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.