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.

 

 

4
Apr

When life gets in the way...

Lately things at home have been pretty hectic.

- We adopted two rabbits. They're adorable and precious, but litterbox-training baby rabbits is not an easy task. It involves a lot of urine-soaked newspaper...

- The dog got an eye infection. Then an ear infection. The the other ear...infected.

- He passed it on to the rabbit (so all 3 pets [2 rabbits; 1 dog] had to be separated, and one dog & one rabbit ended up on antibiotics)

- The dog then scratched his cornea and developed an ulcer in his eye. He's on meds every 3-4 hours over a two-week period, and for now he's stuck wearing his cone 🙁

- My lovely and wonderful best friend is getting married in a little over two months, and as her MOH I've been honoured and delighted to start planning a bridal shower and bachelorette. Also, wrangling friends and family members into planning sessions and coordinating details has, on occasion, left me just the teensiest bit frantic. Even more than that is the ridiculous idea that I need to pretend that I've got a solid handle on everything that's going on --  I'm not sure where this compulsive need to fake it is coming from, but the cool calm exterior that is presented (when in fact I'm tearing out my hair or panicking over details) to others involved in planning is proving a bit draining to maintain.

- Work has been insane. Like, insaaaane. I have, through the sheer luck of being the person who sits next to my group's manager, been tasked with updating some of our systems and processes on top of my regular work duties. It's been fun and challenging, and I've definitely been learning a lot as I go, but I admit it's been a uniquely challenging project.

- My elbow has been acting up. I'm on a waitlist for surgery on my ulnar nerve (that's the one that runs through two bones in your elbow), but I've got about another 6 months to wait, possibly longer. My symptoms have been ramping up over the last two weeks, leaving me trying to balance managing pain with my desire to actually use my hand. More on that later, but to sum it up, it's been making itself increasingly noticeable over the past little while, and nerve-blocking meds are no longer helping.

 

It feels very strange to look back over the last few weeks. Diabetes has actually taken a backseat to the drama of everyday life, and this feels very...strange. My Carelink reports show that I'm trending higher than I'd like, and to be completely honest I haven't done much about it. I know I have an upcoming endo appointment in about a week, and I know she'll make recommendations for changes in my basal and bolus ratios. Does that absolve me of any responsibility to review my data and make changes in response to what I see? Well....no. It does make it easier to just wait to let someone else make the changes, though. Lately it just feels like life has been too busy to let diabetes be as important as it should be, and my Carelink reports are proving that my diabetes care is suffering. I hope that this upcoming appointment can serve as the kick in the butt that I need in order to prioritize my health again, at least for a little bit.

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