#818 Defining Diabetes: DKA

January 3, 2023Scott Benner

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny define DKA.

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Scott Benner 0:00
Hello friends, and welcome to the last episode of the eighth year of the Juicebox Podcast. This is episode 818

Welcome back everybody. In this episode of defining diabetes, Jenny Smith and I are going to define DKA diabetic Kido acidosis. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're enjoying Janney and you'd like to hire her you can she works at integrated diabetes.com. Are you a US citizen who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. And fill out the survey when you complete the survey. You have helped somebody living with diabetes, you're moving diabetes research forward and you may just help yourself T one D exchange.org. Forward slash juicebox. I have a little bit of time here. So I'm gonna say thank you so much for listening to the eighth year of the Juicebox Podcast, it was absolutely record breaking as far as downloads go. I can't thank you enough. If you're looking for a New Year's resolution that's achievable. Listen to a Juicebox Podcast series. If you're newly diagnosed, find the bulb beginning series. Trying to understand what all these words mean. Defining diabetes has over 50 episodes at this point, you're listening to one right now. And if you're really ready to dig in the diabetes Pro Tip series is the way to go. You can subscribe or follow the show for free on Apple podcasts, Spotify, Amazon music or wherever you get your audio even audible. Melissa says Pro Tip series set us on our desired path from the very beginning from a 12.9 a one C A diagnosis to a 5.2 in one year with a no honeymoon. You can find the series and more at juicebox podcast.com. Right at the top in the menu. Or you can go in the audio app you're listening in and just do a search Juicebox Podcast bold beginnings defining diabetes, diabetes pro tip, or how about the diabetes variable series, you think you know what's impacting your blood sugar, maybe you don't completely understand the diabetes variable series will help you to there's a mental wellness series defining thyroid, a collection of episodes about algorithm pumping. And don't forget the after dark series where people tell stories that most won't share. And finally, if you're looking for support, or community, the Juicebox Podcast private Facebook group is absolutely free, has over 32,000 members. And it's just waiting there for you so much good information. You can dive in and talk or just kind of sit back and watch. Whatever you need. That group has it. Alright, it's the end of the year, I did all my ads. So there's no ads in this one. Let's get right to Jenny and I talking about DKA. At the end, I will leave the links for all the advertisers if you need them. Just since you're so excited, I'll start the recording and then I'll tell you, so it's it's Friday. And I have two options today. We can either record for short defining diabetes episodes, which would be DKA MDI, meet the need and maybe something else. Or we could do this one, which I'm not going to be much help on. So that's why I'm asking you first I'll be able to like kick in with like, Oh, I remember doing that. But I need an episode. The people need an episode about the maths. I shouldn't say it like that. But the mass setting up Basal carb ratio insensitivity, like the real math behind that. Are you up for talking about that? Or do you want to do the emptyeyes?

Jennifer Smith, CDE 4:14
Let's do the let's do defining today. That's where my brain is today. I am just

Scott Benner 4:21
that's what I wanted to know. I didn't want to like spring on your like, we're gonna talk about math now. We'll do it later. The people will get it later. All right. Yeah.

Jennifer Smith, CDE 4:29
No, and I think I entirely agree. I think it's a big piece that you know, most people are just given these doses. And they're like, okay, because that's all they know, to say is okay, I got this new thing, you know, so you tell me and then eventually they learn more and they're like, why am I using

Scott Benner 4:51
and how do I come up with that number, but I just see people all the time, say like, my they told me this was my insulin to carb ratio, or they told me this was my insulin. sensitivity or whatever I I don't know where they came up with that. So okay, so if people are hearing this, you're about to hear a defining diabetes episode. But I imagine that by the time you hear this, our math episode will be up. So we will have Yes, we will do pick around, you'll find it.

Jennifer Smith, CDE 5:16
Good choice. Thank

Scott Benner 5:17
you. Do you see why I asked you? Because it's

Jennifer Smith, CDE 5:20
because it's more, it's definitely more in depth.

Scott Benner 5:25
It's mathy. And this Friday, I don't know where you're at. So

Jennifer Smith, CDE 5:29
yeah, I'm not at that on this Friday.

Scott Benner 5:33
Exactly why. And I think this is an exciting moment. Because, as Jennifer will tell you, I've never once told her asked her if she was up for doing what we were doing. Well, this is what we're doing today. And she's like, all right. Yes. So thank you for asking on this. Friday seemed important. The other stuff is, is conversational. Like, it isn't to the people listening because they don't have the knowledge. But for us, you know, if to pull the curtain back, you know, I'm gonna say in a minute. Hey, Jenny, let's talk about, we're gonna define DKA. And I'm gonna say something. And then, before you know it, it'll be 15 or 20 minutes later, and we'll have a clear explanation of the Hey, in a short conversation, because that information is in our head already. And we don't we hope that it's clear. Listen, better be clear. Have you ever listened to one of our episodes and thought, oh, we should have read on that?

Jennifer Smith, CDE 6:26
No, of the ones that I have. I've listened to most of them, I think, at least once? And I don't think so. Although, sometimes some of the older ones, as we've talked before, I think there's more to some of them now. Yeah. Because of other things that just weren't there to talk about or include.

Scott Benner 6:47
Previously, I'm trying to get I'm trying to clean up some of my list right now at the end of the year. And then I assume you and I are going to talk more about adding on to to the previous stuff. So okay, well, I love the defining diabetes series, because almost every time I say to you, Hey, Jenny, let's define blank today. There's a voice in the back of my head that says, you don't need to do that people know what that is. But then that's never the case for everybody. Somebody always doesn't know what a CD is. Or, you know, my favorite example is that I got a letter one time where the woman was like, I didn't know I was MDI until you told me. Right, but I absolutely, I've been doing it for years, like so. Anyway, so today DKA, diabetic ketoacidosis.

Jennifer Smith, CDE 7:35
Yay, define it. I think even defining it in terms of what the acronym is, is important, because most people just know it as DKA. And they're like, Well, I don't know what that means. Not only do they not know, it means like in words, but they just don't even know what it involves. Right?

Scott Benner 7:52
They just know they don't want it. Right. Yeah.

Jennifer Smith, CDE 7:55
No, nobody wants.

Scott Benner 7:58
I know, I don't want it. And I might have to go to the hospital if I have it. And I don't think so. Okay, so let's go through it. Yeah. I'll start with the Mayo Clinic. I like them. Oh, yeah. Okay, diabetic ketoacidosis is a serious complication of diabetes. That condition develops when the body can't produce enough insulin. Insulin plays a key role in helping sugar, a major source of energy for muscles and other tissue entering cells in the body. Without enough insulin, the body begins to break down fat as fuel. This causes a buildup of acids in the bloodstream called ketones. If left untreated, the buildup can lead to diabetic ketoacidosis. If you have diabetes, are you at risk of diabetes? Learn the word we know that part. Okay. You want to talk to me to give you the symptoms of decay?

Jennifer Smith, CDE 8:46
Well, the symptoms I can certainly do that unless you would like to

Scott Benner 8:50
roll through Jenny,

Jennifer Smith, CDE 8:51
let's go. Yeah, absolutely. Some of these can come even if you're not technically in DKA, but are definitely something to consider thirst. Like, I always say this is like extreme thirst. I still to this day, remember how thirsty thirsty I was before my mom took me to the hospital. Okay. It's like parched to the degree that you could just have like a water fountain attached to your mouth and you still would not feel like you're getting enough water.

Scott Benner 9:25
Someone just yesterday was talking about the diagnosis of their young brother nine months old. And he said something I don't think I'm ever going to forget. My brother was sucking the liquid out of the wet wipes. Oh, wow. And I thought that's so clearly illustrated. The just it's not just an urge, you know, right. Yeah, like just Yeah, just a primal thing. Like your brain is just find liquid put it in your mouth because I've heard people say, I caught my kid drinking out of the toilet. And that's shocking because If the toilet but it's not rocking, it's also a big bowl of water and the kids thirsty. So you're like, Okay, that makes sense, right? But sucking the liquid at nine months old out of a wet wipe, I thought that really, that puts a clear description, right.

Jennifer Smith, CDE 10:14
So I think to define that symptom even a little bit further from an understanding of like biology, what's happening in the body is the high levels of glucose, your body again, tries to do what it can, right. And so it tries to clear that excess glucose out. And that pulls fluid from other areas in the body. And so you get dehydrated with the high levels. And the thirst just keeps going. Because a second symptom that goes right along with thirst is going to the bathroom all the time, like, all the time to the degree that you can't wait to have five minutes to just leave whatever you're doing and go to the bathroom. Again,

Scott Benner 11:00
it just keeps happening. And this is your body's kind of way. It's it's last, its last ditch effort to try to remove these toxins, even though this isn't going to work. Right? Correct. Yeah,

Jennifer Smith, CDE 11:11
right. Right. Because of the extreme deficit of insulin, right? There's only one way to get the body to kind of shift gears. And in the whole grand scheme of things besides insulin, there are electrolyte imbalances and things that are also going along with the ketoacidosis, too, that need to be righted, obviously. But definitely thirst and extreme urination. I you know, for little, little kids. It's really heavy, consistent wet diapers, as well. Okay. For little kids who've been potty trained. It's often that they sort of revert back to wetting the bed, or not being able to get to the bathroom fast enough during the daytime and wetting their pants. Yeah.

Scott Benner 11:59
I was gonna go down a different road. But I want to keep I'm not going to Oh, yeah, so I'm gonna stomach pains, the feeling of throwing up or needing to throw up or to actually throwing up. It really is. Can you hear that? I can buy your truck just went by and I was like, I can't believe you can't hear that. It's just for you. Apparently, sorry. I'm hearing voices. Jenny. This is it. So, you know, shortness of breath, fruity scented breath, which is the thing that finally pushed us over the edge with Arden. And confusion. But now is the initial DKA at diagnosis and a DKA that you could run into after you're diagnosed and you're getting insulin. They're the same thing. But do they Yes, but they present. They can present differently? Because? I mean, why do I mean that because when you're being diagnosed, it's not everybody. But you could be experiencing a slow shutdown of your insulin production. So this thing could come on more slowly.

Jennifer Smith, CDE 13:07
Where that yeah, that's a good I guess, description of the difference, because I remember I was thirsty for a good two weeks prior to actually, my mom's like, we're going to the hospital, right, you know, I was thirsty, thirsty, thirsty enough to keep asking my friends for their milk at lunchtime, thirsty enough to stop at the bubbler? There I'll use a local term, the water fountain, in between classes, going into the bathroom in between classes, all of that kind of stuff. I remember also getting up overnight to go to the bathroom. I remember the week before also having thrown up overnight. But you know, at that, like early teen, I didn't really tell my mom Hey, I got sick overnight. Yeah, just I don't know. It was just whatever it is the brain at that age, right. So yeah, I mean, all of those, all of those kinds of things are a lead up in kids or even adults. Sometimes I think the adults who are diagnosed as type one in adulthood. It's even slower progression. Right. So well, in in the time when you are already diagnosed, though. DKA is more of a, as we've already talked about ketones, right. DKA is more of a it's a quick development, I guess, for lack of a better way. I hope that makes sense.

Scott Benner 14:39
Yeah, that's kind of what I'm saying is that if you're being newly diagnosed, you know, you might not even be listening to this. To be perfectly honest, this might be something that people only find after they found that they have diabetes, but my point is, is that if you if your recollection of it is that it came on slowly, you know, and then you found yourself in the hospital with somebody telling you you have diabetes and you're in decay Once you're on insulin, and your pancreas isn't helping anymore, if you lose your insulin, it's going to happen fast like, and it's going to be serious quickly. And that's that changes. You know, I think how you have to handle it, and we have that whole episode about dealing with ketones. So it's why I'm doing this after that one. I wanted to make sure that one was up before before this.

Jennifer Smith, CDE 15:22
Well, and I think people who also have type one in the family, I think this episode is important, just as even reminder of the common symptoms, because some people or kids may present with a few. Not necessarily all of these things at one time. So even though you may think you have eyes for watching for this, it's important to still be reminded,

Scott Benner 15:50
yeah, I think that based on what the doctor said in the hospital, and my being able to, you know, look back on the situation, I think if we don't go to the hospital when we do, I mean, I don't know what happens the Arden in the next 24 hours, really, you know, like she was in a bad way. Yeah, like they seem surprised that we've bit and to feel good about it. We they seem to surprise that we got her they're conscious. And they said so many kids at this age because Arden was too. She's like they come in unconscious or comas, you know, like really terrible stuff. And, and then when they asked like, how did you know? I said, I her breath smelled weird. And then I said that to my wife, and it sort of set off a chain reaction of us, like brainstorming together for five seconds and going oh, God, she has diabetes.

Jennifer Smith, CDE 16:44
Besides the breath. Did she also I know we defined this to the crucible. Well, she had those for sure. Did she have that too? Yep.

Scott Benner 16:51
We were sitting in a vacation home with a full family. It must have been like 16 people there. It was late at night. And we were playing a board game. And Kelly was still in her bikini I think in a rap like a sarong. And Arden was like draped over her lap. fall asleep, having those respirations and I guess it was just a pause and it and we just thought she was sick. You know, like and, and there was a pause in in the in what was going on? And I don't know why. But I said I said hey, I meant to tell you that Arden's breath smelled weird today. And she goes, What do you mean? I said it was like fruity or maybe metallic. Like that was what I remember saying. And then she gets this terrified look on her face. And then I think we both kind of like quietly in our head start doing the math. And I don't know who said it first. It might have been Kelly. And she's like, Oh, god, she's got diabetes. And this was before the internet, like the way you think of the internet now. So someone had a laptop, and we had to hang over the balcony of the vacation home to steal Wi Fi from another house to Google signs and symptoms of type one diabetes. Yeah. And then we saw like, there were like five things in a list. And then we called my buddy who's the kids pediatrician. And then he found a the closest Children's Hospital and kind of sent us to it. I mean, this is before you could get in your car and be like, I want to go to this like we were like in the middle of the night in a city we didn't know.

Jennifer Smith, CDE 18:20
Right, like driving and hoping you're following the right street to get there swear to

Scott Benner 18:24
you. None of you listening there were under a certain age understand that. But like, we didn't just get in the car and go oh, go to the hospital car. And the car was like, Okay. wasn't like that. It was really just a sad moment not to get too far off the path. But I remember I remember sitting at a traffic light on this, like, desolate Street. And Kelly and I like staring forward like almost on purpose not looking at each other. And I said, Hey, right now before we get there, like she's got diabetes, like get yourself. Right. I was probably talking to myself, but talking to her, you know, I'm like, because this is going to be this is about to be horrible, you know, and we need to hold it together. We were still pretty young. And you know, so far our life had been fairly ideal. Like, honestly, like, we grew up hard. We got good jobs, we bought a house like we thought things right, working, you know what I mean? And then suddenly, I'm just like, we're gonna go into a hospital and someone's gonna say this to us, and then all the things that come after it that we don't know. Right, you know, so instead of being tough, we went into a family room and cried after they took her they didn't go the way I thought we weren't all like it's gonna be okay.

Jennifer Smith, CDE 19:39
I'm surprised you sat at the stoplight. Those are the stoplights were like there's nobody around and I'm in a hurry. o'clock in the morning. I'm like, why am I sitting at a red light when there's nobody here? I can tell you why. And am I admitting to bad thing? No, no, not

Scott Benner 19:58
in any other situation. I would Look left look right and been like Scott's gone. But although nowadays they got the cameras everywhere. Right? Right. But But I did that twice that night. The first time was after we realized what was going on, I went to a, um, a pharmacy, a 24 hour pharmacy to buy a meter. And I stood in the meter, I'll I think, on purpose not choosing a meter. Because I had this conscious thought standing there. And I thought if I don't get one of these meters, she doesn't have diabetes. Like, that's how it felt I was gonna cry. I've never cried while I was doing this with you. I'm sorry. I thought like, I thought I'll just stand here forever. And she'll be okay. I'll never see her again. But at least you won't have diabetes, you know. And I made myself by the meter, I drove back. And then I think that stoplight was the same thing. I was like, I could go, but let's just sit here.

Jennifer Smith, CDE 20:53
Let's just give it some time before we get someplace and get news that we don't want to get. Yeah, give me

Scott Benner 20:59
two extra minutes of art and not having diabetes, I think is at the time. But anyway, that's nothing to do with DK and I need a tissue Hold on.

Jennifer Smith, CDE 21:07
I'm sorry. Well, it does have to do with DKA I think it's because these are all the things that go along with it, that it's not just defining something, it's it's important to know that all these emotions and these things, they're going to be there too. And that's, that's not wrong.

Scott Benner 21:27
I mean, so it's just it's one of those things that I mean, DKA could happen once you have diabetes, it could happen at any time. You can a bank cannula could send you there.

Jennifer Smith, CDE 21:38
You know, forgetting some people faster than others. Yeah, right. And so

Scott Benner 21:41
when you see these being very thirsty, urinating stomach pain, throwing up weak or tired shortness of breath, that you know where that fruity breath being confused. I mean, please, first of all, get yourself a ketone meter, there are blood ketone meters, they're way easier than peeing on sticks. And probably sitting there much more accurate, more accurate. Yeah, yes. And then you've got to go into your, into your sick day care. And you clear those up, they're going to clear those ketones, so you're going to end up in a hospital where they're doing it for you. And I don't know, I should find, as we're wrapping up, and you tell me if there's anything else we need to put here?

Jennifer Smith, CDE 22:19
I don't think so. I think that defines it in a, I mean, a simple way, the symptoms and why it's happening. That's the important piece of it. Yeah, what to do about it is clearly if you think that this is a new diagnosis, obviously, you need to just go get medical care. That's the you need the help. If you're at home, and you have really high ketones, like we've talked about in the ketone episode, you either give it a time to clear it, or if it's not clearing within, you know, a defined period of time. You go to the doctor, don't play with it.

Scott Benner 22:53
That's episode 805. It's inside of the bowl beginning series. It's called Bold beginnings, illness ketone management. So there you go. Oh, Jesus. I have to be honest. Yeah. I didn't think I was gonna get upset talking about you tricked me. That's sorry, don't worry. Oh, thank you for doing this. I appreciate it. All right. Holy crap. I didn't know he's gonna cry. Sorry. No, don't be sorry. I make people cry all the time. So don't worry about I was interviewing a guy yesterday, he got choked up talking about his brother. Next thing I know, I'm like, god dammit, I'm crying. But he just told this crazy. Uh, you'll you know, if you catch it, when it comes out. It's going to be an after dark. This guy and his brother were, they lived. Like, hold on, let me I'm gonna stop the recording for a second.

Sorry, I cut that off. I didn't want to give away an upcoming episode. This is pretty much it. It's the end of 2022. I want to thank you so much for listening to the show for subscribing in an audio app for telling other people about it. For participating in the private Facebook group. It's all very much appreciated. I hope you have a very happy new year. Let's say alright, I'm just gonna at the end here, I'll list all the advertisers their amazing support that they've given to the show for some of them for many, many years. If you need an insulin pump or a glucose monitor glucagon or something, it's a huge help to the podcast if you click through my links, so thank you for taking that extra step.

These links I'm about to give you are right on the front page of juicebox podcast.com And they are on every episode page for the specific episodes meaning like this episode here has a page on juicebox podcast.com. Okay, let's go with the first ever advertiser, Omni pod, bought an ad in 2000 wasn't in 15 when in a month, there weren't as many people listening as there are in an hour now, that's pretty much right. Yeah, took a month to get the amount of listeners in 2015 that in 2020 to happen every hour so on the pod was in early and supporting the show back when they really were just supporting the show. I mean, I don't think I was selling a lot Omni pods back then. Anyway, now you can get the Omni pod five or the Omni pod dash through my link Omni pod.com forward slash juicebox I think the next advertiser was Dexcom I think Dexcom was next Dexcom Of course, makes the Dexcom G six and the Dexcom G seven, you can find out more about that you may even be eligible for a free 10 day trial of the G six@dexcom.com. Forward slash juicebox I should throw in that I think you may be eligible for a free 30 day trial the on the pod dash at my link. But now that I said that I have to say for full safety risk information and free trial terms and conditions also visit omnipod.com forward slash juicebox. Alright, I didn't mean to get into that sorry. I think touched by type one was the next advertiser. Great organization helping people with type one diabetes touched by type one.org They're just looking for you to learn more about them go check out their websites very cool. They have a lot of offerings for type ones. I'm gonna say after that Contour Next One, I think the Contour Next One blood glucose meter fantastic meter contour next.com forward slash juice box may be cheaper in cash and you're paying right now through your insurance. One way or the other. absolutely accurate and amazing meter. We've been using it forever. It's fantastic. I'm gonna say that. Then it was je voc hypo pen, je voc glucagon.com forward slash juice box that is the glucagon that my daughter carries. In 2022. The in pen was a sponsor. They are not going to be back in 2023. So I'm not going to give you their link. And what else us med came on? It's 2022 They're sticking with us. Absolutely fantastic. This is where we're getting Ardens diabetes supplies from us med.com Ford slash juice box or call 888-721-1514 If you're sick of that place that you're getting your stuff from now, you don't want to bang your head against the wall like you are with some of the other distributors check out us med T one D exchange is not an advertiser, which might be confusing for you. I actually get paid every time you fill out a survey but I love what they're doing. T one D exchange.org forward slash juicebox. Go take the survey. You'll help move diabetes research forward and you'll help the podcast I think that's it. Oh no, no, no, no. Excuse me. In October Athletic Greens came on board. And they're going to stay for 2023 Thank you athletic greens. So if you're looking for ag one from athletic greens, it's athletic greens.com forward slash juicebox. I'm using it every day and really enjoying it. Alright, if you're still listening Europe, you're a great fan and I appreciate it very, very much. That's all I have for you Have a Happy New Year. I'll be back very soon with another year of the Juicebox Podcast