Saturday, May 12, 2018

DKA and Type 1 Longevity

DKA and Type 1 Longevity
Several years ago I researched but could not find much info about DKA occurring long ago, in the 1940's and beyond. Common sense suggested that there had to be a lot of deaths due to DKA back then. There were no meters that allowed us to test at home, and urine testing was totally unreliable. Animal insulin that was injected once per day certainly did not make carb counting and basal/bolus control possible. My first meter was purchased in the mid 1980s, about 40 years after my diagnosis. My numbers were awful, and most were in the upper 200s and lower 300s. I might have had DKA some of the time. So how have I survived through those years? I did not know about carb counting until the late 1980s, and I did not start basal and bolus insulins until the mid 1990s. So that was about 50 years of poor control due to lack of the necessary devices, insulins and knowledge.There had to be many deaths resulting
from DKA in the early years. I never heard about DKA
(diabeticketoacidosis) until the new century, and I never tested for it until 2007. I think that those of us diagnosed that long ago, who are still alive and with good diabetes health today, must be blessed! I don't know how I managed to survive and stay healthy, but I did, and so have many others among the Joslin medalists. They receive medals for 50 and 75 years of living with type 1. There are almost 6000 people who have received the 50 year medal. and most of them are alive, without any serious diabetes related complications. What makes us different? Why have we survived those early years, and why did we not die from DKA back then? This question is what Dr. King and his research team are addressing at the Joslin Diabetes Center. The Joslin Medalist Study has been running for thirteen years, and more than 1000 medalists have participated. I participated in 2009, and again in 2017. Many interesting results have come from the study.
The above discussion was posted several years ago. A friend replied to my post. She had access to much of the information I was lacking. Here is her report:
From Brie Jontry:
"There is a HUGE span of time and circumstance between having ketones and going into DKA (a drop in blood pH so significant that the blood becomes acidic). For DKA, there has to have been a sustained absence of insulin for a lengthy period of time (I've read that LARGE ketones must have been present for at least four hours--so small-to-moderate would have been present even longer than that--for blood to reach the point of acidosis).
While you likely had small-moderate-large ketones growing up, from time to time, you weren't in DKA for a sustained period. If so, you would have died!
A BG of 250+ also doesn't necessitate ketones. It can come from poorly counting carbs, or other factors, but in the absence of illness and so long as there is *some* active insulin on-board, chances of developing ketones from high BG alone isn't likely.
Here is an article from Dr. Ponder explaining the difference between DKA and ketones:
https://www.facebook.com/stephen.ponder.9/posts/3695328899194
A quote from Wikipedia on Diabetic Ketoacidosis:
"DKA is a medical emergency, and without treatment it can lead to death. DKA was first described in 1886; until the introduction of insulin therapy in the 1920s, it was almost universally fatal. It now carries a mortality of less than 1% with adequate and timely
treatment."
"DKA is the most serious hyperglycemic emergency in patients with type 1 and type 2 diabetes mellitus, and is associated with significant morbidity and mortality. The mortality for DKA before the discovery of insulin was greater than 90%. This was dramatically reduced in subsequent years to less than 50% and was further reduced to less than 20% with the incorporation of antibiotics and forced hydration into the therapeutic armamentarium. In the 1950s, the mortality of patients
with DKA treated with high doses of insulin was reported to be less than 10%. In more recent years, the use of standardized written guidelines for therapy has resulted in a mortality rate less than 2%, with higher mortality observed in elderly subjects and in patients with concomitant life threatening illnesses."
Now I know much more about DKA, past and present, how about you?

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