I need to rethink how I am going about the warning signs of DKA. I was out with a dear friend, an attorney and mom to 3 children with T1D as well as a husband with T1D, when Danielle states, “You know, signs of flu/virus-like symptoms do not mask DKA…….they ARE signs of DKA.”
And I have not stopped thinking about that line since she said it. If someone visits the doctor and has a fever, sore throat, and difficulty swallowing they are tested for strep throat. Symptoms dictate what is tested….right? Talking to decision-makers and people within our community, I have been saying that flu/virus-like symptoms, in some cases, are masking the onset of T1D and we need to do something about it. That message is now changed—my message needs to be that those signs ARE SYMPTOMS.
‘Masking’, actually, is not the case. The case is actually quite clearer than that: The ADA defines the signs of DKA being:
KA usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. Early symptoms include the following: (NOTE the “But when Vomiting Occurs…..”)
Thirst or a very dry mouth
High blood glucose the main sugar found in the blood and the body’s main source of energy. Also called blood sugar. (blood sugar 1. A class of carbohydrates with a sweet taste, including glucose, fructose and sucrose. 2. A term used to refer to blood glucose.) levels
High levels of ketones in the urine
Then, other symptoms appear:
Constantly feeling tired
Dry or flushed skin
Nausea, vomiting, or abdominal pain (Vomiting can be caused by many illnesses, not just ketoacidosis. If vomiting continues for more than 2 hours, contact your health care provider.)
Fruity odor on breath
A hard time paying attention, or confusion
KA usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. So the flu/virus-like symptoms do not only mask what could be T1D, THEY ARE THE ABSOLUTE LIFE THREATENING CONDITION warning signs.
So the question and argument needs to be made, why is the diagnosis being missed? Missed by parents and medical professionals alike? How many times have we heard that the key to medical advice is ruling out what one does not know. The message to drive home is not that this could ‘be something’ but rather DKA MUST BE RULED OUT MOVING FORWARD.
The warning signs are clear…….if someone has any/all/some of the symptoms stated above, the only acceptable practice must be for either ‘keytone’ stick or a simple blood test with a glucometer to rule out DKA/T1D. Neither one, to my understanding, can be used to diagnose but surely the flag of red would be waived vehemently that further testing needs to be done. The point is ‘that it will be caught’ BEFORE a real problem occurs. Again: But when vomiting occurs, this life-threatening condition can develop in a few hours.
Flu/Virus-like symptoms (nausea, vomiting) are not masking the diagnosis; they are SYMPTOMS which should/must make the only acceptable practice to take the steps to confirm or rule-out the diagnosis of DKA/T1D. Period. That is the message to deliver across this great land of ours.
Feel free to email this column to a family practice/emergency room/pediatricians’ offices today…..and let me know you did.
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