The Atomic number 68 nurses had a rough sledding getting the needle in. My normally go veins are so empty that they've retreated into my chalky flesh, dehydration camouflaging their true locations. Notwithstandin, the Quadruplet fluids are at length running now, although I can't say that I'm feeling some meliorate. Not that I'm feeling any anguish. Or nausea. Or much of anything. I'm touch… well, I'm not trusted what I'm feeling. Confused more often than not. Cloudy headed. Tired. Light-headed even though I'm lying flat in a hospital eff.

As and higher up me, the heart monitor sounds an alarm again. Blood pressure low, inwardness rate high.

My mouth is parched, tongue as dry as if I'd crawled across the sands of the Sahara for days followers a plane crash in the arid, barren devastate. I render to reach for one of the popsicle-like sponge-on-a-sticks on the nearby countertop, but I might equally well beryllium in a straitjacket. Tubes and cables snarl Maine like a Borg octopus, limiting my movement.

My diabetes "sister" Lisa hands me one and only of the sponges while she listens to my wife rant about the wait time connected a Monday good afternoon at the ER. "Why didn't you just tell them your husband's a type 1 diabetic who's been throwing skyward?" Lisa asks, "That's what I forever do. Gets me right to the front of the seam."

I'm aghast. "No," I croak though adust lips, "I'm not playing the DKA card just to pay off accelerated service." The mere notion is… condemnable… offensive. Suchlike using diabetes as approximately sort of excuse. A crutch.

At that very moment the harried ER Commerce Department enters the treatment room and without pausing for breathing place says, "Well, you're in DKA."

"No way," I enjoin, stunned, and not just past the timing. I've written about DKA. (More than once.) I've taught people about DKA. I'd know if I were in DKA.

The doc, literally, rolls her eyes.

"I'm sorry," I stammer in apology, "of course there's no mistaking something like that, simply it never one time crossed my mind that I was in DKA."

The doc gives me one of those disrespectful looks the medical types reserve for people who should know better, and goes on: "Your white cell count is through the roof, you're severely desiccated, your electrolytes are way polish off, and you're starting to having whatsoever issues with your kidneys. I'm admitting you. You'll be here at least two years, perchance more, while we sort this all down."

DKA? Pine Tree State? How is that possible? I'd know if I was in DKA… wouldn't I?

Diabetic Ketoacidosis: The 411

The great unwashe with typecast 1 diabetes live life on a tightrope. To 1 side, low roue sugar—known as hypoglycemia—can kill you. On the other side, high blood sugar can gun trigger something known as Diabetic Ketoacidosis, or DKA. It can likewise defeat you.

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Here's how DKA whole works: When insulin is low, the cells in your personify potty't metabolize sugar. Even if there's a ton of sugar to be had. Sans insulin, no matter how more than glucose the cells are swimming in, they can't get a sip of it. Starved in a seagoing of plenty, the cells turn on each other, the lean and mean ones attacking the fat and lazy ones. Instead of sugar, the cells start metabolizing fat for fuel. Yep. It's cannibalism in the better custom of the B&W Tarzan movies of the mid 1930s. All across the jungle of your body, as distant war drums throb, big branding iron pots are dragged out of thatch huts and oily cooking fires are lit. The smoke from those unclean, pyknic-cooking cannibal fires rises above the hobo camp canopy, blocking out the sunlight…

In the typographical error case of your body, these sooty smokes that are the byproduct of metabolic zoftig hot are called ketones, and their mien in high enough volume shifts the integral bloodstream to a more acidic full stop, thence the acidosis in the bring up of this about dangerous of diabetes complications.

And that can cause some bad shit to happen. Including dying.

The main symptoms of DKA that we're told to watch for—other than those associated with high blood sugar in the first place, the likes of looney thirst and peeing like a race horse—are nausea OR vomiting, abdominal pain, fruity-smelling breath, rapid respiration, and confusion.

Of course, you can't tone your own breath. If you are confused you probably don't know it. And well-nig people aren't aware of their respiration rate. So the main warning sign of impending DKA that wholly type 1s are taught to be alert for is the union of sickness and body part pain in the presence of high up blood lolly.

And I never had any. Sickness or pain in the neck, but clearly as my doctor noted, I was experiencing DKA.

My DKA Experience

What happened? I tranquillize don't be intimate. A lot of IT is a blur. Something made me feverish. I did throw up, only my loot was at a normal level when IT happened. But then things went southward. My blood sugar level started rising and wouldn't stop. I threw insulin at it, but information technology all happened indeed red-hot. So frickin' speeding. It only took a couple of hours, coasting upright below 300 mg/dL, to ship Pine Tree State into a glutted-dyspneic metabolic crisis that left me in the hospital for iii years, two of them in the ICU.

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Days later my endo, flipping through the 59 pages of lab results from the hospital and scrutinizing my Dexcom CGM information, remarked that IT looked more than comparable a "pump DKA." But I'm not along a pump. I'm on MDI (injectant therapy), shooting up basal insulin twice a sidereal day and fast-acting different times a day in addition. But somehow the sugar got before of the insulin. Way ahead. Maybe I had some bad insulin. Maybe I made a mistake. But that's not important. Not now. What's important is that the possibility of DKA—a fundamental reality of my condition, my life—simply wasn't in my playbook as a possibility anymore. How did that happen?

I think out it's a naughty side effect of good ascendancy.

Familiarity Breeds Contempt

Back in the day, I had a complete diabetes Go-dish, equipped with everything: Glucose cadence and strips. Blood ketone meter. All-night-needle syringe for intermuscular injections when high. Glucagon ER kit. Meager stuff for whatsoever therapy I was victimization at the time. I was a one-man mobile diabetes treatment squad, prepared for all the world.

Only my diabetes has been in bad OK ascendancy for a long time now, and over the years I've gotten lazier and lazier. Lately, I've been traveling light. CGM happening my arm beamy saccharide data to my iPhone, Flexpen in my endorse pocket, and a sleeve of Overstep glucose gel in each forepart pocket. A couple of save compose needles go around across the pockets of the various jackets I favor, summation a few more in the glove box of my elevator car.

When this cataclysm stricken, non lonesome did I have no clue where my ketone meter—with its dead battery and foresightful-expired strips—was, IT never even once occurred to me during this little gamble that I should screen for ketones. The entire subject had plummet dropped out of my mind.

I'm closing in along two decades of diabetes with no DKA, never evening close, genuinely, and I cogitate that lack of terpsichore with the Devil has lulled me into a false sense of security. Simply put: Because it has never happened to me I must stimulate begun, subconsciously, to believe that it couldn't.

But diabetes never rests. Neither, too, bathroom we afford to.

Back to Basics

As a navigate, I'm mandatory to undertake ongoing training to keep my license current. More professions require something similar. It's called Continuing Education. Even doctors essential continue to study. Part of continued ed is to ensure that professionals keep current with changes in their professions, but it's also a way to ascertain that parts of your knowledge portfolio that you rarely use stay wise. Wish the fundamental need for populate with diabetes to have a sick day plan, something I'd long forgotten about from lack of use.

Indeed now humbled, well-bruised and battered from my stay, telemetry alarms still echoing in my ears, I'm moon-faced with the need to go back to the bedroc. To re-watch the risks, the acquirement sets, the tools that I was introduced to all those years ago chase my diagnosis… and sustain lost since.

And I bet I'm not the only one, soh I'm inviting all of you to junction me on this journey Back to D-Basics, right here at DiabetesMine, protrusive with revisiting DKA prep today.

What am I doing to annul a repeat performance? Other than the renewed awareness that DKA exists, can happen to any of us, fanny happen with sensational speed, and may not come complete with all the symptoms we've been taught to expect? Well, I:

  • Turned back on my CGM's "high" alarm. Suffering warning device fatigue, I'd inverted it off a while back, just going the low alarm in place. I made the mistake of thinking that lows are the greater menace. Now I am reminded that both highs and lows are equal threats.
  • Bought a untried Precision Xtra blood ketone meter and the very expensive strips that feed information technology, to healthier assess the DKA risk when I'm running high. Any time I'm over 275 mg/dL for more two hours, I'm breaking that puppy out. If that meter clocks anything above 1.5 mmol/L, I'm acquiring my tush to the ER. Even if I feel fine.
  • Dug out a ½-inch needle syringe to carry in my re-deep-rooted Go-bag. If I have a stroppy high, injecting chastisement insulin into muscle, instead of fat, gets the insulin connected the job faster—reducing the risk of DKA.
  • Am now carrying said Go-bag around with me again. Everywhere. No more touring light, I'm backpacking everything I need to survive and prosper. I guess I'm a Reborn Diabetic for real.

For my next refresher lesson, I'm thinking of revisiting insulin temperature control. How hot operating room cold can it get ahead losing its punch? How would you know in either case? And what tools and tricks do we have to keep it off the hook?