# Diabetic ketoacidosis threatens hospitalized patients with COVID-19



## Northerner (Jun 23, 2020)

Diabetic ketoacidosis is a common and potentially fatal complication in hospitalized patients with COVID-19, according to a new clinical perspective published in the Endocrine Society's _Journal of Clinical Endocrinology & Metabolism_.

Diabetic ketoacidosis almost always requires special care in the hospital which usually takes place in the intensive care unit (ICU). It is caused by insufficient insulin circulating in the bloodstream, which is more likely to occur during a serious infection like COVID-19. Diabetic ketoacidosis causes a buildup of acids in the blood, leading to serious illness characterized by dehydration and sometimes difficulty breathing.

"People with diabetes who are infected with COVID-19 are at increased risk of severe disease, which in some cases is accompanied by diabetic ketoacidosis," said the paper's corresponding author Marie McDonnell, M.D., of Brigham and Women's Hospital and Harvard Medical School in Boston, Mass.









						Diabetic ketoacidosis threatens hospitalized patients with COVID-19: New approach to treatment protects healthcare providers from frequent close contact
					

Diabetic ketoacidosis is a common and potentially fatal complication in hospitalized patients with COVID-19, according to a new clinical perspective.



					www.sciencedaily.com


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## MrDaibetes (Jun 23, 2020)

I said this from the start, there is a lack of diabetes specialists in ICU, and most staff wouldn't be able to do what a DSN can do.


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## Northerner (Jun 23, 2020)

MrDaibetes said:


> I said this from the start, there is a lack of diabetes specialists in ICU, and most staff wouldn't be able to do what a DSN can do.


When I was diagnosed in 2008 Southampton General had two DSNs for all the patients. 8 out of 10 patients in the Cardiac Care ward where I spent some time had diabetes, as did maybe half the people in the General ward. When I was due to be discharged the DSN spent about 10 minutes with me an hour before I left teaching me how to use the equipment and  inject - she was constantly getting called away  I don't know how much, if at all , things have improved, but I do recall that it very quickly became apparent to me after just a couple of days that I knew more than the majority of nurses or junior doctors  Given that there has been a decade of cuts since then I can't imagine things are better.


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## trophywench (Jun 23, 2020)

We were warned right near the start of this, that should we get it, we would get ketones in single figure BGs.

It's not only the Government that doesn't learn from what they've already found out earlier, then .....


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## MissDaisy (Jun 23, 2020)

Hello Everyone   

Interesting - I shielded myself & family 2 weeks before after writing my concerns to the school that child plus partner could be vectors.

I didn’t know that DSN’s in hospitals are in such low numbers. I think as many of us knew that infection/viruses would make us vulnerable as that’s what’s infection can do. 

I was surprised we weren’t on the shielding list. Research like this and statistics show we are highly at risk plus estimates say a 1/4 of those who died had Diabetic.

There’s some research saying that taking Vitamin D & having good levels helps to reduce the severity of symptoms - so it might be worth taking a daily dose & getting out in the garden to top up!

It’s all such a sad, awful and worrying situation. I am so grateful for all those who helped keep things going and all the HCP - it must be difficult and I think some will have PTSD I’m sure.

I suppose the lack of DSN is again due to constant lack of funding of the NHS. I hope after this the government realise the value of the NHS and that it needs money however I won’t  hold my breath.

I am so glad I joined here as I have learned so much - then afterwards a GP rang that was on the ball on LCHF, however you guys had already told me to ignore GI from another GP! 

Talk about waiting for a bus and the next they all come along at once!!!

MissDaisy


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## trophywench (Jun 24, 2020)

I honestly think that a lot of the time there is shedloads of help available - but only if we tell someone relevant we need help with X, or could do with some advice about Y - so we have to educate ourselves by ourselves (no reading list) to know that X and Y (plus another 24 letters of the alphabet) even exist! 

It's a condition of accessing 'specialist nurse' training that you are already permanently employed exclusively in that speciality, and it isn't quick, because it's another degree course so you have to study for it mainly in your own time since you are employed full time doing nearly all the job anyway to begin with!  Subsequently you are deemed to be ideal for doing all sorts of jobs they didn't tell you about be it Ward rounds for DSNs or for a friend who took the extra degree in his speciality - mental health - being required to do night shifts to cover A&E and any OP clinics when the consultants 'weren't all available'.  He got sick of it and now manages a chain of several really excellent private Care & Old People's Homes 'ooop North' - loves it and none of this lack of PPE etc business on his watch.  Too much cost cutting/lack of whatever experience in the NHS to let any of that happen under his responsibility - of course the homes regular income is more than a factor in this!


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## mikeyB (Jun 24, 2020)

It’s hardly news, is it? In the heading of this thread, replace the words “COVID-19” with any other serious infection. Or even not so serious problems, as I discovered a few months back.

The lack of diabetes knowledge or skills in some hospital wards was identified in Scotland a couple of years ago. They trialled a diabetes protocol to be issued to every ward’s nursing station, firstly in a couple of areas to see if it worked, and with a very positive response from all concerned, it is now standard in all Scottish Hospitals. It doesn’t eliminate all problems (agency staff may not have had time to notice it) but at least the problem is recognised.

You can’t expect a DSN for every ward, that’s a ludicrous expense for a relatively rare disease.


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## EJJ (Jun 24, 2020)

Good afternoon. I was interested to see this thread, as my experience with suspected COVID-19 was very unusual.

Approximately 3 months ago I had symptoms which could be attributed to COVID-19, but if not it was definitely a more serious infection than, say, a common cold. Rather than suffering high BGs and having to employ sick day rules when I was most ill, as you would usually expect, my BGs were running low, resulting in unusually frequent hypoglycaemic episodes, and I had to reduce my basal pattern significantly. 

Some symptoms lasted long after the infection, and I am still not feeling 100% recovered, and while I have started to readjust my basal pattern upwards as required, my daily basal insulin dosage is still approximately 20% lower than prior to infection. As this is so unusual, I was wondering if other insulin-dependant diabetics had reported similar observations.. I have had type 1 diabetes for over 40 years and am an insulin pump user. My diabetes is usually very well controlled.


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## Sally71 (Jun 24, 2020)

Can’t comment on Covid specifically as we have so far been lucky and managed to avoid it.  But regarding illness in general, i would expect daughter to go high when she’s ill but it seems to be roughly a 50/50 split between going high or going low when she's ill.  Haven’t worked out any sort of pattern but then she isn't ill very often (thank goodness!)


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## trophywench (Jun 24, 2020)

For all I know, maybe that is one of the reasons/contributing factors as to why medical advice was given to check Ketone levels at lower BG than 'normal' - not being a fly on any appropriate wall, I wouldn't know.

Suffice it to say that should I ever catch or suffer from any medical condition I personally haven't experienced before - I'll be sure, now, to test for blood ketones as well as BG !


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## Bruce Stephens (Jun 24, 2020)

trophywench said:


> For all I know, maybe that is one of the reasons/contributing factors as to why medical advice was given to check Ketone levels at lower BG than 'normal' - not being a fly on any appropriate wall, I wouldn't know.



I think they've said that is the case: people with coronavirus and diabetes have been seen with ketones at unusually low BG levels.


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## EJJ (Jun 24, 2020)

Thank you all for your replies, which have been very helpful.  I hadn't heard this medical advice about testing ketones at lower BG levels until I read this thread and it is making a lot of sense. I will also be heeding this advice if I find myself in similar circumstances in future.  Stay safe and well, everyone


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