Category Archives: type 1 diabetes

Diabetes ketoacidosis ABC


I have blogged about DKA before. 

DKA – diabetes keto acidosis. Starving in the sea of plenty. Too much sugar – way too much in the blood stream and not enough insulin to get it – the glucose into the cell. Did you ever do those experiments at school about osmosis, where water moves through a membrane to where it is being drawn? In this case the cells, so to speak, dehydrate and start to die and the vascular system is “loaded” with glucose. The cells are dry dry dry and have no way of doing what they need to do – metabolism – without which the human whose cells they are die.

A process begins and catapults quickly and rapidly into a serious life threatening environment which is hostile in the nth degree. Acidosis – pH below 7.4 is very unkind and unfriendly to human life.

The by-products of this deranged metabolism – which is by the way the bodies way of desperately trying to stay alive – are called ketones – these one can measure. 

NOW, a 100 years ago we did not know about ketones, about 50 years ago we discovered a way to measure them in the URINE – major breakthrough. About 20!! years ago we learnt how to measure them in the BLOOD – this is FAR more accurate – far far more accurate, in terms of being related to the timing of what is actually happening in the body as well as giving an accurate quantitative measure of the ketones. In other words one can more accurately monitor and wash them out if you are checking the blood ketones.

Generally speaking if a doctor uses urine ketones to monitor and treat you it will take up to 10 days to get rid of the ketones. IF the doctor uses blood ketones you can see that they disappear (if of course you are doing the fluids correctly and the insulin infusion) within 12-24 hours at the most 48. Not you tell me, patient, medical aid and family which would YOU prefer? Ahospital stay of 2 days or 10 days, one in ICU or one in a well run ward?

Is there a good reason to use urine ketones over blood ketones? No I really don’t think so, it is like using a horse drawn cart to drive to work.

Sorry but I just can not take it any more. Surely it is indelibly printed on your inside if you are a doctor that you wish to do NO harm and wish to HELP your patient to the best of your ability? The best of our ability at this point in time when it comes to DKA is using blood ketones (not urine ketones and yes the occasional blood gas does help but it is a painful investigation and one can very easily and safely manage with new techology).

blood ketones vs urine ketones

blood ketones vs urine ketones

dexcom difference


So I have 5 patients on Dexcom – continuous monitoring for diabetes. They are all type 1 patients (but type 2s could use this device too). It has made the hugest difference in terms of almost NO hypos ! Why? Because you see it dropping and you react !

Seems obvious but if you are diabetic you know how @@$$%% awful a low is. And being able to prevent is like a magic trick.

Also a lot less high excursions – you see the trend of it going up and you can exercise, run a temp basal or if really high like >15 do a correction bolus (aiming for not too aggressive otherwise you induce a see-saw pattern we are trying to avoid).

Delighted I am for them as well as all the other patients in the future that is it going to help.

The technology is simply one that works – an amazing little filament with embedded sensor that detects change that is fed into an algoryhtm. It is accurate, hard working, simply a wonderful armentarium in the diabetes tools.dexcom

Can I ask anyone out there to give feedback on their dexcom tips?

WE have a lot to be thankful for


This is an image of the dog with diabetes that was used to “test” the first insulin in order for it to be deemed safe for human use.

In this case it worked in the dog’s favour too.

Sometimes I think our research and testing does not though.

Technology does seem to come at a price and I really think we don’t stop and think about that price.

thanks to our animals with diabetes

thanks to our animals with diabetes

Before Banting and Best, a sad story


pre insulin

pre insulin

In the olden days, like 1900s and in fact up until not so long ago around 70 years ago, if you had type 1 diabetes the sad reality was that you died, starved in a sea of plenty. Without insulin glucose can not get into the cells where it is needed for metabolism/function. You slowly starve and die.

Banting and Best discovered insulin and have saved all type 1 diabetics this.

We are forever indebted to their hard work in achieving a treatment.

We no longer have to have our hands tied behind our backs in terms of saving lives when it comes to type 1 diabetes and I think every doctor and every parent is eternally grateful for this blessing given to us by these two doctors.