My First, Second, and Hopefully Last Run-Ins with DKA

It’s taken a while for me to churn this post out. I am just so exhausted in every way; even just typing and formulating thoughts has been an involved process. But I wanted to write this post to serve as a detailed update for family/friends and also to help fellow T1’s identify the warning signs & symptoms of DKA. It happens so incredibly fast, so I don’t want it to sneak up on anyone the way it snuck up on me. Also, I don’t really expect any of y’all to make it through this entire post {it’s more like a novel!} But it’s been very therapeutic for me to write. Bear with me. This one is a doozie.

First and foremost, I want to give a sincere, heartfelt thank you to all of you who have been praying for me, encouraging me, listening to me, and just caring about me. I am so deeply touched by your kindness, support, and love. I’ve never felt so supported and just absolutely surrounded by love. Thank you, from the bottom of my heart.

I’m going to break this down by day so y’all can grasp a better understanding of what went down. I’ll try to be as concise as possible. For reference, normal blood glucose levels are in the 80 to 120 range. I am usually very well controlled, and I hang out in that range most of the time. {Anytime you see the abbreviation “BG” I am referring to “blood glucose.” Also the terms blood glucose and blood sugar are mutually exclusive.}

Tuesday February 2nd

Tuesday was basically a normal day of being a Type 1 Diabetic. I had a few highs and lows throughout the day, but I did what I always do, and everything leveled out as it usually does. I had a low blood sugar right before bed {54} so I chugged some juice {22 grams of carbs worth} and went to bed. When I correct a low, I use juice or fast acting carbohydrates totaling 15 to 25 grams, depending on how low I am. Correcting with 15-25g usually brings me right into the safe range, about 90 or 100. When I fell asleep, my blood sugar was 86. Perfection.

Wednesday February 3rd

Morning: I typically wake up in the “normal” range. It’s pretty common for me to wake up in the 80s. I rarely wake up high. However, this morning, my waking blood sugar was 239. I hadn’t consumed any carbs since I corrected my low the night before. Hmm. I assumed it was an issue with my pump site or tubing. Sometimes, the tubing or site can have kinks or occlusions that interrupt the delivery of insulin doses. I figured with a site change and a sizable dose of insulin, I would be good to go {as is usually the case.} So, I changed my site, even opened a fresh vial of insulin just to cover my bases, and ate a carb-less breakfast: eggs. I did everything right. I tested again midmorning=303. Clearly my efforts were not appreciated by my broken immune system. I was frustrated, but stayed calm, and gave myself a double correction dose. Surely, I would come down, and potentially even have a low, right? Riiiiiight?!

Afternoon: Wrong. I barely ate lunch, and I gave a monster dose of insulin for what I did eat. My blood sugar still kept climbing.  I began to notice a slight headache, dry mouth, and some nausea. I decided to start monitoring my ketones because I had been running so high for so many hours; I wanted to be safe rather than sorry, and just keep my eye on it. I started out having small ketones around 11:30AM, and by 1:50PM, I had moderate ketones. For those of you who are unfamiliar with ketones, they’re basically a measurement of the acidity level in your bloodstream. If your ketone-spillage reaches a certain level, your blood basically becomes toxic to your body {for lack of a better term.} The scale is as follows: negative, trace, small, moderate, and large. The highest I had ever measured prior to this day was small. That was quickly about to change.

I was starving, so I convinced myself to eat a grapefruit. I gave myself 20 units of insulin for this. TWENTY. Usually, I would only have to give approx. 3 to 5 units of insulin for a grapefruit, depending on what my blood sugar level is. This time, I made sure to cover my bases. At this point, I was praying for a low. At least I could drink a juice box to correct and stabilize. With highs like this, there’s not much you can do besides push insulin and down water. As the day carried on, my nausea became more and more of an issue, so I continued monitoring.

Evening: I continued to monitor my ketones throughout the afternoon and they kept rising. As my ketone level rose, my symptoms started to worsen. My nausea became extreme, I began to feel jabbing pains in my abdomen and back, my chest tightness worsened and began to shift into a shortness of breath. Once I realized my symptoms were feeling like they were beyond my control to manage, I packed an ER bag {just in case,} and got myself out of the house and in the car. I had to drive to Birmingham anyways to housesit for my parents who were out of town, so I decided I would head towards their house, and if I became significantly worse on the drive, I would head towards St. Vincent’s Hospital. If I stayed the same, I would just get to the house, push more insulin, give some manual injections, chug water, and wait it out. After all, how much worse could it get in 50 minutes?

As I was driving, everything started to quickly derail. I was certain I was going to throw up in the car {never did, thank goodness. One of my worst fears} and my vision was becoming more blurry. I tested on the drive. 567. Not good. Kept driving.

All of my symptoms continued to worsen, but what really began to scare me was how difficult it was becoming for me to breathe. The harder it was to breathe, the more frantic I became, perpetuating the breathing issue. Then, I began to feel changes in my heartbeat. “Okay,” I thought. “You can’t keep justifying everything you’re feeling and just keep shrugging it off. You have to seek emergency treatment.” So I drove to the hospital. When I reached the lobby of the ER, I tested my blood sugar. “HI” was all it could register. I was so high that my meter couldn’t even read it. And my ketone strip was the darkest purple it possibly could be.

The date/time settings on my meter are way off {always have been} and I don’t know how to fix it. Just disregard!

By the time I reached the check in counter, I could hardly get out more than 2 words at a time per each breath. You would’ve thought I had been running a half marathon based on the way I was breathing. I signed in at 7:04PM. By 7:08PM, I was in a room, hooked up to a monitor, getting my vitals taken. Yes, I was alone. No, that didn’t bother me. I preferred it, actually.

They hooked me up to oxygen as they assessed my current state. They decided to push fluids ASAP because I was deteriorating by the second and they wanted to keep me out of the ICU {I was appreciative of that.} However, they had a heck of a time trying to get my IV in. It took several attempts from several nurses, and when they finally hit the jackpot, my blood spurted  everywhere. On the nurses, on me, on the floor. Splash zone. But the weird thing was, I didn’t even know I was bleeding. I couldn’t feel it; most of my limbs were tingly/numb at this point.

They didn’t want me to sleep because I was still in the danger zone as far as a coma was concerned. So we chatted, laughed, played games, did anything and everything to keep me up. It. Was. Brutal. I was fighting so hard. I could literally feel everything slowing down. My heart rate was irregular, heavy, and slowing; my breathing was out of my control. My body wanted me to fade away. I fought tooth and nail to resist that coma; to resist that urge to let go and just “sleep.” It’s very difficult to exactly put into words how that felt. But man, it was terrifying.

“It’s a good thing you decided to head this way when you did. You weren’t far off from becoming comatose,” the doctor said to me as he reviewed my chart. “So many T1’s wait until it’s too late. Good job listening to your body and following your instincts.”

I had never experienced DKA before, so I wasn’t sure if I was just blowing things out of proportion or not. It encouraged and empowered me to know that I made the right decision. 

My sweet friend, Hannah, came to visit after I began to stabilize some and she helped keep me awake. She made sure I had warm blankets and that they were taking good care of me.

They gave me so much medication and fluids, that my blood sugar came down to 162. They wanted to admit me for observation, but I had an endocrinologist appointment in a few days, so I asked if I could go home since soon I would be meeting with her to troubleshoot and fine-tune things. They let me go {I’m persuasive like that. Or stubborn? Let’s call it persuasive.}

When I got home, my blood sugar crashed to 50 due to the fluids/meds hitting me all at once. I corrected, and finally went to bed {I was BEAT.}

Thursday February 4th

Woke up ready to rest and recover so I could return back to my normal life on Friday. Tested my blood sugar: 388. “THIS CANNOT BE HAPPENING!” I totally panicked. And I was just really sad. My ketones were moderate, my blood sugar too high, and my body? Totally and completely devoid of any trace of energy. I rested all day, treated all day, and no matter what, I continued to rise all day. I only ate once: soup from Panera {thanks, Christy!} and I had a latte {thanks, Lindsay!} but besides that, I couldn’t really put anything in my body. I had no appetite. I overexerted myself by leaving the house in the evening; I thought I was feeling better than I actually was. {Target called, I answered.}

Friday February 5th

Friday was essentially the same as Thursday, except with some bad lows. It seemed I was either 50 or 500. Let me tell you y’all, that is a lot for your body to keep up with. My brain was totally foggy, I hadn’t eaten since 1PM Thursday, and I was a weird jumbled mess of starving but also totally nauseated by the thought of food. I had a smoothie and continued to rest for the remainder of the day.

Saturday February 6th

I woke up feeling like a new woman just about! I actually left the couch and went to a yummy brunch with my sweet friend Hannah. I laughed, conversed, ran errands, and then helped my friends the Livingstons paint at their church. I felt like I was turning a corner. I was human again! My levels weren’t great, but they weren’t detrimental either. I was so excited to start feeling better. I wasn’t able to sleep well Saturday night. I fell asleep at 2:30AM Sunday morning, and my alarm went off around 5:45AM because I was singing on the vocal team at church.

Sunday February 7th

This was the second bad day. I woke up and got ready. I felt awesome to be putting makeup on my face, doing my hair, wearing cute booties…I was ready to have the best day. I got to church at 7:00AM for rehearsal. I was running a bit high, and my site felt weird, so I changed my site as we rehearsed. In order to combat the high I was experiencing, I gave myself a manual injection in tandem with a nice bolus {dose of insulin} from my pump. Everything should’ve evened out just fine.

I made it through rehearsal, the 9AM service, and the majority of the 11AM service just fine. I was sitting in the dressing room around 11:50AM, waiting to sing again. Suddenly, I was hit with a wave of extreme nausea and dizziness. I had chills all over my body and my throat instantly tightened. I tried not to panic, but I felt absolutely miserable. I tested my blood sugar {448} and then I decided to test for ketones, just to be safe. Surely this wasn’t about to happen again….right? 

My ketones were large again. My breathing was becoming worse by the minute, and I was shaking all over. My friends were trying to convince me to sit the last song out, but I’m persuasive remember? {Read: stubborn.} And I just couldn’t let T1 win. “I can get through the next twenty minutes,” I thought. And I did. But not without messing up the third verse of “Come People of the Risen King”…sorry Brook Hills. My brain was a swirly mess.

The service ended and I high tailed it out of there. I was ready to avoid the hospital at all costs, though I knew I wasn’t far off from how severe I was on Wednesday. I drank 42oz of water immediately after walking in the front door, I gave a huge manual injection of insulin, and then I napped for two hours. I totally shouldn’t have slept. That was stupid and very risky of me. But I was so extremely exhausted that I couldn’t fight it. My brother was at the house and was on standby in case I needed him. I should’ve gone to the hospital, I knew that, but I was seeing my endocrinologist first thing the next morning, so I decided to spare myself a second ER bill {if I didn’t have an endo appointment for the next morning, I would’ve gone to the hospital.}

When I woke up, my blood sugar was 294, and I had never been so happy to see the 200s. I could breathe again, so that eased my mind beyond belief. I was starving because I hadn’t eaten in about 24 hours, so I made eggs again {very minimal carbs} and gave insulin {even though I typically don’t even need insulin when I eat eggs.} I read my book, chugged more water, and got ready to go back and sing for the evening service. I tested on my way there=500. Y’all, I was so frustrated. I was 500 with large ketones, but I could breathe and I felt decent, so I powered through. “I need insulin and a whole lot of Jesus,” I grumbled.

 I don’t remember much of Sunday night; everything is hazy. I was just pushing insulin and chugging water like it was my job, and I went to bed early.

Monday February 8th

My endo was very concerned as soon as she saw me. She could tell by looking at me that I was fighting DKA again. She tested me for ketones amongst other things and she ran an EKG. She was fearful of the damage two bouts of DKA was doing to my heart. Turns out, my heartbeat was very irregular, and I was still full of ketones. I was shutting down again and I barely knew it {because I was starting to get used to that feeling.} “Based on your blood work from the ER the other night and today’s tests, for the past few days, your blood has been containing the same level of acidity as a battery,” she told me, and she prepped me for more tests.

Back at it.

Horribly unattractive picture of me, but I always have to keep it real. Notice my rosy cheeks…my face always gets so red and hot when I’m super high/in DKA.

Receiving more fluids & meds was nonnegotiable at this point. She wanted to admit me, but I asked if we could pound a couple bags of fluid first to see if it made a difference. She’s a very patient-driven doctor {I love her so much} so she agreed to my proposition.

People keep asking, “what’s the cause of all this?” And so far, the answer is: That’s just how T1 is. Sometimes there isn’t a reason. You can be doing everything right and this can still unexplainably happen. It’s the nature of the beast. We’ve ruled out pump malfunctions, bad batches of insulin, etc. So far, there’s no concrete explanation.

Aziz Ansari’s book Modern Romance kept me company & cracked me up as I passed the time. He still hasn’t tweeted me back…

I miss my kids at school so much, so my co-teacher, Shannon, had Caroline FaceTime me when I was hooked up to machines. I smiled so big.

 We were able to flush out the majority of my ketones, and I even finally had a low blood sugar. So after they helped me treat it, I was released. I was starving because I hadn’t eaten in over 24 hours. I met my mom for lunch before heading back home, because once I was home, I was ordered to essentially be on bedrest for 24 hours. I tested, programmed my pump to give me insulin, and waited for my bolus {insulin dose} to go through. Then…

Y’all…I lost my ever-lovin’ mind.

My DKA was not caused by a pump malfunction; these events are not related. I finally thought everything would be evened out. And then, of course on this day, this has to happen. My pump was not delivering insulin to my body no matter what troubleshooting I was doing. I had an insulin pen with me, but I didn’t have a needle. I took my food to go and rushed back to Tuscaloosa to fix the situation.

I called Medtronic and they helped me adjust and ultimately fix the problem. I gave myself a manual injection on top of a bolus just to cover my bases. Around 4PM, my blood sugar dropped to 38. I drank 40g of juice to treat my low, and stabilized eventually. I spent the rest of the evening watching Disney movies and sleeping.

Now…here I sit. My brain is a foggy, jumbled mess. My body is absolutely covered in bruises. My back and stomach ache. I barely have enough energy to even keep my eyes open. But y’all, I’m here. I fought, I’m fighting, and I will never give up. Today has been better blood sugar-wise, but I really just want my energy back. I return back to work tomorrow, and at this point, thinking about picking up a child feels borderline impossible. But I’m going to do what I always do: pick myself up, put a smile on, keep laughing, and stay focused. I know I will get better soon. And as I celebrate my 23rd year of life tomorrow, I couldn’t be more grateful to be here with all of you. I promise I will never let T1D win {I’m stubborn, remember?}

If you have any questions, please reach out to me! I’m happy to answer and help. Also, it’s very difficult to explain the exact sensations that I’ve been experiencing. Hopefully you can get the gist of it or at least you can empathize. Thanks for the love, y’all! You’re not getting rid of me yet!

xo

Me, today. After my 5th nap. Keepin’ it real.