High blood sugars come in three different tiers for me: No Big Deal (NBD), Tricky Little Sucker (TLS), and What The Eff (WTE).
No Big Deal (NBD) highs are the ones I see when I first hear the Dexcom BEEEEEEEP!ing. They are the 180 – 240 mg/dL highs, where I’m cruising out of range, but not so far outside that it takes hours to correct. The NBD highs are usually mild in their symptoms (kind of thirsty, sort of tired, maybe wouldn’t have noticed if the Dex hadn’t hollered) are thankfully short in their duration, so long as I’m on the ball about keeping tabs on my blood sugars.
Tricky Little Sucker (TLS) highs are obnoxious pieces of garbage that hang on for hours. These highs are the ones where you hit anything over 200 mg/dL and just ride there for hours. HOURS. Like you can undecorate the Christmas tree and pack up all the holiday nonsense back into the attic and STILL find yourself rolling outside the threshold. They’re the ones that prompt rage bolusing, long bouts of batting practice, and are seemingly resistant to insulin. No matter how I attempt to tame it (bolus, injection, bolus-and-injection combo deal), the TLS highs are aptly-named. Tricky. And sticky. But despite their tenacity, they don’t throw ketones. And I try not to throw tantrums.
The ketone pee sticks.
But the ones I dislike the most are the What The EFF (WTE) highs. The numbers may vary, but one thing is for certain: these highs come with ketones. Trace, small, moderate, large … whatever the size, a WTE high has that airplane-glue-scented-acetone-taste to it that leaves you slide-tackled with exhaustion and the need to pee every fifteen seconds. Ketones make everything more complicated, because you have to keep consuming water and carbohydrates, even if your blood sugar is still elevated, to help your body flush the ketones out. It’s a process that must be followed with precision, or you can go into diabetic ketoacidosis and then you’re in a world of hurt.
I had my first WTE high in ages this past week, and it knocked me for a complete loop. I woke up with a blood sugar in the 90s, bolused for breakfast, and thought all was well. About 45 minutes later, I watched as the Dexcom graph started to do the whole Cliffhangers thing. And about two hours later, I realized my bolus wasn’t even touching breakfast. High, ketone-laced symptoms were in full effect: lethargy, headache, limbs that felt 15 lbs heavier apiece, that weird pressure feeling behind the eyes, and a thirst that couldn’t be properly quenched.
To truncate a long story (the pump site was fine but the insulin turned out to be spoiled – last bit in an older bottle, I guess), it took four hours, two injections, and a whole new pump site to bring my blood sugar down. And even after it had fallen back into range, I was still flushing ketones for the next few hours (took almost five hours to go from “small” to “negative”). Epic hydration, like the guy from Big Fish.
Nothing feels better than to drink a glass of ice water once the ketones have evacuated. Drink it, you know … just because you want to. It tastes so cool, so crisp, and so blissfully unnecessary.
*This blog post was originally published at Six Until Me.*