Recurrent Diabetic Ketoacidosis: a phenomenological case study exploring the experiences of young women with Type 1 Diabetes Mellitus

Introduction
Type 1 diabetes mellitus (T1DM) affects approximately 400,000 thousand of the United Kingdom's population and is characterised by an absolute lack of endogenous insulin production. Management requires complex decisions to be made on a daily reoccurring basis, and levels of distress and burden are unsurprisingly well documented across this population. If supplemental insulin is insufficient, the person will rapidly develop hyperglycaemia and, if uncorrected, diabetic ketoacidosis (DKA). This is a life-threatening acute complication often necessitating admission to an intensive care unit, with an increased risk of death. Despite DKA's impact on those with T1DM, the experience of developing and living through it has not yet been reported.
Methods
Five young women were recruited and interviewed, with nine semi-structured interviews completed over fifteen months. A phenomenological case study approach to analysing and interpreting interviews was utilised. Phenomenology aims to capture the uniqueness of experiences and phenomena. Drawing upon Merleau-Ponty’s (2014) philosophy by exploring the embodiment of experience and how individuals make sense of or perceive events over time. Analysis and philosophical interpretation are presented thematically to form the case study of recurrent DKA.
Findings
In total, seven themes were developed. Despite the initial questions remaining the same for both rounds of interviews, the themes differed over time. The themes for the first interviews were: 1) Diabetes is constantly on my mind; 2) The shaming and the blame; and 3) Fighting to stay alive. Four themes were developed from the second interviews; 4) Watching it constantly; 5) I feel really broken; 6) The importance of others and 7) I feel really broken.
Participants were profoundly affected physically and psychologically by having developed DKA, the legacy of which lasted beyond the initial hospital admission. They reported the overwhelming experience of being in DKA and having to give their bodies over to others to provide hospital treatment. There was a battle between the body and the mind both during the daily management of diabetes and during DKA which resulted in a disassociation between body and mind.
Conclusion
The case study highlights the fear of experiencing recurrent DKA. There were periods when the burden of daily diabetes management was overwhelming, and participants just wanted the normality of their old bodies back without diabetes. During these times, there was an internal battle between the mind's rationality and the body's experience. Still, these were inextricably intertwined, leading to the inability to prevent DKA from reoccurring. Participants felt blamed by health care professionals when DKA developed, causing delays in accessing emergency care. Using a phenomenological method in this case study provided the understanding that DKA was an embodied, temporal and corporeal experience for the young women in this case of recurrent DKA.