Summary:
- Twenty-three year old Lauren Williams was rushed to Danbury Hospital with diabetic ketoacidosis (DKA), a serious complication of Type 1 diabetes
- Danbury Hospital emergency, progressive care, and endocrinology care teams are highly skilled at effectively and expeditiously identifying and treating DKA
Newswise — DANBURY, Connecticut, May 8, 2019 — Twenty-three year old Lauren Williams was rushed to Danbury Hospital’s Emergency Department (ED). During the past 13 hours, she had vomited 35 times and was severely dehydrated, even though she’d consumed sports drinks and three full pitchers of water. Lauren had begun breathing very quickly and heavily, and she was extremely fatigued. Lauren thought she just had a stomach virus, but since she has Type 1 diabetes, her mom didn’t want to take any chances — so she called 9-1-1.
Emergency response to treat DKA
When the care team in the ED learned about Lauren’s diabetes, and discovered her critically high blood sugar, they diagnosed her with a serious complication of Type 1 diabetes called diabetic ketoacidosis (DKA). DKA occurs when a diabetic’s body can’t produce enough insulin, resulting in dangerously high levels of blood sugar and ketones (molecules that can acidify blood).
As Danbury Hospital multispecialty rapid response registered nurses, Tracey Rullo and Linda Najam knew they needed to quickly start Lauren on an IV so they could give her insulin and fluids. It was almost impossible to locate a vein in her arm or hand due to her dehydration. So Tracey and Linda advocated for Lauren to have a central line with three ports placed in her neck to expedite the delivery of insulin, electrolytes, and fluids.
The Danbury Hospital ED is excellent at identifying DKA and treating it appropriately. Then it’s time for an endocrinologist to determine why DKA happened in order to develop an effective care plan.
Why did DKA occur?
Umar Ahmad, DO, an endocrinologist at Danbury Hospital, first met Lauren in the Danbury Hospital Progressive Care Unit (PCU), where she was still receiving an insulin infusion, and IV fluids and electrolytes as an aggressive hydration replacement.
“Lauren was still very dehydrated and fatigued and we needed to regulate her blood sugar,” said Dr. Ahmad. “It’s inherently hard to manage diabetes, and Type 1 diabetics have a low threshold for developing DKA. They are a very vulnerable population, and DKA can happen at any age.”
Symptoms of DKA include excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion. DKA is usually triggered by an infection or other illness that causes the body to produce higher levels of certain hormones, such as adrenaline or cortisol, that counter the effect of insulin.
DKA can also be the result of a problem with the person’s insulin therapy. If a Type 1 diabetic misses their insulin treatments, or receives inadequate insulin therapy, they will have too little insulin in their system which can trigger DKA. People may also experience DKA after they get a new insulin pump and are learning how to use the technology, or if they experience a pump malfunction.
“It’s not always clear what came first— did an illness cause DKA, or did DKA cause an illness?” said Dr. Ahmad. “In Lauren’s case, a stomach virus could have caused the DKA. But then we also learned it may have been the result of her pump malfunctioning. Once her condition had improved, and she could come off of the insulin infusion, we put her back on her pump and it failed.”
Dr. Ahmad and the PCU care team resumed Lauren’s insulin infusion, provided her with insulin shots, and got her a closed-loop insulin pump with an integrated continuous glucose monitor (CGM), which can change the rate of her insulin infusion based on her real-time blood sugar.
Recovering from DKA
Lauren spent five days in the Danbury Hospital PCU recovering from DKA.
“I received fantastic care when I was in the PCU. I had amazing nurses, nurses’ aides, nursing students, and doctors taking care of me,” said Lauren. “One of my parents stayed every night, and the staff was really helpful making sure my parents were okay too.”
The PCU is a 14-bed unit that is part of the critical care cluster at Danbury Hospital. The PCU has the latest technology and equipment, and a highly skilled and dedicated care team including an intensivist, a board-certified physician who provides special care for critically ill patients.
“The PCU is an incredible unit that functions as a family,” said Shelby Newkirk, RN, PCU assistant nurse manager, of the unit that won a Danbury Hospital Team Excellence Award. “They are an example of how a team should work. You don’t have to ask for help because everyone meshes so well. We take care of the whole patient, and we also take care of each other.” Shelby was also recently recognized by Danbury Hospital as a Nightingale Nurse for exceeding the standards of clinical nursing practice established by the American Nurses Association.
Cindy Pinto, RN, a PCU nurse, cared for Lauren and also got to know Lauren’s entire family. Cindy said that the PCU team noticed Lauren’s family was feeling down because she was in the hospital over the holidays. So they arranged for her to have a massage, a visit from a therapy dog named Maggie, and to receive a gift basket delivered by volunteers.
“We always rally for our patients — whether it’s to celebrate a birthday, holiday or graduation, or just to help them feel supported and comfortable,” said Cindy. “We love our patients and their families, and we’re looking out for them.”
“The nurses in the PCU will always hold a special place in my heart and the hearts of my family members,” Lauren said.
The night before Lauren was ready to be discharged, she walked a lap around the PCU without getting out of breath — something she was unable to accomplish previously while her body was full of the carbon monoxide and acid that was affecting her breathing. But she was still weak and didn’t have an appetite, so she also consulted with a Danbury Hospital nutritionist before she left. When she went home, it took several weeks for Lauren to feel normal again and comfortable not being alone in case something happened. Now, she is accustomed to her new pump and feeling well.
Managing Type 1 Diabetes
Lauren will continue to see Dr. Ahmad and also Tricia Krueger, APRN at Western Connecticut Medical Group (WCMG) Danbury Endocrinology to help her effectively manage the Type 1 diabetes.
“We provide close follow up care to our patients that are on insulin pumps. We set aside a lot of time to look at their pump settings, and how best to care for them,” said Dr. Ahmad.
Lauren wants others to understand Type 1 diabetes.
“I want people to know that Type 1 diabetes isn’t the same at Type 2,” she said. “Many people incorrectly think you get Type 1 diabetes because of a lifestyle choice. I’ll see someone posting a picture of soda, chips, and junk food on social media and it says, ‘What’s one word you think of when you see this type of picture? Diabetes.’ Type 1 is with us forever. I can’t exercise this away.”
Lauren also wants people to know how important the support of family and friends is to help someone manage Type 1 diabetes. Her parents and younger sister, Becca, are aware of the signs that mean Lauren needs help. In fact, Becca saved Lauren’s life when they were younger by acting quickly, giving her a glucagon shot, and calling 9-1-1 for emergency help.
“Diabetes doesn’t have to define you, and it doesn’t have to burden you,” said Lauren. “With the support of family and friends, lifestyle modifications — like using a mobile app to help me plan my meals — and a trusted care team, it’s totally possible to live a normal life with Type 1 diabetes.”
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