Diabetic Ketoacidosis

What is Diabetes Ketoacidosis (DKA)?

Diabetic ketoacidosis is a serious and life threatening condition that impacts primarily type 1 diabetics but can also occur in type 2 diabetics.

How does it occur?

It happens when your body can’t produce enough insulin to help your body’s cell absorb the glucose in your blood to provide energy to your body. So instead your body starts breaking down your fat. Your fat gets broken down by the liver for your body to use as fuel, usually occurs when you go a long period of time between meals.

When your liver breaks down the fat it produces acids called ketones. If fat is broken down too quickly, a buildup of ketones occurs in the bloodstream causing your blood to become acidic. Ketones can overflow from the bloodstream into your urine. If there is a prolonged buildup of ketones in the blood, it could lead to death.

How do I know if I have DKA?

Symptoms occur quickly, usually within 24 hours.

  • Excessive and prolonged thirst
  • Stomach pain
  • Fruity-scented breath
  • Frequent urination
  • Weakness or fatigue
  • Confusion
  • Nausea and vomiting
  • Shortness of breath
  • Dehydration
  • Headache
  • Deep, rapid breathing
  • Flushed face
  • Muscle stiffness

For more specific signs, you can use home testing kits to test for high blood sugar level or high ketone levels in your urine.

What should I do when I start showing symptoms?

Contact your doctor immediately if you are vomiting or unable to tolerate food or liquid, your blood sugar level is higher than your target range and home treatment is not helping, or if you have moderate to high ketone level in your urine.

Seek emergency care if your sugar is consistently higher than 300 mg/dL, you have ketones in your urine and are not able to reach your doctor for advice, or you show any of the other signs of DKA.

How can I prevent DKA?

  • Commit to managing your diabetes. Eat a healthy diet, engage in regular physical activity, take your oral medication and/or insulin every day as needed.
  • Monitor your blood sugar. Check 3 to 4 times per day, more if you are ill or under extreme stress.
  • Adjust your insulin as needed. Contact your doctor or diabetes educator to learn how to adjust your insulin.
  • Check your ketone level.
  • Be prepared to act quickly.

References

Mayo Clinic
Medline Plus

How to Have a Less Painful Insulin Injection

For all my lovely insulin dependents, are you scared of injecting your insulin tonight because the last one stung a lot? Are you having trouble finding the right place for injection? Have no fear, let me share with you what has helped me take on the fear of painful injections.

First of all, it doesn’t matter if you use a needle and vial or if you use a pen, if you’re dependent on insulin injections, you have to overcome the fear of the injection. If you’re on an insulin pump, I’m not sure if you’re lucky or not, I’d love to know what kind of experience that is to have an insulin pump attached to you at all times.

Before I continue, here is a .PDF file that answers some questions about injecting insulin that I think would be beneficial for all diabetics to know.

The best places to inject is your abdomen, thighs, arms, or buttocks. Injecting in to your abdomen has the quickest dispersal of insulin. You would choose sites 1-2 inches from your belly button in the fatty areas of your abdomen.

Injecting in to your arms and thighs are a slower dispersal of insulin. You should inject in to the fatty part behind the upper arm between the shoulder and elbow or the outer thigh 4 inches from the top of the leg and 4 inches from the knee.

Injecting in to your buttocks is the slowest dispersal of insulin. You should inject into the fatty tissue of the upper buttocks below the waist. Probably have someone you trust doing that.

Your goal is to aim for the fatty layers just under the skin. You need to use fresh needles with each injection to avoid painful injections. Your insulin should be at room temperature; cold insulin could cause a stinging when pushing down the plunger.

Before injecting, relax the muscles in the area you’re injecting in to. Pinch up as much skin and fat you can hold in your skin, then one rapid movement to penetrate the skin with the needle. A rapid penetration is less painful than slow-and-easy.

To help make it even less painful, use a short, thin needle. The thinner the needle, the better. You want to avoid long needles because it could penetrate in to the muscle. Injecting in to muscle is more painful and it could disperse the insulin too fast meaning the insulin won’t last as long as you need it to.

Another tip is rotating injection sites. DO NOT INJECT IN TO THE SAME LOCATION TWICE! This could lead to scarring and pain. Make sure there is at least half an inch distance between injection sites to avoid skin problems. Also, avoid scar tissue, moles, swelling or inflammation, and stretch marks. The thicker or tougher the skin, the more painful the injection. Rotating injection sites also helps the area heal nicer. Generally, you should inject in to the same area for at least 20 days so having 20 different sites in the same injection area is awesome!

To prevent insulin leakages after injection, pinch the skin before injection, rapidly penetrate the skin at a 45 degree angle, and release the pinched skin before you inject. After injection, leave the needle in for another 10 seconds before pulling the needle out, then place a clean finger on the injection site and apply a little pressure for 10 seconds.

As long as the insulin doesn’t come running out of the site like a little stream, you shouldn’t have to worry about replacing the insulin that was lost.

A last ditch tip to help minimize pain, you can use an ice cube to numb the area before you inject, just make sure the area is dry before injecting.

I hope this helps you with insulin injections. I know I still experience pain while injecting. Only just now I learned that a quick penetration is better than the slow-and-easy route I’ve been going. I probably should have known this because that is the way my pharmacist gives me the flu shot, like throwing a dart into my arm. The .PDF has illustrations for what areas to inject in to. For the last five months, I’ve been using my abdomen for injections but it has become so painful for me and I have so much stretch marks that I don’t have anymore places to inject so I have switched to using my thighs.


References

Diabetes In Control


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