Headache. Check. Eyes that weighed at least a pound apiece. Check. Mouth full of sweaters. Check.
Looks like they're all here - the symptoms of a high blood sugar.
Sitting down to catch up on some emails, I absently fish my meter out of my gym back and lance my fingertip. I hit send, graze against the new infusion set on my left thigh, and see a meter result of 420 mg/dl.
"Oh, that is just fantastic."
Taking out my pump, I calculated the massive correction bolus and felt the quiet sting of the insulin as it coursed through the infusion set I had placed an hour earlier. Normally when I'm at an elevated blood sugar, I feel lethargic and generally Crumbs Morrone, but this one had a different feel to it entirely. My stomach felt like it was playing host to a hamster wheel, and my headache was blinding.
I brought the ketone strips into the bathroom and watched uneasily as the pad on the ketone strip turned a deep purple. Large ketones. I hadn't seen those suckers since my days at Clara Barton Camp. I never, ever have ketones, and I test regularly for them. So where did this come from?
My stomach in knots, I wandered back into the living room and filled Chris in on the situation.
"I'm high. Like crazy high - 420 mg/dl. And I just tested for ketones. I have large ketones. I feel like complete shit, and my stomach is really nauseous."
He rubbed my back. "So what do we do?"
"Drink a ton of water and try to flush out the ketones, I guess. If I can't keep the water down, we're off to the emergency room." It dawned on me that I had the process of treating a low blood sugar down to a science, but navigating a serious high was unfamiliar territory. Normally, I just bolus and wait for the numbers to fall, but this high came with an added bonus of ketones. The word "ketones" was enough to send me scouring for my old Joslin manuals from 1986, breaking open that red binder and searching for the antidote.
I drank several bottles of water and willed myself not to throw up, even though my body disagreed with that decision. "Do not throw up. Do NOT." The mantra ran through my head and I tried to relax on the couch, drinking water all the while. After about an hour, my blood sugar had fallen to 248 mg/dl and the ketones had retreated to "moderate." Three hours later, my system was flushed clean, ketones were down to "trace," and my numbers were hovering around 170 mg/dl.
But I was still confused - where is the emergency room threshold? DKA is defined by Wikipedia as "a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). Near complete deficiency of insulin and elevated levels of certain stress hormones combine to cause DKA." Okay. And Joslin had it beaten into my brain that ketones + vomiting = emergency room. This is serious stuff. But there is that gray area where large ketones are present and proper management steps are being taken, should I still be under the care of a medical professional?
I opted to stay home and wait it out, since I wasn't throwing up and my blood sugar was falling from that obscene high. And today, at my doctor's appointment, I asked Dr. Connecticut about when I should be checking myself into the ER due to high blood sugar. She confirmed that as long as I wasn't throwing up and that my blood sugar was coming down, it was okay to treat at home. She did add that if I was showing signs of another infection, like a urinary tract infection or a sore throat, that the emergency room should be on my "must see" list.
Over 21 years with this disease and there are still uncertainties that touch in at any given moment.