Wednesday, 26 March 2014

DKA

This will be a long post so...Let me start from the beginning, last week my wisdom teeth started hurting me so we went to the dentist and he said they were mildly infected, but if they got worse to go back and he would give me antibiotics. Cut a long story short my teeth failed to get better and my blood sugars were all over the place- hovering around 15-20 despite copious amounts of insulin. On Monday morning, everything spiralled out of control really. I woke up early with a small amount of ketones, corrected and fell asleep again. When I woke up the ketones were larger and I just generally felt terrible; even giving insulin with my pen didn't touch them or my blood sugars. They were 6.1; they should be 0. I could hardly move without feeling like I was going to throw up...fast forward a few minutes and I threw up about 4 times. My parents decided it was probably best to go to A&E so we went.


Arrived at the hospital at about 9am and waited for about 10 minutes before a nurse came scurrying through. I can't really fault the hospital this time; everyone was really nice and really on the ball with everything. They knew what they were doing. I.V's were set up. One in my left wrist, another on my right hand. I felt so nauseous that I didn't want to do anything but lay down, once the saline started to kick in I didn't feel as nauseous. I also had an injection in my stomach to prevent blood clots and that hurt- it stung for at least two minutes after. The A&E doctor was very funny and made me smile; he said "I always like to inject some humour into the situation. It normally makes people smile". Once everything was all set up I was seen by various doctors including the diabetes team. (may I just mention one of them was very good looking indeed) They I would be admitted overnight because my blood was acidic and I was definitely in DKA. I was taken up to 'Quince ward'...a name that my parents, sister and I laughed about for a few minutes.

"Where? Quincy?!"
"No I think they said Quince"
"Who? Quasimodo?"
(We knew what they said really...but thought we would joke about it for a few minutes)
That made me laugh quite a bit; I was surprised I managed to keep my spirits up despite how unwell I was.

I was in A&E from about 9am till 12-ish? I was taken up to the ward which I can honestly say was about 95% OAP. That's the thing, you go from the children's ward with screaming babies to the adult ward with a bunch of old ladies, but my little friend Winifred was adorable and always smiled at me so I suppose that made it slightly better.

Que Arterial Blood Gas number 1. The doctors were surprised that I looked so "well" despite being so not well. They wanted to do an ABG to test the acidity of my blood again to see how things were going. It was improving slightly but not enough for me to look as I did; so perhaps I'm just fabulous and look great even when on the verge of a coma? I'm kidding. I still looked like a troll and felt rubbish; I just don't like feeling sorry for myself because that doesn't make things any better; plus I don't like looking like an invalid. So a few more hours passed and I just sat on the bed playing games on my phone. My blood sugar was tested every hour so about a million finger pricks passed too.
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Arterial Blood Gas number 2. Really? The last time I was in DKA I had one and that was bad enough. Having two was not ideal. A nice young lady doctor came in and did it for me, thankfully the blood came out pretty quickly and it was over in a few seconds. "Good job, you hardly flinched!" I find that I have quite a high pain tolerance for those kinds of things so it was bearable despite it being such a grim blood test. After that one of the doctors from the intensive care team came down to see how I was doing- then my eyes started doing some witch craft on me and it felt (and looked) like they were going cross-eyed; that puzzled him for a few seconds while I said "Hold on. My eyes feel really weird" Then they stopped and that was the end of that.

The day nurse was really nice. She was quite chatty too so that made things better. My mum, dad and sister were with me for the whole day on Monday but then my mum had to go to work, so my auntie came to see me with my little cousin. The lady in the bed next to me was being discharged so as she was leaving she said "Do you want my TV?" Basically you could rent a TV while you were staying on the ward. "It's paid for until tomorrow?" I accepted and then my dad and the nurse went next door to unplug the TV and put it in front of my bed. I thought it was really nice of her to do that. I sat and watched New Girl for a little while before I got distracted by my phone. The signal was terrible though so I couldn't do much without holding my phone about 20 feet in the air to even gain one bar. I had another blood test done and my veins would not bleed. So the doctor said, "do you mind if I look and see if we can do it from your foot?" I nearly choked on my tea at the thought but of course, I said okay. So he tried, no blood. Then eventually got it out of one of the small veins on the underside of my wrist.

The most annoying thing was having to wait for a nurse to disconnect me from the I.V pumps so that I could go to the toilet. I was hooked up to three pumps and two fluid bags- the pumps were also plugged in and charging so I couldn't even take them with me. More boring hours ticked on, saying that, my family were very good at keeping me amused and some of the conversations the nurses had with one another were quite funny too. One was telling the other nurses about how one of the patients was refusing hospital transport to take her home and walking up and down the corridors waving a £50 note for a taxi, then she apparently "cancelled" her "dinner" with the nurse. It was quite humorous to listen to them talk about it.


 8pm came about and the shifts changed. My family went home and I sat listening to music. Then I was introduced to the night-nurse. He was quite funny. Always starting a random conversation with me about something. He came over and turned on the night light and said "Let there be light!" I started laughing because of the way he said it. I didn't fall asleep until about 1am, to be honest I didn't actually realise that I fell asleep, so when I woke up at about 5:45am I thought it was the middle of the night still but I then looked over at the windows and there was light peeking through the curtains. It always feels like midnight in the morning in hospitals.

 At 6am one of the doctors came round to do a blood test; it wasn't an  ABG this time either, thankfully. It took him so long to try and find a vein as well- my hands were really cold and most of the "good" veins were affected by the I.V so they couldn't use those. At one point he sat back in his chair and said "Do you know any good veins?!" then we both laughed. He found one in the end after about 15 minutes.

At around 7am I had my billionth finger prick test done. My blood sugar was 4.7. The lowest that it had been in days! This was apparently a little too low because the I.V insulin would have made me go hypo so the nurse came round and "bolused" some glucose into the I.V cannula to counteract the insulin a little bit. It was so cold! My whole arm was freezing afterwards and it actually really hurt. On Monday morning in A&E a doctor walked past and waved at me and it left me kind of confused, I was wondering who he was. Anyway I saw him yesterday morning and he said "You may have seen me floating about everywhere!"...Yeah. He looked through my notes.


"That's thing about with you diabetics! You always have so many notes to look through!"
He said the results weren't as good as he hoped they would be- "You're not fully recovered yet" but the doctors were doing the ward rounds so he said he would wait to see what he says. He wanted another blood test done so when the phlebotomist walked into the bay he said "Ah! This young lady here is the most important in terms of blood tests!" She came in, tried, and still no blood. Then she called in the doctor to do it. He eventually managed to do it. So along came the doctors and they said that I could go back onto my insulin pump and off of the I.V's after lunch, then they would monitor my blood sugar for a little while after that and then I should be able to leave that afternoon. A few minutes later the young doctor came back in to do a blood test, I can't remember all of the blood tests I had the past few days but it was definitely more than three- not including the ABG tests. For most of them I had the same doctor do it- and every time he left he said "Hopefully this will be the last time!" Yeah it wasn't the last time for 95% of them. Also, if I had a £1 for every time I heard the sentence "Sharp scratch coming!" I would be rich.


Que the third ABG test. After the doctors did their ward rounds I had another blood test. This one didn't go quite so swimmingly, I said "still no blood?" but he replied after a few moments and said "Wait...yep there it is!" Then said again..."Hopefully THIS will be the last one for definite" The doctor who saw me yesterday morning came in literally just before I was due to have the I.V stopped and he said "Bad news unfortunately! You're going to have to stay on the I.V a little bit longer" The results of this one still weren't so good because it showed that my "lactate" was raised which meant I was still dehydrated and also my blood hadn't restored normal acidity yet. Then, once again...the young doctor came in again to do another blood test, the third ABG and once again...he said "Hopefully this one really is the last!" He said I was really hard to get blood out of because my veins are small. A couple more hours passed and I sat reading magazines with my mum and sister and chatting away. The doctor popped his head round the corner and said "The results of that one were better!"

Then the diabetes team came back and saw me. They discussed more about getting me off of the I.V and back on to using my insulin pump by itself again, and then...they saw that my bicarbonate was high. Which apparently means that my body STILL wasn't fully recovered from the DKA. They wanted my bicarbonate levels to be much higher than what they were. So, once again- the I.V stayed on. The diabetes consultant said "Then let's do one more ABG to check that everything is better"


Que the fourth and thankfully FINAL, ABG test.
It was the young lady doctor who did my first one. She also commented on my little veins. It was over quickly and she said "This is probably definitely the last one" and it was...My blood tests returned to near-normal again and they said that they would turn off the I.V. Finally, it was turned off. But the nurse didn't want to take out my cannulas until she was sure about me being discharged. The last few hours were a battle to keep my blood sugar under 13 mmols. If they were under 13 I could go home. Before I ate dinner they were 17.7 so things were not looking promising. I had dinner and after dinner I tested on my own meter- 13.9. So CLOSE. It was about 7pm now and I corrected with my pump and hoped with every inch of my being that my blood sugar would fall below 13. The nurse came back in..."The on-call doctor said that if you can get it below 15 now, you can go home" Well by this point I knew I had it in the bag.

8pm- 12.1.
"Yay! You can go home!"
YES.
Finally. I was so relieved. After so many blood tests and finger pricks and seeing so many different doctors and nurses and listening to them silly I.V pumps beeping, and listening to the screaming old lady next to me and everything hospital-related. I could go home. Two days spent in that smelly hospital. But I can't really fault anything they did at the hospital for me, they were all so nice and genuinely knew what they were doing so it made the experience a little bit better. Finally my cannulas were removed, and I was out of there by 8:30pm yesterday.

DKA is a horrible experience and I hate that I've been through it four times in just five years but I come back fighting and never let type one diabetes get me down. I know I will struggle in my life with type one diabetes and DKA has been one of those struggles. But I kept my spirits up and I am okay now; that's the main thing. We figured out that the episode was probably due to my wisdom teeth being infected plus I wasn't feeling very well the day before with swollen glands and a sore throat, plus I have the "monthly curse" so hormones played their part in throwing everything off course too. As strange as it sounds I am looking forward to being able to return to school tomorrow- I suppose I just appreciate being able to be at school because being at school means you're okay and aren't in hospital or off sick because of blood sugar issues. After three days off I can finally get back to catch up with work and my friends. That's how you know you're a teenage diabetic...come out of hospital and one of the first things you think about is homework or school!

So, it has been a very tiring and long last few days, I don't know how I would have got through it without my mum, dad and sister being there. Excuse the VERY long blog post. I probably still missed things out of the "story" but that's okay- you all get the picture. I'm still feeling the aftermath of my hospital stay, especially with my bruised arms, hands and a small bruise on my foot. But they will go away, and so did the DKA and I can resume "normal" life. I say normal in quotation marks because a life with type one isn't exactly normal but it's my normal.



P.S I almost forgot! Yesterday a small irish lady called Sister Agnes came round to the bay to pray with the old lady next to me; then as she was walking out she stopped by my bed and had a little chat; then asked if I wanted Holy Communion; I am Catholic but I politely refused because well, I just wasn't feeling up to it. Then I thought she was going to leave but she started to pray for me. It was really sweet of her, but at the time I was thinking "What is she doing!?" But it was a lovely thing to do.

-Ellie

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