12 ms·

> Sorry to be crass, but this type of argument is exactly why non-experts shouldn't be talking about topics > I myself am not a doctor. I love to learn from m

> Sorry to be crass, but this type of argument is exactly why non-experts shouldn't be talking about topics > I myself am not a doctor. I love to learn from my wife. I suggest that you speak to your wife before correcting my unimpeachable explanation of why someone might die from being told, incorrectly by their CGM, that their blood glucose is low. I say this as someone doesn't need to rely on a spouse but have actually received my own medical education. And I've had my own HHS patients—it's not even clear if your wife (!!) works in this area. As the sibling commentator shares, we don't really expect these patients to show up after a day of bad data, but we also have no idea how many days of bad data occurred.

pixl97 10mo ago
As someone that experienced DKA when I was young I'm still not sure how that happens unless there were a lot of other confounding factors. Having hypoglycemia that high for a while will make everything start smelling like varnish. Also you start physically hurting especially your kidneys which is not something you can ignore. If there were other confounding factors then I'm wondering what their endo told them, unless this is one of those countries you could buy it without a prescription? Any endo with any training would have a fragile diabetic using more than one monitoring method and have them doing regular blood tests.
- bonsai_spool 10mo ago
  I responded to your sibling post: https://news.ycombinator.com/item?id=46395603 https://news.ycombinator.com/item?id=46395603 DKA is a common presenting symptom for new T1DM patients but that's definitely not the only time it occurs. And we also have HHS which can occur in T1DM and T2DM.
SkyPuncher 10mo ago
Thank you for offering your credentials. By nature of this being an internet, tech-focused forum there just aren't many doctors here. Without a reference to credentials, I made a (poor) assumption about your authority on the matter. I was very clear that I probably know more than the average person, but I'm certainly not an authority. I do think my underlying point is generally, correct, though. And, implicitly supported by your retort. Low and high blood sugar are emergencies of different acuity. To be clear, by the time either of them turns into an emergency, they are both emergencies. However, the time frame for going from "my blood sugar is managed" to "I need emergency intervention" is generally different (and longer for high blood sugar emergencies).
- bonsai_spool 10mo ago
  I'll respond to the sibling poster with the same content—yes, DKA won't cause coma as quickly as insulin overdose but it can indeed come on acutely and it absolutely does kill people. I'm a bit frustrated by the number of people on this page who are saying that high BG readings aren't an emergency; the timeline to death isn't weeks or months or 'next time I get to urgent care' but instead 'later today' or 'early tomorrow'. DKA may be precipitated by infection (like the seasonal flu), and in that setting, worsened further by an unreliable CGM. Here are some case reports that relate to this: - https://sci-hub.box/10.2337/diacare.6.6.622b https://sci-hub.box/10.2337/diacare.6.6.622b (note two patients who were 'intelligent' presented with DKA despite multiple normal readings) - https://pubmed.ncbi.nlm.nih.gov/40811481/ https://pubmed.ncbi.nlm.nih.gov/40811481/ (pregnant women can have DKA irrespective of blood glucose readings due to changes in normal range attributable to pregnancy) You can read many more of these kinds of cases: https://pubmed.ncbi.nlm.nih.gov/?term=(diabetic%20ketoacidosis%5BTIAB%5D%20OR%20DKA%5BTIAB%5D%20OR%20%22Diabetic%20Ketoacidosis%22%5BMESH%5D)%20AND%20Case%20Reports%5BPTYP%5D%20AND%20(adult*%5BTIAB%5D%20OR%20Adult%5BMESH%5D)%20NOT%20(pediatric%5BTIAB%5D%20OR%20child*%5BTIAB%5D%20OR%20infant%5BTIAB%5D%20OR%20adolescent%5BTIAB%5D)%20AND%20blood%20glucose%20monitor&sort=pubdate https://pubmed.ncbi.nlm.nih.gov/?term=(diabetic%20ketoacidos...

pixl97 10mo ago

As someone that experienced DKA when I was young I'm still not sure how that happens unless there were a lot of other confounding factors. Having hypoglycemia that high for a while will make everything start smelling like varnish. Also you start physically hurting especially your kidneys which is not something you can ignore. If there were other confounding factors then I'm wondering what their endo told them, unless this is one of those countries you could buy it without a prescription? Any endo with any training would have a fragile diabetic using more than one monitoring method and have them doing regular blood tests.

bonsai_spool 10mo ago
I responded to your sibling post: https://news.ycombinator.com/item?id=46395603 https://news.ycombinator.com/item?id=46395603 DKA is a common presenting symptom for new T1DM patients but that's definitely not the only time it occurs. And we also have HHS which can occur in T1DM and T2DM.

SkyPuncher 10mo ago

Thank you for offering your credentials. By nature of this being an internet, tech-focused forum there just aren't many doctors here. Without a reference to credentials, I made a (poor) assumption about your authority on the matter. I was very clear that I probably know more than the average person, but I'm certainly not an authority. I do think my underlying point is generally, correct, though. And, implicitly supported by your retort. Low and high blood sugar are emergencies of different acuity. To be clear, by the time either of them turns into an emergency, they are both emergencies. However, the time frame for going from "my blood sugar is managed" to "I need emergency intervention" is generally different (and longer for high blood sugar emergencies).

bonsai_spool 10mo ago
I'll respond to the sibling poster with the same content—yes, DKA won't cause coma as quickly as insulin overdose but it can indeed come on acutely and it absolutely does kill people. I'm a bit frustrated by the number of people on this page who are saying that high BG readings aren't an emergency; the timeline to death isn't weeks or months or 'next time I get to urgent care' but instead 'later today' or 'early tomorrow'. DKA may be precipitated by infection (like the seasonal flu), and in that setting, worsened further by an unreliable CGM. Here are some case reports that relate to this: - https://sci-hub.box/10.2337/diacare.6.6.622b https://sci-hub.box/10.2337/diacare.6.6.622b (note two patients who were 'intelligent' presented with DKA despite multiple normal readings) - https://pubmed.ncbi.nlm.nih.gov/40811481/ https://pubmed.ncbi.nlm.nih.gov/40811481/ (pregnant women can have DKA irrespective of blood glucose readings due to changes in normal range attributable to pregnancy) You can read many more of these kinds of cases: https://pubmed.ncbi.nlm.nih.gov/?term=(diabetic%20ketoacidosis%5BTIAB%5D%20OR%20DKA%5BTIAB%5D%20OR%20%22Diabetic%20Ketoacidosis%22%5BMESH%5D)%20AND%20Case%20Reports%5BPTYP%5D%20AND%20(adult*%5BTIAB%5D%20OR%20Adult%5BMESH%5D)%20NOT%20(pediatric%5BTIAB%5D%20OR%20child*%5BTIAB%5D%20OR%20infant%5BTIAB%5D%20OR%20adolescent%5BTIAB%5D)%20AND%20blood%20glucose%20monitor&sort=pubdate https://pubmed.ncbi.nlm.nih.gov/?term=(diabetic%20ketoacidos...