So it is crystal c r y s t a l shepherd 1441777 20 year old lady past medical history type 1 diabetes mellitus diagnosed 2018 uti is coded in 2024 pregnancy and delivered by emergency cesarean section february '20 '20 '6 so investigations renal function normal outpatient's baseline lfts alt 37 note previously 8 crp 10 previously has been 2 back in may may so every year okay urea normal ast normal full blood count platelets 444 from 236 hinchfield's 5.22 and white cell count normal heavy growth of a coliform on the 02/07/2026 from a low vaginal swab other microbiology reviews urine mcns is from january 2026 negative and august 2025 negative antenatal serology for viral hepatitis and hiv in august 2025 was also negative I think I talked about that lady was incorrect so in terms of diabetes management previously been on basal vagus ratio most recent hponc 47 on 12/16/2025 and prior to that 59 on the 09/04/2025 hi crystal alright I'm rob I'm 1 of the medical experts nice to meet you how are you feeling well I'm glad good I'm glad now you have a pump is that right doing well and the pump is not working or whatever it is working so what happened I had an infection in my arm from the front of the light I don't know if that from the libre side or from the pump the pump because I gave my episode a week ago yeah I've heard about it congratulations thank you because the hormones my doctor said it's probably just hormones so I haven't eaten at all so I'll be starving and then I'll go to eat and I'll have a few bites now but just so I haven't had like a complete like a lot so that's probably and the infection is probably just of course and did you have treatment for the infection antibiotics or anything like that yeah so yeah it's drained out now and where's the baby gigi 's because none of he's old he's old enough okay good so that's fine breastfeeding or no I wish I would have missed a difficult 1 we'd be nervous agreed it would be very challenging yeah yeah and it'll make this kind of thing incredibly challenging I think it's a sensible choice yeah yeah you do great so baby's okay you're doing okay your numbers are getting better on the blood test which is great you can treat it for dka but it's funny as with the pump if it was if any insulin is given to you you shouldn't go into dka but did the pump come out at all no so I think I think as well because I've obviously it's new 1 think sometimes I take it out like when I'm getting here to something between my eyes it's change of it's pretty full on having a newborn let alone having a newborn then I I've got I'll I think I took it out then I'll forget and then I'll out my pee and then I'll put it back in but I think there's little sections that I haven't had in my yeah yeah I understand and how long might you go without without having to put in any treatments it won't be long because obviously the baby's over 30 to 3 hours so that's probably what he is pushing on yeah but you could get an act tracked didn't you I guess without your help yeah he's starting to get used to sleeping when he's bed now okay so that's good that's good yeah it's fine lovely and your first nice what's his name leo leo yeah that's a nice name great nice and and so obviously we're sorry that you're in hospital but we'll get you sorted and get you out of here as soon as we can yeah when you came in it was 7.18 it hasn't really made a huge difference since then but unfortunately it takes a bit of time to start clearing then when you start clearing your ketones the lungs will get better quite quickly and you're on all the right treatment today and your team will come in right which is good and your ketones coming down they are nicely aren't they so once they start to normalise your your ph is a normalised treatment which is good and then the question will be about what we do do need to pump back in don't we yeah so they said when they start on the insulin yeah I was supposed to have injections for a long time yeah we could put you back on a basal bolus regime like your what what you were on tresiba before weren't you yeah yeah but I think they just didn't put me on that because it lasted longer exactly they they spoke to me about it and I just didn't wasn't really sure because like in an ideal way I guess given recently in birth we can't get you out of here as soon as possible to get you back to your baby and do exactly but if babies look dark then that's good to come and come up with a more sensible plan so maybe getting you on some tresiba in the long term to drip in while you're on this that will help us move from this to the pump more smoothly if that makes sense because otherwise it'll be lots of insulin and then nothing and you're at risk of going into dka again before the pump kicks in okay and so maybe having a bit of tresiba just 1 dose is when you were working how much tresiba did you take when you took before you went on the pump I thought it was so bad I about 500 then you get on so I'm not I have a good idea okay maybe they'll have it on you because we talked time to do it was it fine I thought because I thought I read that relatively recently you were on no they I was on 1 when I was late I was pregnant like maybe 2 months ago okay alright of course it makes sense I guess so before you were pregnant you went on the pump that then so what that was october time was it you got pregnant yeah it previous was no it's bonded with who knows bonded with it's okay well let's have a look how's your day back next to this yes type 1 diabetes tresiba 30 units and novorapid 4 to 5 units with meals does that sound about right it is sounds good doesn't it ah okay and that was just when you that was when you were 6 weeks pregnant yeah so I guess that kinda makes sense so why don't we give you 60 units of tresiba which is ultra long acting as you know and that will just trick along in the background as long as they're in from once this is sorted back to your pump oh okay and you can manage the pump in terms of when you switch this off you'll be happy to turn the pump back on that sound good and in terms of infection and things like that obviously you've had this arm infection any urine infection or chest infection symptoms nothing like that and how is the arm at the moment is it looking okay no she's got she's on that side oh she's doing fine it's fine yeah yeah yeah yeah times around no but she needs to stop like no okay that's good and you can come and get her to the knees yes no not anymore there was what is coming on for you looks like it still might be something just I haven't had it anyway I drained it it's really big because it looks fine nothing else was going on with it so because your markers of infection are ever so slightly up your crp is know yeah well sometimes infections can predispose you to get dka as I'm sure you know yeah and your crp is 10 not crazy high but normal is less than 5 and your platelets are ever so slightly up like you're responding to an infection and if you're not breastfeeding you don't have to worry about baby getting any antibiotics unnecessarily so it the balance of benefit probably swings to give you a bit of antibiotic okay if that's okay and do you what's your diet like you've been off your feet since giving birth is that right yeah I would say I was alright when I was in the hospital yeah mhmm I was in the hospital for 2 weeks I think since it's obviously 01/2020 mhmm but I think it started like a week after that mhmm and then I mean my partner thought I just did a depression I was like no it's something I don't wanna eat yeah I just just don't feel hungry yeah just physically cough because you feel nauseated or no so after I was feeling really hungry like it's why I really wanted a cheese sandwich I was like craving it and then I'm I eat like half of it I was like I feel sick now it was like do you know when you're falling you're just like if I take a bite I feel like I'm gonna be sick mhmm that's what I get like but it doesn't look like a free bite brilliant. And I I went to the doctor and she said it's probably just horrible and sick and then because I threw up mhmm and then you threw up before you came in here well I was on the way here you threw up yeah okay and do you feel like after you eat you feel full for a really long time do you get belchy and things like that on that part say like I do feel full like I probably eat like 2 meals a year mhmm so I'm just not pregnant but then I I need to feed and this is all since doing birth yeah mhmm so they just think it's on yeah maybe we just it should be everything to hormones don't mean we're terrible yeah when you're pregnant it's your pregnancy when you're not pregnant it's your hormones yeah they were like unless you're sick it's like it's probably just hormones then it's like well I don't know if I'm sick because I'm not eating or if I'm sick because I'm really here good and obviously you spent some time with with the diabetes not optimally controlled it's fair to say that and sometimes that can damage the nerves around the stomach makes me worry wonder about whether there may be a potential for that so something we can consider that in an ideal world we'll just get you feeling better and hopefully raise the leg so it could have been the infection brewing in the background and all that kind of stuff but if you don't get better then I think it's worth speaking to the endocrinologist again to see whether you might have something called gastroparesis or sluggish gastric emptying which is what happens when the diabetes isn't perfectly controlled for a bit of time mhmm and sometimes it usually gets better with more diabetic control alright gonna have a quick listen to your chest is that okay yeah you want some no you don't take anything off okay let's have a look at that k is that your bottom of it you're pressing any swelling in your legs or cellulitis on your legs any infection nothing like that that's fine good great so we'll carry on our protocol it always seems to work when we give it enough time to work I'm going to proceed up I'm it going in the background for a few minutes said to have a told you I don't know what it's called it's fine so they sorted it all out ignore them they're gonna go with humidonide which is fine so that's a good alternative dose good alternative insulin and you're gonna get a preventative dose that'll be great and then we should get you something to eat we'll try and get you eating and feeling better do you still feel nauseated during the steps no I feel puffy good fantastic great so they've got you sitting there we'll carry on everything and then we'll once we've focused on they'll get you out there does that sound alright are we gonna have a cheap baby to look at in a minute I hope so really good nice to see you see you later sorry of course you do it more harder hold sorry I can use the other phone if you want it's fine I know you've been talking for ages she's doing really well already yeah it's great isn't it ketone's coming down really nicely 2 minutes yeah and then immediately and it says and it says there's a clonidine look what is this I don't think it's past okay she's got a good 1 she's got good a she's she's she's got got a good a a all the other carcets are small so I'm calling your charger what your tablet is what your tablet is and many are you making well to be fair I'm just gonna wait for the amount of the thousand y because my feet to throw in the office too once I go back to normal I'll be asking if I'm allergic to it we'll have to see what they say okay just draw okay so the infusion so my patient is gonna have a blood smear test. So they're gonna have up to and just check the blood so we're getting really anxious and they've had to give me any pictures anymore along that day I'm gonna last for a month then it I'm had gonna to be done so when I when was in the hospital I had to see a lot of antibiotics but what I've been doing is I've been asking about which you've got you said she got a bit of a fever so I just wanted to see got a gold in the hairdressers this year but the only time he tried which we knew he was going to was when I was getting my hair washed it's a dye on the towel and then as soon as I arrived back in the chair what's your plan on a station like this well he hasn't been to speak for a while so he's just given a cover of what's done you what's the second hold on just cut my hair you can put clothes on my hair it's great it's so wide so I found the tip it's a little sorry I'm going on I'm sorry I'm not gonna make this a little I don't even know it's so that's that's that's really weird really weird this is finger that way I just he needs to fight get the reception out of the way and even if you make a conscious effort of of eating eating little and often yeah that's what that tells us yeah I mean like this morning you only had a heart attack and it was throughout that other part in cleveland put it in the trachea and look like that and then I'll give you a normal quarter size of a much better thing to see okay so you can have 1 at dinner time and then later on if you're hungry and then you think you need a drink okay that's the other bit yeah or keep it in the fridge and have it for lunch the next day that might be good so sorry about that I put the phone down for a while and didn't record anything but impression is dka secondary to nonuse of insulin pump in the context of recent birth and looking for after a newborn and also pump site infection on the left arm plan oral flucloxacillin to cover for pump site infection given slightly raised inflammatory markers on bloods continue dka protocol until resolved long acting or intermediate acting insulin as per the diabetic team that I've already reviewed once dka resolved restart pump and aim home