7
Apr

Ketones and thoughts about lows

About two weeks ago I had an interesting experience with DKA.

 

I went to bed as usual, but woke up around 1:30 to go to the bathroom. I noticed my mough felt fuzzy, dry, and cracked, and (sorry: TMI moment coming up) peeing... hurt. This raised some alarm bells for me, since normally it isn't uncomfortable to pee.  I briefly panicked and wondered if this was the first symptom of a UTI. I've read several articles that discuss how UTIs are more likely to occur in people, specifically women, with diabetes, so given my symptoms, that was one of the first things I suspected.

 

I checked my bg and found that I was suuuuper high. The bathroom discomfort prompted me to check for ketones which, I discovered, were present in my  body in HUGE quantities.

 

I quietly wondered: Is it supposed to hurt to pee out ketones? <<file away under the "Google this later" category>>

 

 

I feel very lucky to have access to the healthcare team that I've got. When I realized I had ketones, I gave a correction bolus for how high I was and called my hospital. They directed me to the endocrinologist on call (since it was the middle of the friggin night), who called me a few minutes later to discuss what was going on. I explained the situation, and described how I don't usually have ketones, so I wasn't really sure what to do. Should I give extra insulin for the ketones? What if that extra insulin made me go low? Could I still go to bed with extra ketone-fighting insulin on board?

 

My worry was that if I gave the extra insulin that's normally required to treat high ketones, it would actually be too much, and in the morning I simply wouldn't wake up. I explained this to the doctor.

 

 

I don't think that anyone with diabetes has it easy, but I am pretty fortunate in that I am able to, with the usual loss of sleep and consultation with a medical team, tighten up my overnight insulin (basal rates) so that my blood sugars stay pretty stable overnight. This tends to change a few times a year, or when I experience extra stress, but for the most part I only tend to do a HUGE basal-rate-overhaul maybe 3 or 4 times per year. I only mention this to explain that when I go to bed, with basal rates that usually work for me and with the added benefit of my cgm, I don't always worry about whether I'll wake up in the morning. This night, I worried.

 

 

This story doesn't have a very interesting ending. I corresponded hourly with the on-call doctor, who gave me instructions for insulin and water consumption, and had me report on blood sugars and ketone levels until everything was back in range. I admit I did still wake up low, but it was a "mild" low ("mild" as opposed to "my glucose-starved brain is pretty sure I'm going to die, BUT maybe I can stave off death if I eat everything in the fridge"). I think I woke up at around 3.8, which for me is still a BG from which I can wake up. Low 3s or below means I won't wake up.

 

Looking back, it feels almost strange to think that at 3.8 I can accept that I woke up low but it was ok, whereas a 3.2 would probably have had me unconscious and missing my alarms, laying in bed until Boyfriend (or BFF) noticed something was wrong and gently nudged me, repeatedly, all the while shoving a ready-to-drink juicebox in my face and hoping I wouldn't throw it at him(/her) or drip the whole thing over a pillowcase (I've never done that while low... I swear.).

 

0.6 mmol/l (or around 10 mg/dl) can make the difference between waking up and not. I'm really not trying to be over-dramatic...just stating a fact.

 

It's weird to think of your own mortality. Some nights (some mornings...some days) I think I get closer to death than most. I guess one of the sad things is that you sort of get used to it over time.

 

 

22
Feb

End-of-day lows?

Last week I ended one day with a pretty bad low.

 

2.8.

 

It was bad enough for me to chug back 2 juice boxes (20-some carbs apeice) to try to feel better) before I left work).

 

The thing is?

 

I walk into a door on my way out of the building.

 

I had 2x 21 carbs PLUS a 2-floor walk before I hit that door...but sometimes It just isn't enough to figure out whether the door opens in or out. *sigh*.

 

i walked into a door on my way out of the building;

&' yes...

21
Feb

Overnight lows

I've been having some issues with overnight lows lately.

 

I've been setting a 70% basal overnight for the last few weeks. Most of me knows that a 70% basal will make me wake up ok; fortunately for me I have a pretty solid network of friends who help me to fee not-so-terrible when I've had some delicious delicious wine.

 

My overnight basal rates have been too high for a while, and the weird thing is that it seems to take having friends over for dinner and drinks to figure out that I need to do something more permanent than a 70% overnight basal.

Bah! I don't want to have to re-jig my overnight insulin rates! Sometimes changes, whether stress levels or natural life stuff, BLOW.

2
Jan

<3

For those lows when it feels like laying down is great, and no matter what happens I should lay down and should stay that way:

image

boyfriend aka bringer of juice

I am very lucky to have him.

25
Aug

Rafting and pump supplies

I went whitewater rafting this weekend.  I spoke to my d-team in advance so I could have a solid plan for switching to injections for a day, since my last pump vacation was a bit of a disaster. This time around wasn't perfect,  but it was pretty damn good!

I disconnected from my pump and left it in a cooler in the car (along with my transmitter) after giving a bolus for half of my morning basal insulin.  We decided  to go with half because
     a) rafting is a ton of exercise (possible lows),
     b) I would be in the sun all day (again,  another trigger for lows), and
     c) On my last "pump vacation, " I went super low for a loooong time (so my full dose of basal insulin would probably cause -- you guessed it -- lows!)

I went low somewhere during the safety training. 2 bottles of juice and a banana for me, & then we were off to the boats! The rafting team had my emergency bag in their dry bag; Boyfriend and another close friend both had glucose gel packs in the pockets of their shorts, and I felt as prepared for the day as I could possibly be.

By lunch I was 15.7. Hardly surprising,  since I gobbled down around 90g of carbs to treat the low before we left... At lunch I added together the insulin I'd need for the correction,  the meal bolus, and the "missed basal" bolus, then gave 2/3 of the whole thing, and by the time we finished for the day I was back at 5.6. I think I'd call this a successful(ish) pump-free day. I've obviously got a bit of work to do to fix what happened in the morning, but I stayed safe all day and ended up with a good #, so I'm happy with it!

Of course,  whitewater rafting beat the crap out of both my sensor and infusion set site. The infusion set (big bloody mess) still worked but was extremely sore afterwards,  so it has been changed to a new location. The sensor was also pretty badly squished and abused throughout the day (and gave me a sensor error when I first reconnected it) but seems to be working fairly well again. The excess tape that I had to use to hold it down is making the whole thing feel like a big sticky glob of constantly damp and itchy grossn.ess on my side, but at least it's only 36 hours until I'm due for a new sensor.

2
Jul

First "pump vacation"

Last weekend I took my first "pump vacation."

It was short - very short. I had plans to go waterskiing/wakeboarding/knee skiing with Boyfriend, and since this coincided with a site change day, I figured I'd leave the pump at home for a few hours, rather than expose it to the (however slim) possibility that I'd lose it off of the side of a boat.

I think my problem was that we slept in. I had a late breakfast on Saturday, so my breakfast bolus was still in effect when I disconnected from my pump. When the time came, I figured out approximately how long I was going to be off of my pump (I figured about 4 hours), calculated my basal insulin over that time, and gave it as a bolus - then said goodbye to my pump, double-checked that my purse was loaded with juice boxes, test strips, and the Frio pack that held my Humalog pen needle, and I was off boating!

....enter low BG. I'm not sure if it was the heat (around 40 degrees with the humidity!), the stacking of my breakfast bolus + "missed basal" bolus, or the exercise from waterskiing (or trying to), but I spent the first 2 hours sucking back juice boxes just to stay above 4. The lowest I got was 3.6, but a lot of that was because I had around 8 juice boxes over that 2-hour period.

Yup -- that's 200 grams of carbs.

Looking back, I think I'm lucky it didn't end up worse than it did. I felt mostly fine throughout the day -- a little shaky at times, but overall more excited about water sports than concerned about BGs. It wasn't until later in the day that I realized just how much juice I had gone through. 

At least it helps me to realize that next time I want to take a pump vacation, there's a lot more to consider than just my "missed basal" insulin. Stuff like IOB (insulin on board, or Active Insulin), outdoor temperature, and exercise had a HUGE impact this weekend. I wish I could have anticipated that.

When bad things happen, my tendency (like that of many people with diabetes, I know) is to give myself crap for letting it happen. I'm trying to be better about focusing on how I really did try - I tried to figure out how much background insulin I needed, and I didn't think it would be so hot once I was in the water, so I hoped that the effects of the water would negate those of the heat. I really did try.

So much of the daily diabetes-things seem unpredictable and (semi)uncontrollable sometimes. I'm trying to take credit for the "good" numbers, but also trying to give myself credit for trying even when it doesn't end up going so well.

Saturday did not go well. I am lucky that it wasn't worse.

I am happy that I didn't ruin a fun day with diabetes-related "sick people stuff" that would have held up our water sports.

I am very, very happy that I had enough juice boxes around to keep my sugars from completely tanking.

On top of all of that, I can also say that I've learned something. It could have been worse, but it wasn't, and I can remember this next time I plan to take a short break from my pump.

I am feeling encouraged by the fact that I'm considering this as a learning opportunity. I certainly don't want to downplay what could have been a very serious, very dangerous situation, but I also don't want to dwell on it.

On a lighter note, I hope you had a fantastic Canada day! Cheers, folks! 🙂

11
Jan

Hello again, nighttime lows.

My second low of the night - by 2am I had hit 2.5 (45 mg/dl) TWICE. This is a) unusual for me, and b) super crappy.

Naturally,  I dealt with the second low by drinking....this:
image

(that jug of juice was full before I opened it to treat low #2)

Also naturally, a half hour later I am 11.2 (~200 mg/dl) and probably still rising.

I'm just getting over a head cold (which usually pushes me super high), as well as a double bacterial eye infection caused by the spreading of a sinus infection (SO. GROSS.), and am on nasal spray steroids to deal with the sinus stuff (which I would expect to also cause highs?) but, much to my surprise, lows have been kicking my ass lately.  I've reduced my levemir by 20%, and I'm thinking my nighttime dose needs to come down even more. I wish everything could just stay nice & stable... like, once basals and boluses are all figured out, we could have nothing ever change. With all of the extra work that d-folks already do just to stay healthy, is that too much to ask?

K, whine officially over. Time to get back to bed!

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