Long term impact of DKA and low PH levels on mental health

I’m wondering if anyone else knows of research in the T1d community of long term effects of low ph levels on mental health. I’ve seen studies linking low ph to mental disorders like bi—polar and depression. But, I haven’t seen anything that might suggest irreparable damage to brain chemistry due to past low ph levels but currently under control.
I know for those that have been in DKA the low ph levels has an immediate impact. But what might be the long term impact?

Short answer: It depends on the length of DKA and the level of discord. For the average person, emotional trauma developed through life or physical brain developmental differences will have far more influence over mental disorders than intermittent DKA, especially if brief and furthermore if emergency treatment was obtained.

Long answer: If desired, would be a very, very long answer.

In our situation our 7 year old daughter had a ph I believe of around 6.8 when diagnosed. So, she went undiagnosed for over 3 months. I don’t know if you can call that a short period or not.

Apologizing in advance for various typos, as when I finished my explanation, it looked like a thesis. Sorry.

I suppose it would be good to have a reference point, since there are many things that could contribute to various ph changes, each of which have independent studies which may or may not apply to (D)KA, as it’s induced much differently, but one thing I would point out is that a large number of mental health disorders, AD(H)D and bipolar included, have physical, chemical, and neurological (specifically referring to synapse response, firing, and seizing) signatures in various parts of the brain. For less serious ones, take AD(H)D for example, it has been found that there are both chemical (obviously, as the dopaminergic system is directly effected in someone with add/adhd) but ALSO physical alterations to the brain, when compared to an “average” sample size. Both the change (probably originally chemically, but this is conjecture) molded a physical change, and these things can compound each other (especially true in something like Alzheimers’, although it is a different system entirely). Unsurprisingly, when supplemented with stimulants, most commonly in the amphetamine tree, this chemical and physical alteration is less pronounced.

Coming around full circle to why that wall was required to make a point, 3 months is an INSANELY long time if she was at 6.8 the entire time. The fact that she is a child is probably the sole reason she is alive currently, as 6.8 is easily coma inducing at minimum for most people. Presumably it peaked around when the diagnosis occurred, which is a good thing it was noticed. A large concern for DKA is less the ph imbalances and more the edema, stemming from the blood brain barrier being allowed to be crossed by the very ketone bodies causing the dka to begin with. This pressure in an of itself can cause irreparable harm. Secondly, you get O2 deprivations, and in extreme cases, cerebral hemorrhaging, but this is most found during rapid changes in the blood, and almost exclusively in older people, simply due to the nature of the incident. While all of these things are terrible (potentially), it’s of high likelihood that some change would have been noticed at this point if any of these things occurred. If it was something as simple as slight memory loss or minor motor function damage, it may never be discovered - period. It might be that slight. In regards to ph in and of itself, if normal levels are being adhered to, and there’s a nice control on BG, I would honestly say there’s nothing to worry about, and that as a child, any potential short term damage would likely be healed anyway.

You have to remember, especially when it comes to something like the brain, it has yet to finish developmental maturity until roughly the age of 24, but in some people this can be close to 30 (26-28) for fully developed cerebral cortex tissues. It also takes plenty of damage from day to day activities, which is quite efficiently repaired more often than not. Take aspartame for example, when broken down via CAC, it can cross the blood brain barrier and actually becomes neurotoxic…and that’s an artificial sweetener! However, unless you literally drink/eat products with ungodly amounts of the stuff…(and I mean truly, its an obscene amount) the likelihood of anything more than maybe a slight headache every now and then is almost zero. Also take into account that ph derivatives correlating to mental illness - while being a standardized fact and even referenced in sources used by the DSM - is NOT taking into account the physical attributes that coincide with those results, as many other studies will show. Looking at one piece of the puzzle obscures the entire picture in this situation, as multiple things occur simultaneously to cause someone to succumb to [insert various mental illnesses here]. This includes genetic predisposition to those illnesses and immune strength (though this mostly applies to malignant brain tumors).

If you can get an MRI, or insurance would cover it given the situation, you could help give yourself peace of mind by doing a full brain imaging - however it is rarely used for such purposes, and when it is, it’s generally under the suspicions of [insert X here] and the scans are to potentially confirm aforementioned suspicions.

I would suggest that she will be just fine, so long as repeated DKA episodes do not occur. Their frequency, and their severity are important, and you want both to be…well 0, but at the least extremely low. Incremental damages may not cause symptoms initially, maybe at all, but subject an individual to repeated exposure and the risk of severe side effects skyrockets, especially with almost anything metabolically related.

I’m not a doctor, I just went to school to much.

Thank you for the very thorough response! Ever since the summer before our daughters diagnosis her emotional state has been unbalanced. It’s been 3 years now but we were starting to think the ph imbalance might have had something to do with it.
My wife discovered something called DMDD which sounds like some of the symptoms our daughter has but we are on a waiting list of 10 months to get an evaluation.

That’s an insanely long time, Where you from?

Also, If you were concerned about symptoms like that, DMDD. ADD, ADHD, GAD, CBD, OCD (I think), are all in a similar category in regards to generally being caused by chemical irregularities. A friend of mine’s kid had symptoms of extreme mood and a feeling of disconnect, joined by peroids of over excitation. I recommended they talk to their GP and see if they could get an opinion (in their case I recommended asking him about an amphetamine, in this case vyvanse and dexedrine) The Dr. agreed to try a low dose of vyvanse to see if there were any mood changes and go from there, as their insurance was being weird about a psychiatrist, and sure enough it worked like a charm. After that insurance agreed to pay for the psychiatrist and go figure, she was ADD…

Granted this is one situation and very well might not encompass everything youre going through, but if you have to wait a long while, you may be able to research specifically what symptoms you see and speak to a GP about potential solutions. In this case, the medication was used in an exploratory, and ended up illuminating the issue.

Of course going down this same road, especially for a child, a lot of mental health conditions want to prescribe a type of anti psychotic or other form of chemically mind-altering medication if therapy or less potent medication is ineffective. I would definitely stay away from those without a diagnosis FROM a psychiatrist, not just a GP, as they can do as much good as they can bad if mis-prescribed.

On the flip side, you have drugs like propranolol (originally for cancer patients to reduce vomiting, but is off label prescribed for anxiety related symptoms and for its mentally calming effect), intuniv [Guanfacine] (which has shown effectiveness in ADHD and does not alter the mind in any way), stimulants [dextroamphetamine] {vyvanse, dexedrine} (adderall LAST for children only if the others dont work, levoamphetamine is not the greatest) (low dose, especially for kids, only for suspected adhd and similiar dopaminergic neurochemical imbalances), certain SSRIs and of all these, they are relatively low risk (medium risk in the ssri category).

All this is meant to outline is that there are plenty of options if you see something happening that concerns you before you’re able to get a full evaluation. In the list above, “risk” is short hand for simply experiencing side effects, not generally for anything serious, and any doctor would screen out those risk factors before a prescription (case in point, a stimulant will not be prescribed to someone with most*** heart issues, as that can make a relatively safe drug a potential health risk.

***Some do not apply, Example: a mitral valve prolapse (because if this was bad enough that you couldn’t take a stimulant, you’ve already had heart surgery probably)

I sometimes get carried away, forgetting not everything needs to be a book, but the tl;dr of everything since the first question is:

1.) She’s probably fine. [Short and Long Term]
2.) Note irregularities in behavior or motor function or cognitive development
3.) If any exist, seek professional help (beyond just a GP)[IE Psychiatrist,neurologist,ex]
4.) Keep in mind your various avenues of options if the wait to evaluation is long
5.) And most importantly - STAY OUT OF DKA

If there aren’t frequent dips to DKA, or even better, there isn’t another one - ever - then surely you will have very little to worry about short term, other than better control. If hyperglycemia is common, eat less or use more insulin. I’m reluctant to say she should eat less, since inherently T1D can eat whatever they want, whenever they want to, and anyone telling you otherwise is just misinformed. WITH THAT BEING SAID THOUGH, the correct insulin is required for the above to be true (I’m guessing she was diagnosed when they found DKA?, I didn’t ask for backstory so maybe there is some basic information that you could benefit from)
When I was diagnosed my A1C was 13.9 and my in office test was 750 something mg/dl. Somehow I wasn’t in DKA, and somehow I was also still conscious. The body is quite resilient.

Are there any textbooks or papers I can read to find out more about DKA?

Textbooks, I’m sure in any book that is describing most metabolic issues however what you’re probably looking for are recent research results with Source information and data to check with

I would direct you to Google what your question is and specifically look for abstracts of that question.
Look at experimental data
look to see if it was funded privately or not since this could sway findings
Look to see sample size
Look to see margin of error
Check testing methodology and whether or not it is double blind with control groups and has been repeated elsewhere if medications are involved

All of these will be good strategies to find whatever it is you’re looking for. There are literally metric tons of information available but most of it is an abstract form so you will be reading literally the published scientific journals

I would caution against literal textbooks or almost anything on actual paper, use the internet to your advantage. Especially in fields where there is rapid development and research by the time a book can be printed it may be weeks to months out of date
If you ensure that you sift through all of the available published works you’ll be able to be more readily able to access updated information and rest assured that that information is accurate

@tjaslonaker @Lostinthemidwest

I would urge you to start with your endo and then move to specialists if necessary, because among other things, it is almost impossible to parse the endless useless and incorrect information mixed in with actual information, available via the internet.

I have no idea how you can just look at DKA when there is also a chronic disease present - and isolate which one… the DKA or the diabetes… contributes to depression or other attention, cognitive, or impulse disorder.

high and low blood sugar, and insulin, (all of which are present) have impact to a person’s mood. A 7 year old trying to understand chronic disease is reason enough for a mood disorder. I don’t have real statistics, but the incidence of depression increases with chronic disease in general and diabetes in particular…

I wish you good luck, and I hope your daughter gets the help she needs.

I fully agree with @joe about not just looking at one little piece of a very complex condition, TypeOne Diabetes, rather than looking at the whole, panoramic picture of managing diabetes.

High glucose readings, say above 250 ng/dl, do NOT mean DKA. My “blood sugar” readings have often been above 250, including during a stay in the hospital three years ago when my readings never went below 500 mg/dl but I did not go into DKA, I have entered what is now called DKA only once - and that was more than 60 years ago. Keep in mind that DKA is when a persons body consumes itself because it can not utilize the foods brought in by mouth.
Don’t get me wrong, DKA is very real and is dangerous but it involves more than a bunch or “high” BG readings.