£8,000 settlement for diabetic ketoacidosis

30 October 2023

Our medical negligence team, has secured an £8,000 settlement on behalf of Mrs M, who suffered diabetic ketoacidosis and acute kidney injury due to insulin being withdrawn. 

The facts 

Mrs M contacted us to pursue a clinical negligence claim after her insulin was withdrawn and left her suffering from diabetic ketoacidosis (DKA) and acute kidney injury, requiring intensive care. Diabetic ketoacidosis is a serious condition that can happen in people with diabetes. It is when a lack of insulin causes harmful substances called ketones to build up in the blood. It can be life-threatening and needs urgent treatment in hospital. 

Mrs M has type 1 diabetes, managed with long-acting insulin in the evening and doses of short-acting, novorapid insulin with meals. 

Mrs M was admitted to the hospital with left-sided weakness. She was transferred to the hospital's stroke unit, and an MRI scan confirmed a large stroke. 

On admission to the hospital, Mrs M told the doctor she had type 2 diabetes, which was recorded in her notes. The doctor queried the nature of Mrs M's diabetes because they thought the insulin dose was unexpectedly high. The doctor reviewed the clinic letter stating Mrs M had type 1 diabetes. Mrs M's notes were immediately altered by writing 1 over the already documented 2. 

Mrs M's insulin was omitted three days after her hospital admission but was given every day from day four to day thirteen after Mrs M's hospital admission. Nine days after admission, intravenous fluid was also started because Mrs M's blood results indicated an acute kidney injury, which resolved. 

Fourteen days after Mrs M's admission, insulin therapy was stopped because of hypoglycaemia (the sugar level in Mrs M's blood dropped too low). The decision to stop Mrs M's insulin therapy was based on the fact the doctor mistakenly understood Mrs M to have type 2 diabetes. Mrs M's capillary blood sugar readings rose throughout the day, and a referral was made to the diabetes inpatient nurse but was not received. 

Sixteen days after Mrs M's admission, Mrs M began vomiting, and the advice was to give her long-acting insulin. Mrs M was reviewed again, and it was noted Mrs M had an increased respiratory rate. Mrs M had an arterial blood gas test (ABG) – a measure of the oxygen and carbon dioxide levels in the blood as well as the blood's pH balance. The arterial blood gas test showed Mrs M had abnormally high blood acidity, and her blood sugar levels had dropped too low. Mrs M's clinical notes were reviewed again, and type 1 diabetes was confirmed. 

A diagnosis of diabetic ketoacidosis was made, and Mrs M was transferred to the intensive care unit for further management. Mrs M remained in intensive care for six days. Mrs M was transferred back to the Ward and discharged three months later. 

The claim 

Our team instructed a consultant physician and endocrinologist expert to report on breach of duty and causation and a consultant in neuro-rehabilitation medicine to report on causation. The experts were of the view that the Defendant Trust had breached their duty of care to Mrs M because they should have clarified that Mrs M had type 1 diabetes sooner and, therefore, should have ensured that insulin was not withdrawn. 

They also confirmed that because of the breach of duty, Mrs M developed diabetic ketoacidosis requiring intensive care treatment, and Mrs M's stroke rehabilitation was delayed. 

Our team submitted a pre-action letter of claim. Negotiations to try and settle the case before incurring additional costs of issuing court proceedings proved successful, and a reasonable offer to settle was made rather than proceeding in court. 

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