DKA
Seven Ambulances: What DKA Taught Me About Thinking I Was Invincible
Diabetic ketoacidosis is the most dangerous short-term complication of Type 1. Here's everything I wish I'd known.
I've had DKA seven or eight times.
Most of them in my teens and early twenties, when I thought I was invincible. Often with drink involved. Drunk, and not taking any notice of myself.
Every single time ended the same way. Ambulance. Admitted. Three to five days on a ward while they stabilised me. At its worst, the pain was crippling. DKA sucks the energy and the life out of you.
I was never invincible. None of us are.
What DKA is
Without enough insulin, your body can't use sugar for energy. So it starts burning fat instead. That makes acids called ketones. When ketones build up, your blood turns acidic. That's DKA, and it needs urgent hospital treatment.
What causes it
- Too little insulin. Missing doses, or not taking enough.
- Illness. Being ill pushes your sugar up. The classic mistake is stopping insulin because you're not eating. NHS sick-day advice is never to stop your long-acting insulin when you're unwell.
- Injury or surgery.
- Pump failure. A pump only holds fast-acting insulin, so there's no long-acting safety net. If delivery stops, DKA can start within 4 to 6 hours. That's why my "out bag" goes everywhere, with pens and needles as backup.
- Alcohol and drugs. In my case: being drunk, not paying attention, and thinking I was bulletproof.
The warning signs
- Very thirsty and peeing a lot
- Stomach pain, feeling or being sick
- Deep or faster breathing
- Breath that smells fruity, like pear drops
- Tired, drowsy or confused
- Blurred vision
They usually build over about a day, but can come on faster.
Know your ketone numbers
Check your ketones when you're ill or your sugar is high. Your team will tell you their trigger level. The NHS guide for blood ketones:
| Blood ketones | What it means | What to do |
|---|---|---|
| Under 0.6 mmol/L | Normal | Carry on |
| 0.6 to 1.5 | Slightly high | Test again in 2 hours. Call your team or 111 if you feel unwell |
| 1.6 to 3.0 | At risk of DKA | Contact your diabetes team or 111, even if you feel fine |
| Over 3.0 | You may have DKA | Call 999 or go to A&E. Don't drive yourself |
Your DKA kit, today
- Find your ketone meter or strips. Are they in date? Do you know how to use them?
- Ask your diabetes team for your sick-day rules. Write them down somewhere you'll find them when you feel rough.
- If you're on a pump, check your backup pens and needles are with you.
- If you drink, remember alcohol messes with your judgement. That's how it got me, time after time.
DKA is not a normal part of Type 1. Most of the time you can prevent it with the right knowledge, the right kit, and a fast response.
My DKA came from young stupidity, alcohol, and being completely disconnected from my own health. I wouldn't wish it on anyone.
Have the kit. Know the numbers. Never ignore the signs.
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