DKA In Real Life: ‘It Can Happen to You’ with Danica Collins

[00:00:00] Rob Howe: Hello, listeners. What you are about to hear is a series that I've been working on for quite some time, and I've taken great care in every aspect of it because it's centered around a very serious topic, diabetic ketoacidosis, or DKA. But we know that by openly discussing serious topics, we can take some of the fear away from them, learn about them, and hopefully improve the way that we deal with them. Name it to tame it. So this is a five-part series where we discuss diabetic ketoacidosis. It is sponsored by Abbott. The views expressed should not be used for medical diagnosis or treatment or as a substitute for professional medical advice. Individual symptoms, situations, and circumstances may vary. The series is in our podcast feed as well as on YouTube, Instagram, and TikTok. I hope you find it informative, entertaining, and I hope it helps you understand a little bit more about DKA, its causes, and what you can do to make sure you're ready in a DKA situation. Enjoy. Hello and welcome back to Diabetics Doing Things. We are telling the amazing stories of people with diabetes from all over the world. I'm very excited for this interview because my guest today, and I have known each other for many years, and I think you might be the person I've run into the most across all the diabetes events over the past six or seven years. So my guest today, Danica Collins, welcome to the show.

[00:01:24] Danica Collins: Hey, Rob. Thanks so much for having me. I'm so excited to be here.

[00:01:29] Rob Howe: Danica, you have lived with type 1 diabetes for 19 years. You're a health care consultant, you're a health coach, a patient advocate, and diabetes creator. You and I met each other for the first time, I think it was 2019, and it was at a then JDRF, now Breakthrough T1D Colorado Colorado Summit. So now they're called Community Summits. Back then they were type 1 Nation Summits. So many name changes over the years, but the thing that hasn't changed is you and I still both live with T1D. We run into each other at ADA conferences over the years, all the way through there was a MannKind or there was another Patient Advocate Summit that we were at in Florida. So I think we've probably run into each other close to about 10 times. So you haven't been on the podcast, it's your first time. Thank you so much for making the time for us.

[00:02:13] Danica Collins: absolutely i am so excited i listened to the podcast it's a great way for the community to stay connected and it's funny just to see you on a screen and not in person

[00:02:23] Rob Howe: and it's it's the rare uh the rare time that you actually we've actually met in person both of us are taller than we are online uh that's a fun thing a fun note for uh for viewers and listeners so almost two decades for type with type 1 diabetes for you how does that land for you and And where are you? How do you find yourself in your diabetes journey today?

[00:02:45] Danica Collins: Looking back and seeing how far I've came as a diabetic is pretty much a miracle in my book because I was a stubborn teenager. It was like, I don't know what this is. I don't have time for this. I just want to play basketball and be with my friends. And having a fully like immersed family get diagnosed at the same time to now me living across the country, me pretty much traveling for living, learning how to manage diabetes and just knowing what I'm doing for the most part is just life altering in some ways, because I can't believe I've had this for like almost 20 years and that I know what I'm doing. I'm helping people just like me with this. It's a full change of events because it took me a good eight to 10 years to really get the gears on, care about this and really start to see like, oh, I can do this or this is what this means or find my missing gap, which really was the community piece.

[00:03:45] Rob Howe: I'm really glad that you brought up the journey, right? And how you didn't just one day wake up and become Danica the diabetic who's got it all together, who's navigating her life on the go, that it was a learning process and that the community was the sort of the missing piece for you. So like, as you think about that first eight to 10 years, and now the most recent 10 years where you're more involved in the community, what would you, you know, for somebody out there listening, who's maybe afraid to share their voice, or maybe is kind of holding themselves back from being more involved in the community, what would you tell them?

[00:04:20] Danica Collins: I would tell them everyone's journey with diabetes is different. And that's okay. That's the beauty of it. No one's diabetes is the same. And when you're ready to tap in, there's a community here waiting for you. It's something I see people, they see me out, they're like, what's on your arm? Or what's going on? Or why are you drinking a juice box? Aren't you an adult? Yes, I am. But I like them. But also, it's great for me to tell my story through how I'm managing my diabetes. And that's something I personally like. But I also, sometimes I don't want to talk about it. So I don't. So it's your choice on when you bring it up and how you display it and how you talk about it. But it's something different when you're talking to people who have the same disease and they're going through it and you don't have to explain it. It's just kind of like a breath of fresh air. So if you're out there and you haven't got to tap in, that's okay. If you want to, we have many ways to connect in different ways online, in person, through events. There's a lot going on. So when you're ready, we're ready.

[00:05:21] Rob Howe: I love that. I want to have that be sort of the foundation for our conversation today. Because one of my goals from this series that we're doing on diabetic ketoacidosis is to talk about topics that are uncomfortable and a lot of times scary. And so for you today to be able to share what was going on in your life this year, because this year in 2025, almost 20 years in with T1D, like you said, you're on the go. You are basically living all around the country. your job and your advocacy work take you all over the place, you had an experience with DKA that you shared on social media. You made the decision to say, hey, I'm going to bring in the greater diabetes community and even outside the diabetes community into this story that happened in my life. And because like all that self-advocacy that you shared along with that actually got you to a safe resolution. So even someone who's so informed and like hyperconnected like you are, you still encountered barriers. So let's talk about that story of that cross-country flight, like going from California to New York. And what happened with you on that flight that took you from, okay, well, I'm having a little bit of diabetes difficulty to, oh, I need to go to the hospital because I'm in DKA.

[00:06:42] Danica Collins: Yes. So I fly all the time. It's nothing for me to take a cross-country flight. So just another day. I was probably tired, but nothing like that. It was Monday. I was tired anyway. But I had a flight which was already rough because it was delayed a little bit. So I was just like, I just want to get this over with. I'm trying to have dinner with my friend. I don't get to see. I get on the plane and my blood sugar, like a middle flight, I noticed it's a little high. Like I think the highest it was was 320. And out of nowhere, I just started getting sick. and I threw up, I think eight to 10 times on the plane, which I don't recommend throwing up on a plane once and having to do it so many times. And I don't really know what's going on because it's like, I'm just, okay, like it's a long flight. So I throw up, kind of sit there, fall asleep, get up, throw up again, get up, throw it again. And it's just one of those things where I'm like, all right, is this gonna end? And then I started to get a little bit worried because my blood sugar was a little bit high, but I just corrected and I wasn't worried about my blood sugar. I was worried about like, why am I throwing up? And I tried to drink some water. Okay. Had to throw that up. Tried to drink some Gatorade. Had to throw that up. Ate a cracker. Had to throw that up. I was like, okay, this is a problem. And it started to get worse and worse and worse. And I think at the beginning or the middle of the flight, I threw up and it was spaced. It was spaced and I was like, okay. Took a nap, came back. And then towards the end is where I was like, okay, I'm rapidly vomiting. I can't keep fluids down. I don't feel good. And it got even worse. It was like the worst flight of my life. We're going past where I was flying to JFK and they wouldn't let any planes land. So then we're circling around. They're like, we might have to go to Syracuse. We might have to go to another place. And I'm like, you've got to be kidding me. I got to get off this plane. I don't feel good. I can't keep fluids down. I don't know what's going on. and I'm just taking everything like literally like second by second. And my diabetes is not my concern in that moment. It's like, oh, I'm fine. Like it's not buzzing. It's not telling me like something crazy is going on. And I'm just like, why can't I keep water down? Like I'm dehydrated. I'm severely dehydrated. That's all I was thinking. So while we're sitting there waiting to land, I'm sitting here, I'm like, well, what do I do? Like, do I go to my hotel? Do I go to hospital. Like I probably need an IV if I can't keep fluids down. Like that's one thing that'll help. So I was like, I'm just dehydrated. Like maybe flying put me into a super dehydrated state. I wasn't even really worried about like my stomach in that moment because it was like, oh, I'm just throwing it up because I can't, I don't know. It was just something was off. It was like maybe I ate something bad because I do that all the time. And it was just a lot. And it's like a little bit of panic because I'm like, OK, like, where am I? Where is JFK? Like, I know a couple of hospitals here. I work with hospitals. I was like, but I don't know where they are. Like, you know, like I put in GPS and I'm sitting here. I'm like, where, how do I do this? So I'm Googling hospitals. And like, the last thing you should do is read Google reviews about a hospital because most people are not happy at the hospital. And I'm like, well, none of these have good reviews. So I was like, OK, like, I know this one hospital. I it's a top teaching hospital like they they have to be the place for me it's like it's a little bit of a commute but I'll do that so then we land and things get like a little worse because I'm like oh I I don't feel good I'm very very fatigued I feel so weak I like when everyone's trying to get off the plane everyone's like trying to get their bags everyone's frustrated and I had the flight attendant was someone that I've had I had him two weeks ago which I've never had that happen. I fly all the time, never had the same flight attendant. And he remembered my name because I had snacks. I was bringing snacks for my flight attendants. And he was like, Danica, are you okay? Because I looked really, really off. And I was like, no, I need to go to the bathroom. I knew I did not feel good again. I knew another throw up was coming. And it was just like water, just straight water coming out again. And I'm like, I don't know. And he's like, are you okay? And I was like, no. I was like, you need to call me a wheelchair. I don't think I can walk. And I get off the plane and I get there. He did call for wheelchair, but the wheelchair didn't come. So I'm just sitting at the gate, like calling my mom and I'm like, hey, like, and it's late. It's super late. This is like one in the morning or something, or it was super late. My mom's in a different time zone, but I was just like, I don't know what's going on, but I can't get a wheelchair and I don't think I can walk. And I said, I think I'm going to take myself to the hospital. I just know I'm dehydrated and I don't know. And she's like, how are you going to do this? And I was like, right now I can't even figure out how I'm going to get my luggage. So I went to, like, I sat there for a while just because I was trying to feel okay enough to like ask for help. And I did all that and they got one of those little like motorized little cart things and they're like, hop on this. And that only took me to baggage claim. So then I get there. I'm like, okay, let me get my body together and get my bags. And I somehow called an Uber and took myself to the hospital and sent in my hotel.

[00:12:02] Rob Howe: Sorry to interrupt you. I wanted to stop there just because I think it's really important to highlight a few things. Number one, you fly all the time. Like you just said, it's nothing for you to fly from one coast to the other on a regular basis. You're always on the go. So you've done this before. You're such a good traveler that you make snack packs for your flight attendants. So because that's a thing I know that people really appreciate. So somebody, because of that, noticed that you were down. We talked a lot about in our DKA 101 episode, which is episode one of the series with Dr. Miller, about one of the things that can put you at risk for DKA is just being outside of your regular routine. And there were a couple of things like not only are you outside of your regular routine because you're away from home, you're traveling. but then also this flight that you've done a bunch of times now is not going the way that it normally goes and your blood sugar is not in the range that it normally is and you're having this response and you're going through this really difficult physical situation where you definitely don't feel your best you're constantly nauseous nauseated but then also you're dehydrated like you're starting to feel the effects of this over time so it's hard to make decisions and even muster the energy to get yourself out of the airplane across the terminal to your bag into an uber to the hospital and i just want to talk about the difficulties of that like and the self-advocacy right where you ask for help and then so that was your first kind of say hey yes you you recognize flight attendant that i'm not myself i need help i need a wheelchair here but then that it doesn't come so and you are you feel like the anxious moments to take action knowing that you have to get somewhere to get yourself some help. And I just want to normalize having that self-advocacy because that continues throughout this journey. And I also want to talk through, like, you shared this in your LinkedIn post that you're, you know, we assume when we talk about DKA in the diabetes community, I think we always associate that with a really extremely high blood sugar, like maybe higher than, you know, 400, 500 range. And something that this series has taught me is that that doesn't necessarily always happen. You could be a DKA with only slightly elevated or even sugars that are in range technically, but it's the ketones that have the issue. And you're in a place where you don't have your ketone test kit. You're just kind of going off of your knowledge of what's going on with your body and taking action for it. So you, I know, shared, you took maybe an inhaled insulin dose to bring your sugars down, even though your real problem was the nausea and the you know dehydration at this point yes so it was a

[00:14:37] Danica Collins: lot and I was like looking back it's like I didn't even like I don't ask for help it's rare but when I need it I will ask for it and in that moment I really really needed help and it's like I probably should have asked for help when I was on the plane you know like but I didn't realize it was going to continue happening and I was just trying to focus on being okay in that moment with like the tools I had because like I probably wasn't all there and then asking for help like at the airport and it's like that's this whole time all I did was ask for help and I'm so glad that I did and I want to normalize that because when you're off and you're not feeling good like it's okay to need help and it could potentially like change your life in a different way like this stuff gets very very serious very quickly. And no, my blood sugar was not sky high. And that's why I wasn't really concerned about it. And I was like, okay, I'm off. I know this is going to work a little bit better. I'm a little bit higher than I want to be because I'm a really aggressive bolus-er sometimes. And I was like, let me just take this. I didn't want a problem with my diabetes. That's why I went that route. Let me take my inhalable insulin. I don't have time for that to get messed up because I'm already not feeling good. So it was kind of out of sight, out of mind. And it was wild.

[00:15:57] Rob Howe: I'm glad you brought up, I'm glad you brought up like that you don't ask for help very often because that really resonates with me because something I was having a conversation with someone in the community recently is, you know, when you're in a diabetes medical emergency situation, it's not a character judgment on you to ask for help. It's not a character judgment to go to the hospital. It's not like a judgment on your ability to manage your diabetes. It's you have this chronic illness that at this point is very acute. You need help. You need to go bring in, you know, ask for help and advocate for yourself so that you can get the help you need quickly before you're in a situation that's extremely dangerous. And so I'm like you. I don't ask for help sometimes when I probably should. I don't ask for extra accommodations when I probably should. But, you know, you sharing this really resonated with me as like, even when we have it, you know, people with diabetes who have it all together, quote unquote, you guys can't see if you're listening, but putting the air quotes on like people who have it all together, you still need to ask for help in a situation like this. And it's extremely important that you're comfortable doing that and know that it's you're doing what's best for you by asking for help.

[00:17:07] Danica Collins: Exactly. And it just it's something that it's OK to do. And that's part of advocating for yourself and doing what's best for you is asking for help because sometimes that's all you can do.

[00:17:22] Rob Howe: You get in the Uber. You're on the way to the hospital. Where does the story pick up from there?

[00:17:28] Danica Collins: So I'm in the Uber. I think that's when I took my inhalable insulin because I normally have it on me. But for some reason, I had to put my bag up or something. So I didn't get it. and then getting through the chaos and getting my bags everything I was just focused on getting there and that was that so I take it and then I'm pretty sure I fell asleep in the Uber because this is like a long Uber it's a very long Uber to get from Queens like to like Manhattan area so I just remember kind of like waking up and I'm pulling up to the hospital and I was just like the Uber probably thought I was crazy because I had all this luggage and he just got my bags out And I just walked into the emergency room with, and I had a, cause I was gone. I was supposed to be gone for like two weeks. So I had a lot of stuff with me. So I had like two suitcases in a backpack. And it's like, it's adding on to my anxiety through all this because I get there and like, I forget, like I'm in New York. It's not, not every hospital has like detailed security. And I get in there, like before I can even be seen, I have to go through like a metal detector. So they went through all of my bags. I was like, I just need an IV. That's all I was thinking about. I am so dehydrated. My mouth is ripping. I didn't feel good. And it's late. It is late. And I'm just like, please, someone give me an IV. I don't care about anything in my bags. Take my bags. I don't care if they get stolen. I don't have any weapons. I probably just have way too many shoes. And I get through that. And then I get to the desk to check in and I cannot stand. I am so weak. So I'm leaning over and they're like, what's going on? I was like, I need an IV. And they're like, well, and I was like, I'm just very dehydrated as I'm diabetic. And it's like, I had to go tell that story like three different times before I got seen. And it was a really quick process because normally like your emergency room wait times can be very, very long. And it is just a big issue. And then I get there and like, they give me a little bracelet to check me in. And they're like, okay, you're gonna just sit and someone will be with you for a minute. I'm like, oh my goodness, please be quick. And it was, it was like five minutes. And then a PA comes and talks to me and she's like, okay, so what's going on? And I'm like in a back room with a little curtain right behind like the waiting room. And I'm explaining, it's like, okay, so I was on a flight, very long flight. It threw up a ton and I didn't feel good. I got really weak and I couldn't keep water down, couldn't keep Gatorade down. I am a diabetic and all these things. I was like, I really need an IV. I'm dehydrated. And she's like, okay, we can do that. And she's like, we're going to put you an IV in and then you're going to wait here for a minute and we'll get you into the emergency room. And then they put me in the hallway for like an hour. and I'm sitting there and I can't keep water down. So they give me ice chips and they start, they put an IV in and they took some blood. They're like, Hey, and I was like, this, this isn't an IV of liquid. I'm still dehydrated. You guys were just taking blood from my veins. And so I'm a little just like, come on guys, it's not that hard to put an IV in and put some bags on me. Like I know I need it because my body is just crashing. I can just feel it, feel it crashing. And at this time, my blood sugar, by the time I was like actually admitted my blood sugar was 195. And I'm like, I'm good. I wasn't worried about my diabetes at all. I was just rocking. And I was like, I just, once I get some liquids, I'll be out of here in like an hour or two. That's what I was thinking. And I finally get to the emergency room. They put me in a room. It's just like one of those curtain rooms. And another provider comes in and she has a binder. And she's like, oh, like, you're good. We're going to move you. We're just doing diabetes protocol for DKA. And I was like, what? Or it's like diabetic protocol. And like, I don't know in that time if I remember, like heard her say like DKA, but she said diabetes protocol was like to send me to the ICU. And I know that's not always protocol. Every hospital is different. But I was like, well, this is weird. I was just wanting an IV because I still don't have an IV. And I finally get up to the ICU. They put me on like, not a wheelchair. It was like on a stretcher. And it was funny because I'm sitting here like videoing it because I thought it was hilarious because I was like, I could walk. I'm okay right now. I'm like, my blood sugar is good. I'm feeling good. I just need like an IV so that I can get back to like drinking again, like consuming water. And the ICU was actually pretty great. I did. It was, I was severely dehydrated because I had three IVs in, three different IV ports, It's a bunch of bags. It wasn't just saline they were giving me. I was getting potassium and I was taking magnesium pills. Like everything was off. And then things started to get real because they were like, okay, like we want to give you insulin and we're going to give you some glucagon. And I'm like, what? I was like, I'm good. They're like, well, no, it's protocol. Like we just want to make sure we're going to take care of your diabetes. I was like, oh, you know what? I haven't had this happen in 20 years. Let me let somebody else do this. but then I had the reality of okay they're going to start checking my blood sugar like pricking my finger every 20 minutes doing a bunch of labs and it took me a few hours to start feeling like oh okay because like I wasn't vomiting anymore I was just like my stomach hurt and that was what I remember but I was just so tired and just so dehydrated and it wasn't getting better. It wasn't like a couple hours go past and I was just like, oh, I'm still dehydrated. I can't eat anything. I can't drink anything. My body is not okay. And like you said, you hadn't been

[00:23:12] Rob Howe: hospitalized since you were diagnosed, right? You hadn't had somebody else managing your diabetes for you in almost 20 years. You knew what your blood sugar was, your blood glucose, 195, which is out of range, but not that high, right? Like, okay, cool. It's probably not diabetes related. you're thinking it's more maybe stomach flu or food poisoning, and you just got to get those fluids in you and everything's going to be okay. But I think that's really important to talk about like DKA, especially for people with diabetes who are really active about their management. I love the way that you said like you're a willing boluser, because you know, if you're out of range, you're a bolus, no problem. And I think it's important to really recognize those symptoms, like especially if you don't have a ketone test kit around you, or you're not in a situation where you have access to one right away. And, you know, really acting out and like making sure you're taking advantage of, you know, being proactive with that, because at least in this case, even though it took them a long time to get you to that IV bag, like you said, once they put the three ports on you, they're putting a lot of different fluids and a lot of electrolytes in you to get you back to normal. And, you know, that's an indicator, right, that it's not just your everyday dehydration. So from there, like you're also like continuing to have to ask questions and advocate for yourself with the flight attendant, with the hospital security, with the ER check person checking you in with your first doctor, with your with your nurses, with your second doctor, like now you're in the intensive care unit. And you're finally at least feeling a little bit more like yourself, but like you're still not rebound and you know, something's off. So when did you find out, when do you remember having a conversation with a doctor or somebody at the hospital telling you what was going on?

[00:25:00] Danica Collins: It was the next day when somebody was really coming in. Because everyone else was like, hey, you took inhalable insulin. What is that? Or how are you managing your diabetes? What are all these things? I'm like, you've got to be kidding me. and that's the last thing. I don't want to be a science project right now. I really just want hydration. So every provider that was coming in, I was just re-explaining and I was educating and it was more like, hey, I'm at work. I'm not a patient today. And it was frustrating and it's like, I love to educate, but that wasn't the time to. And the next day, I think is when they told me I was actually in DKA because I just thought, I didn't know what was going on. I was just like, all this for some IVs. And it was a lot. And I still like, I think I was two and a half days in there when they told me like I had a stomach virus. And looking back, I really don't know if it was a stomach virus or not, or if it was just the side effects of DKA, because I couldn't get a diagnosis like quickly on anything. And I think they were just so focused on making sure I was good. The ICU nurses were fantastic. They're like, hey, like, we know that you know your diabetes, like, we're going to do what we have to do. But like, tell us if something's off, which I respected that because they're like, you do this every day. We don't.

[00:26:23] Rob Howe: And that's one of the hardest things for people when they get put into the hospital, especially people who are really active with their management is that you have to relinquish some of the control. And sometimes that can be like that, that conversation like those nurses had with you doesn't always happen. So that was good on them to at least meet you kind of where you were and recognized that you could be a help to them. Yep. And that doesn't happen. So it was

[00:26:45] Danica Collins: really, really helpful. And like throughout my stay, it was not the same. Because your nurse, your staff changed. Like I had people come to make sure I could walk. I had to do like physical therapy while I was in there. I had to get shot so I don't get a bed sore. It was just a lot was happening. And I like, I just remember after the first night, one of my friends, the one I was supposed to get dinner with like came and she was there. I'd like, I think everyone else knew how serious this was. And I was just like, ah, it's protocol, whatever. Like I wasn't, I wasn't taking it as severely, like seriously as everyone else was. Because next thing I know, my mom is there and my mom's in Nashville and I don't know how she got there so quickly or anything. I have no idea how my mom got to New York. And apparently my mom and my friend were like communicating because I had apparently just put a very nonchalant text in our family group chat. And my siblings were like, Like we woke up and we were like, what? You're in the hospital? You're dehydrated? Like that's a big deal, especially for somebody who's not been hospitalized since being diagnosed. Well, I've been once. I was hospitalized. I took myself to the hospital. It's a whole different story. It was an injury. But nothing diabetes related. And just knowing like, okay, this is a big deal for my mom to fly across the country to come. And this is a big deal. Like my friend is sitting here just sitting with me worried. And this is the ICU. you can't really have a lot of people around. So it's like, I don't even know how they got in there. And it was just nice.

[00:28:14] Rob Howe: I do want to touch on something because this part of the story, I think is really important from your perspective, right? Because you haven't had a history of hospitalizations. Like you haven't been hospitalized for diabetes since you were diagnosed, almost two decades. And part of what we're trying to talk about more is that DKA can happen at any age, especially when you're outside your routines. And even someone who is as versed in healthcare as you are and works with hospitals can find yourselves in this position that you were in. So navigating through a strange hospital by yourself in a strange city, away from your home network, and continually having to advocate for yourself, what advice would you give someone if they found themselves in that same situation?

[00:29:03] Danica Collins: Yes. If you were in the situation, go get help. talk. Just tell your story. Tell what you do. And just tell everyone. Even if they ask you a million times, you know yourself, you know your body, and you know your diabetes. You know how you manage it. And when you're in the hospital, you're not with a specialist the whole time. I know with diabetes, we're with specialists a lot. And it's not there every day to have a diabetic patient. It's our every day to be diabetic because we have to. But that's why I really want to emphasize and share it, talk about it, even if it's annoying, because it's a delay. It's like a gap. It's not something they might have read in the book. They might be a newer nurse, newer something that might not have seen a case like this before. So the more that you can inform and explain how you're doing it is really just going to help your care. And it's okay to need help. It's okay to need to take yourself to the hospital. That's what it's for, these emergency situations, because when you're in DKA, it's not just your blood sugar and your body needs insulin. And that's why you need to get there because you need it through a different port. That's why my blood sugar came down and probably wasn't even higher because I was able to take it through a different port of entry, which is the whole thing. Because when you go through an IV, it's directly into your bloodstream. When we're doing, if you're giving yourself a shot or if you're using another site or something, it's not going directly into your bloodstream immediately. It's subcutaneously. So it's different. But there's a reason why there's protocol. There's a reason why there's training on this. And there's a big physiological piece of this too. And that's something that we might not know the details on or we've seen it or we've heard about it. But all I really knew about DKA is just, here's some signs. Here's what happened. Your blood sugar could be really high and this happens. I never thought about, oh, like it could happen. It could happen anyway. It's like, I never thought it would happen to me. It could happen outside of diagnosis. And I think it's something that I'm so glad we're talking about this because yes, I'm 20 years in and this hasn't happened before, but it did. And it can't. It can happen to me today.

[00:31:15] Rob Howe: And I think that's the main takeaway I want people to have is like, it's twofold, right? recognizing that it can happen at any time. And two, like making sure that you have your care plan with your with your doctor, with your endo, with your care team, with your specialist, like you're talking about so that you can follow the steps. Because like you said, because it doesn't always get talked about, or you we think of DKA maybe only at a diagnosis, or only at certain times, we kind of get into this mindset, like you're saying, like, oh, it's not going to happen to me. But it could. And so having a plan is really important. And you and I were talking the other day about a friend and community member that you had, that now as you are able to share this story and share your experience, you're able to pay forward the steps of like what to do if you find yourself in a situation like that. And so I think, again, like you're saying, I want to reiterate, sharing your story, even in small pockets, can reach someone at the right time so that they can learn from you and build a plan. And I think, again, back to working on this from the start to the finish, I now have my ketone strips that are not expired ready to go if I need them. So it's like, okay, well, this is something that, you know, me five years ago, I might have been, well, I don't need new ketone strips. Like if I ever get into a situation where I need them, I'll just go buy them. And now it's like, well, the more prepared that I can be, the better. And working this plan has been really great. So, Danica, I mean, what a story. I think, too, like sharing it publicly, what was the response from that? And like how many people did you have reaching out to you after, you know, I saw it on Instagram and LinkedIn and seeing that story sort of make the rounds in the diabetes industry. What were some of the things that people share with you from from being external with that story?

[00:33:06] Danica Collins: Well, I think it was overwhelming because I had thousands of people reaching out to me. And a lot of this I was doing in real time, too. I was like, I am in the hospital. So I couldn't respond. I still am catching up on messages, I feel like, because people were like, oh my goodness, are you okay? I didn't know this could happen. What else happened? What's going on? Or how did you get here? Because I think people were surprised because I am very vocal about my diabetes to see that something happened. But the biggest ask were like, oh, what is DKA? What is it? Is this something I should be worried about. Like, yes, we should all be prepared for it. I don't think it's something we need to live in fear of. I don't like to live in fear, but I like to be as proactive and prepared as possible. And I've had so many people reach out and I've had some really heartbreaking stories. Like someone that I had met a month before reached out to me. She's like, oh my gosh, this is how my sister died. And that hit me really, really hard because I had maybe four or five people tell me about loss because they weren't able to get help. And that just even hit me harder because it's like, we need to talk about this more. We don't talk about the bad things. We don't talk about how people cannot get help or be in situations because this is a very serious thing and it can go south really quickly. And if you don't get help, you're in a very bad situation. And I think that was the hardest of the messages and the conversations was just connecting with people that had lost loved ones to DKA, which I never had that connection before.

[00:34:47] Rob Howe: It is serious, right? And heartbreaking to hear about people with diabetes who suffer incidences of DKA where, you know, somebody is lost and there's a loss of life. And I think when we started talking about this campaign, what I wanted to do is exactly what you're saying, which is if we can speak things, we can define them and talk about them openly. we can take away some of the fear and some of the power that they have over us. And so by naming it and speaking and talking about diabetic ketoacidosis and DKA and building awareness around what it is, what it isn't, how to make sure that you're prepared when the time comes, even if you never need it, at least you were prepared. And so that you don't have to be part of the really tragic stories that happen. and we can grow together and support each other in this shared community experience. So I do want to thank you for sharing the low moments, the difficult times, where there's a lot of really good positive things that happen from the diabetes community, but I think it's equally important that we share the real low, ugly, uncomfortable, throwing up 10 times on a flight type stories where sometimes your best laid plans just don't work and you're able to turn a negative situation into a positive for someone else and for the community. And I'm just really glad that you were able to contribute your story to this series.

[00:36:15] Danica Collins: Oh, absolutely. And I think something else, I don't know if you're highlighting on this, is the follow-up after. This impacted me. It wasn't just when I was in the hospital. I was out for a couple weeks. I had extreme fatigue. I went back to my endocrinologist, and he's like, Like he assured me, he's like, Danica, like you did nothing wrong. Because I'm sitting there, I was like, what did I do? How did I miss something? And he's like, you did nothing wrong. It was a weird, crazy storm. And that's it. And like, that was the most reassuring thing because I could not get over it. And it's like the anxiety, like I had panic attacks. I had all this other stuff. There was, they give you medication. I couldn't get the medication. I had to get over my fear of flying like quickly. Like I didn't have time. I had to get home or I had to do something. And it's just, it wasn't just, oh, I was in DKA. and I went to the hospital and got helped. It took me pretty much weeks to get a full back calibration, feel a little bit normal. I had to slow down a bit. And I had to just take a breath, take a beat and let things be and let my body heal. And it was a lot. And just being able to go and do my follow-ups because I needed to tell my doctor. I am sure the hospital sent him something. But it's like, no, I need to talk to you. Is something off? I need to change my settings? What's going on? And it was reassuring and just continuing my blood work because I wanted to make sure everything else was back to normal. But it was a process. And yes, I didn't do anything wrong. And that's what diabetes is. We are missing something. Something isn't working properly. We could do everything right and still have problems. That's how you can have high glucose or low glucose because we live with a condition where that happens. And it was just, I had to give myself some grace. And I think that's the biggest lesson I learned that this is like, hey, things happen. Even when you're doing things right, even when everything looks good on paper, things can still happen because I couldn't see my ketones. I was in the air. I was focusing on throwing up. That's all I cared about. Like that's what was happening in the moment, but things were happening in the background. And that's how I ended up where I was. and that's how the human body works.

[00:38:31] Rob Howe: It's a delicate balance, right? And we're doing so much work every day. Like if you're probably not, we probably don't give ourselves enough credit for all the decisions and all of the measurements and all of the action that we're taking to keep ourselves alive on a daily basis. And sometimes through no fault of our own, whether it's devices malfunctioning or an outside illness coming through or just being in the wrong place at the wrong time, you can find yourself in a difficult situation. and DKA can happen at any time. And we just need to be more aware of not just the symptoms, but also give ourselves grace, like you're saying of the fallout and not beat ourselves up, not turn a mistake into something that's a judgment. So Danica, I want to thank you for being so open and sharing your story with the community and for being such a welcoming space and such a supportive person in the diabetes community. I am lucky to know you and I'm really glad that you were able to share your story as part of the series.

[00:39:26] Danica Collins: Thank you so much for having me and giving the space to talk about this because it's important. And I just love the work that you're doing. I'm glad we're friends and we're able to do this. And I hope everyone who's listening was able to learn something today.

[00:39:38] Rob Howe: Thanks, Danica.