manufacturers ready to serve you. Below is a list of some of the resources we’ve found to be highly useful. They are organized in the following categories:
Associations and Organizations
Awesome Apps
Clinical Diabetes Experts
Financial Resources
Kick-Ass Products
Suggested Facebook Groups
Websites and Blogs
Recommended Books
(Note: All phone numbers are in North America unless otherwise indicated.)
Associations and Organizations
Academy of Nutrition and Dietetics
800-877-1600; eatright.org
American Association of Diabetes Educators (AADE)
800-338-3633; diabeteseducator.org/living-with-diabetes
American Association of Kidney Patients
800-749-2257; aakp.org
American Chronic Pain Association
800 533-3231; theacpa.org
American Diabetes Association
800-342-2383; diabetes.org
American Foundation for the Blind
800-232-5463; afb.org
American Heart Association
800-242-8721; heart.org
Amputee Coalition of America
888-267-5669; amputee-coalition.org
Assistance Dogs International
assistancedogsinternational.org
Bolus and Barbells (for people with diabetes interested in strength training)
bolusandbarbells.org
Celiac Society
celiacsociety.com
National Celiac Association
888-423-5422; nationalceliac.org
Children with Diabetes (regional and national programs and support services for children, young adults, and caregivers)
childrenwithdiabetes.com
College Diabetes Network
collegediabetesnetwork.org
Diabetes Canada
416-363-3373; diabetes.ca
Diabetes Education and Camping Association (DECA)
239-984-3554; diabetescamps.org
Diabetes Sisters (programs and support services for women affected by diabetes)
diabetessisters.org
Diabetes Training Camps (athletic training and diabetes management for teens and adults)
diabetestrainingcamp.com
Friends with Diabetes (Jewish programs and support services)
845-352-7532; friendswithdiabetes.org
Gluten Intolerance Group of North America
253-833-6675; gluten.org
International Association for Medical Assistance to Travellers (IAMAT)
716-754-4883; iamat.org
Jewish Diabetes Association
718-303-5955; jewishdiabetes.org
Juvenile Diabetes Research Foundation
800-533-2873; jdrf.org
National Diabetes Education Program
800-860-8747; niddk.nih.gov/health-information/communication-programs/ndep
National Federation of the Blind
410-659-9314; nfb.org
National Institute of Diabetes and Digestive and Kidney Diseases
301-496-3583; niddk.nih.gov
National Kidney Foundation
800-622-9010; kidney.org
National Library Service for the Blind and Print Disabled
800-424-8567; loc.gov/nls
Riding on Insulin (action sports for the type 1 community)
406-214-3266; ridingoninsulin.org
Taking Control of Your Diabetes (nationwide conferences and education for people with diabetes)
800-998-2693; tcoyd.org
TrialNet (diabetes risk screening and research supporting those at risk for diabetes)
800-425-8361; trialnet.org
We Are Diabetes (support for people with type 1 diabetes and eating disorders)
wearediabetes.org
WeAreNotWaiting (the Nightscout Project)
nightscout.info
We Are One (connecting healthcare professionals with diabetes all over the world)
858-755-5683; weareonediabetes.org
Local Type 1 Diabetes Support Networks
Cincinnati, Ohio: T1D Journey Inc., t1diabetesjourney.org
Maine: P-Pods, maineppods.org
Maryland and Delaware: Diabetes Destiny, diabetesdestiny.org
North and South Carolina: The Diabetes Family Connection, thedfc.org
Northern California: CarbDM, carbdm.org
Seattle, Washington: ConnecT1D, connect1d.org
Awesome Apps
Data Download and Reporting
• Accu-Chek Connect
• Contour Diabetes App
• Dario
• Dexcom Clarity
• Glooko
• OneTouch Reveal
• Tidepool Mobile
Data Logging and Sharing
• Blue Loop
• Diabetes Pal