How to manage type 1 DM with diabetic ketoacidosis?

Question

Hello doctor,

I desperately need advice about my type 1 diabetes, which is getting out of control lately. My glucose readings have been swinging between 45 and 320, no matter how carefully I count carbohydrates.

Last week, I had three severe hypoglycemia episodes where my partner had to give me glucagon. The third time, I was unconscious for almost five minutes. My glycated hemoglobin (HbA1C) jumped from 7.2 to 9.8 despite increasing my Insulin (Novolog) dosage.

I have been experiencing this weird tingling in my feet that gets worse at night, and sometimes I cannot feel my toes at all. My vision gets blurred randomly throughout the day, especially when my sugar spikes.

The continuous glucose monitor (CGM) that I got last month keeps giving me false alarms, and the adhesive gives me these painful rashes that take weeks to heal. My endocrinologist suggested switching to an insulin pump, but my insurance won't cover it without better documentation, whatever that means.

I am losing weight even though I am eating normally. I have lost 15 pounds in just two months without trying. Is this diabetic ketoacidosis? The ketones in my urine test are moderate to high most mornings. I am worried about long-term damage to my kidneys and eyes. What adjustments should I make to my insulin regimen? Should I be hospitalized?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I am sorry to hear about your struggles with type 1 diabetes. Here are some points to consider:

Glucose control: Your glucose swings and high glycated hemoglobin (HbA1C) indicate that your current insulin regimen might need adjustment. An insulin pump could provide more precise control, so it is worth pursuing the necessary documentation for insurance.

Symptoms: The tingling in your feet and vision issues could be signs of diabetic neuropathy and retinopathy, respectively. These need immediate attention to prevent long-term damage.

Diabetic ketoacidosis (DKA): Moderate to high ketones in your urine, along with weight loss and high glucose levels, suggest you might be at risk for DKA. This is a medical emergency and requires prompt treatment.

Hospitalization: Given the severity of your symptoms, it might be wise to seek hospitalization to stabilize your glucose levels and prevent DKA.

Insulin regimen: Adjustments to your insulin regimen should be made under medical supervision. Consider consulting with your endocrinologist for a detailed plan.

Kindly consult a specialist doctor, talk with them, and take medications with their consent.

I hope this helps.

Thank you.