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Guest Post: Thai High.

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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Ralph.  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.  

Bad.  

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.

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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.  :)

Comments

Great post. Thank you for sharing. I may be the only one, but historically highs really scare me more than lows. I think it is just based on how my teenage years went. I was always on the higher side because my mom was so afraid of lows and then any time I didn't eat the right thing or misjudged the food or got sick I would end up super high and in the hospital. I am one of those that anytime I went over 350 it got really bad and ended up in DKA.
Now that things are more in line I see the dangers of the lows more, but still any reading over 180 gets me in a super viligant almost panic mode.
I wish you all the best in avoiding the trigger foods and hope you are feeling better.

Thanks for posting this. My 2 year old son has T1, and we're constantly struggling to figure out if his behavior is due to diabetes or just being a 2 year old. Needless to say, we check his blood sugar a lot. It’s helpful to read about the symptoms of highs and lows felt by other Type 1s.

Scary. The dehydration and headache are terrible (my spouse describes it as my body "cannibalizing" itself. Nice image eh?)

I read somewhere that if you exercise when your sugar is over 14 (Canadian measurements - I'm sure there's a conversion tool somewhere online), that it can actually spin you higher, rather than bring you down. Apparently you should only exercise if your sugar is below 14. One of those random "good to know" bits of information that I learned by luck. I've always wondered why the medical people never told me that - seems so basic.

Thanks for the post. I've had diabetes since I was 18, almost 7 years, and I think the extremes scare me almost equally - lows because of the immediate danger, and highs because they don't always make sense and can result in really bad lows. I've had something really similar happen to me and it was comforting reading your reactions and responses and seeing how similar they were to mine (even not wanting other people to worry - that gets me a ton!).

What's most scary about that kind of high is that it just keeps going up. It starts to get scary b/c whatever you do it's just going up up up, like on a roller coaster. I would have changed out the pump site and probably taken a shot. But even that wasn't going to have an immediate affect--that's the worse part, that you just have to wait, and after that waiting it may be even higher. ugh.

Denise, though I forgot to mention it, the very first thing I did was swap out my infusion site. The other thing I didn't mention is that I'm a Type 1.5 - started out as Type 2 and then had my pancreas completely check out several years later. So I deal with a somewhat unpredictable insulin resistance along with no insulin production.

Ditto on K's observation. I think it's 250 in mg/dL. Another frustrating thing on highs is meter (in)accuracy. Some people "undercorrect" for extreme highs because of it. (As always, YDMV)

Thai food sends my daughter on a roller coaster every single time she eats it. Which sucks because my husband is Thai and it's our favorite food. I seriously cannot figure out the dosing for it at all.

Thanks for writing this.

"rage bolus" Ha! So true.

I've found that dual wave bolus is the trick for these food situations.
Anything that has a higher fat content and is loaded with carbs (pizza, thai food with a sweet sauce and fried noodles) a dual wave takes out any initial meal spike and the wave handles any carbs that are slower to absorb due to the fat content. YMMV.

The one time in my first pregnancy that I drop-kicked my bg for a field goal was the night we thought we'd just go try that interesting new Thai restaurant in town. How do Thai people manage on such a diet? Maybe their pancreases wear capes and can leap tall buildings in a single bound. Someone should research this!

Thanks for posting Ralph! Maybe it was the thought of the noodles that sent you soaring in the first place. Stranger things have happened with this funny disease!

I, too, was told not to bother excerising if I was over 12 (darned Canadian Metric system!) (multiply (or divide) your meter reading by 18.1818181818 and you'll get somewhere close!)

I ususally just pop a few units and go have a nap. Luckily, lows still wake me up!

"I didn't do anything that bad." That's a phrase that resonates for all sorts of reasons...

Thanks to you all for the wonderful discussion and feedback.

I can only say what works for me, but insulin that isn't mixed with exercise usually works pretty slowly for me.

Nathan, I love your comment on trying to figure out if whether your son's behavior is because his sugars are off or just because he's two!

Thanks, Kerri, for sharing your blog and encouraging me to write about my experience.

For Ralph:
On my birthday weekend back in September... i ate almost an identical meal at a quaint Thai restaurant. It had the same effect... to wear I yanked out my insulin pump, bolused with a pen... and waited 5 hours to come out of the 500s. No ketones. Just weird and awful. I wonder if there's some secret diabetes kryptonite in Thai food?

Thai is my favorite! This used to frequently happen to me and it was frustrating. For the past year I have used a CGM and it has changed my life. I can tell within the first hour after eating if I estimated my carbs right. My solution is to bolus the minimum amount that I think I will eat 10-15min before I eat it and the rest as soon as I get my food. This will allow the insulin to peak as my BG peak resulting in a very small change. I also do this with my morning oatmeal. I used to spike to 250 and then drop back down to 100 within 2 hours. Now I just see a little blip of 125-150 and I’m back to 100 within an hour. I would recommend a free CGM week trial to get a better picture of what your BGs are doing.

I've had a few highs like that. I would never go to the ER for high blood sugar alone, unless I was out of insulin.
General rule for blood sugar that high is: drink fluids, check ketones (blood ketones if you can but urine ketones are okay). If ketones (esp blood ketones) stay moderate to high for more than about six hours, that's when you might need to head to the ER. Although even in that case, I'd call and get my endo's opinion first.

High blood sugar also sometimes makes me throw up; I can imagine a situation in which I might go to the ER to deal with the vomiting, though I haven't done it yet.

I, too, now know why the highs are scarier than the lows. My 8 yr old daughter was diagnosed on Feb 21, 2011. Up until Tuesday, I was always more worried about the lows than the highs. That was until she was a consistent 400 all night on Monday night. I spent all day Tuesday home with her, trying to bring her numbers down. We had changed her site the night before and thought maybe she had a bad site. But after we changed it at 6 a.m., she was still super high...ALL DAY long. Finally at 10:30 that night, she was 128. But then, of course, at 2 a.m., she was low and I had to wake her to drink juice. UGH. The hardest part is having no clue why she was high. Bad site? Fighting off a virus? We'll never know. It's hard to explain to her that she did nothing wrong and that this is just life with diabetes.

I too was never told by doctors to not exercise with a high blood glucose. I found out many years after I was diagnosed (T1 for 12 yrs now), from an online source. The endo I see now confirmed it. It would have saved me and my parents a lot of frustration and confusion as a kid..

Just shoot up and wait an hour or so :)

LOL @ secret diabetes kryptonite in Thai food :)

Amanda, my daughter was diagnosed@ age 2 and she is 10 now. Besides the things you mentioned, bad site, fighting a virus, etc., don't forget a growth spurt. Those times when they are growing like a weed can send the bg's soaring too.

One issue with Thai food is that the noodles are usually rice noodles. White rice noodles. In other words, extremely-high GI, and there are lots and lots of them. A pint (small order) of noodles may have 100 g carbohydrate without the sauce. I think one reason a number of low-carbers are successful is that many of us have GL thresholds, over which our bodies just go into some sort of insulin-resistance attack, spreading the processing of our meal over a much longer period of time and keeping us on those raging highs. (BTW, this happens with T2s as well, only for those of us who don't need to take insulin, it occurs over a much narrower range of numbers.)

I have had times like you where my sugar went to 500+. I started to get nauseous and was in early ketoacidosis. I am a type I on the pump. I turned up the basal rate, took about 25 units every 1 1/2 hrs and it came down.
One comment, if you are taking insulin and the sugar is not falling, change your insert! You may not be getting the insulin! Take care!
Phil K

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