So am I?

Doc: "Type 2 diabetics don't have to worry about DKA (diabetic ketoacidosis), it only affects type 1's."
Me: "But I'm type 2, and I've had two DKA episodes now."
Doc: "Hmm, yes. About that..."

Since my type 2 diabetes diagnosis around fifteen years ago, I've been labouring under the impression that type 2's can't end up with DKA. It's common knowledge; it's a condition reserved for type 1's.

This time last year

So my first episode was almost twelve months ago to the day, and I was feeling really, really poorly after a viral infection. I hadn't been able to eat for a couple of days, and I was vomiting. We got our next door neighbour to drive me to A&E where I expected to be sat around in the waiting room for at least eight hours until a doctor told me to go home and stop wasting their time. At this point I was so ill that I just wanted to lie on the floor and die. Seriously, even sitting in a chair wasn't enough. I just wanted to be as low down as possible, on the floor tiles and just to fade out of existence.

With help, I managed to be seen by triage nurses who took some bloods and asked me to go back to the waiting room. To my surprise, no more than a few minutes later two nurses and a wheelchair came barrelling out of the double doors to collect me and rush me to "resus". I vaguely remember one of them saying something to me about high ketones and dehydration. I wasn't sure what all the fuss was about at that point as I believed slightly raised blood ketones weren't something to worry too much about. I soon found out that they weren't 'slightly' raised, and it was indeed something to worry about had I been conscious enough to appreciate it.

The next twenty four hours were a bit of a blur of 'sharp scratches', cannulas, glucose, insulin and fluids. Lots and lots of fluids, and an array beeping machines and monitors clamped to a pole next to the trolley I was laid on. I came to every now and again as a nurse or doctor came to stick something else into me and draw more blood for testing. My poor wife was worried sick, not understanding what was going on. I was beyond caring, I just wanted to sleep. I have a vague memory of a couple of clusters of plain-clothes doctors coming to see me during the night. They wanted to know how I'd managed to get DKA, as if I'd been busted whilst trying to access something I wasn't entitled to. They had to make do with my steadfast pleads of ignorance and then they went away again.

I was eventually moved to the Medical Assessment Unit in a different part of the building where there were other occupied beds. The nurses were friendly and chatty and I spent time just absorbing the comings and goings, my frequently-broken sleep interrupted again by another blood test, or the fluids bag or the sliding scale syringe needing changing. I recall people trying to get me to eat something, but the mere thought of food was enough to make me feel like vomiting again. Our next door neighbour worked in MAU at the time, and came to see me. She asked if there was anything she could do, but I just wanted that elusive sleep.

Only a few hours later I was moved again, this time to a men's ward. It was now the early hours of the morning - breakfast time is early in hospital - and people tried and failed to get me to eat something. Another doctor with a small entourage of note-scribbling subordinates came to see me and he tried to get my confession about how I'd come to have DKA. I told him that I'd had a viral infection in the few days prior to coming to hospital. He seemed partly appeased but suspicious before floating off with his groupies.

I eventually got discharged after a few days and sleepless nights. I'd had to wait until I was able to keep food down, and then had to eat a few meals before I was taken off the sliding scale insulin/glucose combo.

For the last twelve months I'd been relatively fine. I've been aware for ages of course that I don't properly fit the type 2 diabetic profile. Even though I try to keep my blood sugar levels low, favouring a mainly ketogenic diet and I walk - a lot - I often get weird curve balls where I get unexpected prolonged highs and lows. It can sometimes take ages for a bolus injection to start to lower my sugars to the point that I re-dose and end up stacking with predictable results.

Hospital redux

Having started with a vomiting bug last Saturday afternoon, I'd suffered with it until the Monday morning. My stomach was empty, but still I was bringing up just water, really. My wife was concerned about my shallow and rapid breathing, but we put it down to a side-effect of the puking bug. By Monday morning I felt something was really not right. For want of other options I rode an Uber to A&E and admitted myself. Again, only a short time after being seen by triage, I was in a wheelchair and headed for the "resus" team.

After looking at my chart, one of the staff apparently made a comment that I "hadn't been looking after my diabetes", and was "uncontrolled". My wife heard the comment, and put him right but to be fair it said 'T2D' on my medical records, so I suppose some false conclusions could have been drawn.

This time I was flat on my back for five days with even more fluid and medication lines in me than before. I was finally free of the cannulas and catheter, and was mobile on day six but I lost so much strength during that time, plus my system had taken a bit of a beating so it's going to take a while to recover.

The big reveal

On Thursday morning, another doctor came to see me to discuss what had happened. We talked about how long I'd been diabetic, the erratic, unpredictable nature of my blood sugars and how this was the second time I'd been admitted for DKA. I stressed that I knew I don't act like a typical type 1, and told him that I'd asked for a test years ago but had not been given any results. He got all interested at that point and mentioned to one of his juniors that they should chase it up.

Only half an hour later, he came back and told me that the type 1 test results had come back 'strongly positive'. Added to the fact that this was DKA number two, he said that I'm not type 2, but type 1 as I'd long suspected. At least I know what I'm dealing with now.

Off the sliding scale medication and free from tubes in my arm, I spent another two days waiting for the go-ahead to go home. I waited all day on Saturday for the pharmacy team to bring my meds and they finally arrived in the evening. My medical records are being updated to show my new condition and I have a new meter and test strips for blood ketones in addition to my existing Libre 2 CGM. On the plus side, I've also been given both Omeprazole and Gaviscon bottle on repeat so my stomach should be a lot more comfortable and allow me to sleep through the night.

My wife came to meet me when I left the hospital, as I really wanted some fresh air and a leg-stretch on the way home. I quickly discovered how much strength I'd lost even though it was downhill all the way. On the plus side, my dog Fyodor was really happy to see me home, and I got to sleep in my own bed last night.

I'm so grateful for the medical team that looked after me this week, especially the nurses and HCAs. I've got my next appointment with my diabetes consultant in early April. Hopefully I should have a lower A1C by then, and I'm going to ask about getting put on a DAFNE course sooner rather than later. Hypo's aren't fun, especially when I should be sleeping!