The other day, I received a direct message on Twitter from Ralph about high blood sugars. "Have you ever written about them?" I knew I had, but I also knew that Ralph had just experienced a whopper of a high, so I wanted him to share his story. Because, as he states, lows are scary, but extreme high blood sugars can make you nervous in an entirely different way. Thanks, Ralph, for sharing your Thai-high.
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I’ve always been more afraid of low blood sugars than highs.
But then again I’d never been through a really bad high before.
Killer lows, those where you drop into the 50s, the 40s, the 30s… the kind that leave you twitching, bathed in sweat and incoherent… are the quintessential diabetic horror story.
But highs, serious highs, can be brutal in their own, more subtle ways.
It all started with Thai noodles.
I know better than to have something like Pad Thai or Phad See U or Drunken Noodles for dinner. I know I’m going to be bumping against 300 or so all evening if I do this. Lunch with an afternoon to work it off? Maybe. Dinner? No… just no.
But I’d been running low all afternoon. And everyone else in the house was talking about Thai, and my thoughts never went far beyond “Yum.” I wanted noodles.
When I got home with the food, I checked my blood, and the meter showed I was up in the 200s. How’d that happen? (For you non-diabetics in the audience, you want to be somewhere around 100. Anything lower than 80 or higher than 200 is not a good thing.) So I dish up about half a container of noodles, pop a Metformin, and take a big dose of insulin from the pump to compensate for the high starting blood sugar and the honkin’ serving of carbs.
After dinner, I went to work at my computer. But I soon had all the symptoms of a high creeping up on me. My mouth was dry, I was really thirsty, I was getting irritable, and I really, really had to pee -- the whole constellation of symptoms you live with before you’re diagnosed.
I took my blood, and the meter showed 395. This was not good.
I took a big bolus of insulin and went out for a 20 minute walk to help bring it down. When I got home, I had to pee again.
I took another reading. Crap. My blood sugar was up to 422. I can’t remember the last time it got that high.
I took some more insulin and sat down to try to work. Half an hour passes; I have to go to the bathroom again, and the meter shows I’m now up to 480. This is getting scary. I don’t remember being this high before. I bolus more insulin. And that makes me nervous about how much insulin I’m taking. It’s been 12 units in the last hour. I don’t want to rage bolus my way into a serious low.
Another 20 minutes pass, and I’m feeling really bad. Nothing as specific as a low. Just bad. The thirst is terrible. I simply can’t drink enough. I check again, and my blood is up to 565. I’ve know I’ve never seen a reading like that before.
As a symptom of the high, I’m starting to get angry.
I didn’t do anything that bad. I had half an order of drunken noodles. They were spicy, not sweet. Why is this happening? This isn’t fair….
If I can’t get that meter to head down, I’m going to have to go the ER. In addition to being expensive, it will upset the kid, my wife, and my mother-in-law -- everyone in the house who worries about me.
I don’t take any more insulin, but I get on the exercise bike for 45 minutes. But halfway through I have to stop to pee one more time.
When I’m done, I take my blood again. I’ve never been so happy to see 460 on a meter before. What’s more, my pump says it’s safe to take another several units of insulin.
The trend over the next hour or so continues down, but the work I was intending to do is a complete loss. I can’t focus, I’m exhausted, and I feel lousy. I give up and go to bed, knowing that sometime during the night I’ll pay the price for all the insulin and have a low.
Which I do.
Lows are scary because you’re on the ragged edge of passing out, but the treatment is easy as long as you have juice, or glucose, or Cap’n Crunch around. The worst that will happen if you over-treat the low is that you’ll end up pushing 300.
But a high that won’t come down is dangerous on its own, but it can also prod you into taking more and more insulin to the point that you could take yourself down into dangerously low territory. And I must confess I don’t really understand the dangers of venturing into the 600s, though I know they’re bad.
What really scares me is I don’t really know what triggered this high. I mean, I know I had a bad dinner, but it wasn’t the worst I’ve eaten as a diabetic. What combination of factors made my blood sugar soar this time?
I was angry and railing about the unfairness of it all when I went high. I know the anger is a symptom of a high because my wife still talks about how angry I was all the time before I was diagnosed 10 years ago. I’ve long ago quit worrying about fairness. The world isn’t fair, and I have a pretty good life. But I’m not going to have Thai noodles again anytime soon. Fair or not.
* * *Ralph is a professor of communication at University of Nebraska at Kearney, and has been diabetic since 2001. He blogs at ralphehanson.com and is on the Twitter @ralphehanson. So what are you waiting for? Go connect with him on Twitter - he's awesome. :)