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Such Great Heights.

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.

Older photo (from 2008, I think), and I think I only recently bought a new bottle of ketone strips.  Ooops.
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.

Comments

I'm curious (and as a person with diabetes for many years, a little embarrassed to ask as well) - how did you know the insulin was bad? Elimination of other variables, or...?

I always feel really crappy the day after the highs. Does anyone else have that too? Messes with my digestive system or something...

I hate the TLS highs. I also have a tendency to "rage bolus" when that happens and eventually bottom out. Blah.

Dexcom: "Your pump is not working!"

Pump: "Don't blame me, I'm fine!"

Kerri: "It must be the insulin."

I'd believe the Dexter myself.

Dexcom: "Your pump is not working!"

Pump: "Don't blame me, I'm fine!"

Kerri: "It must be the insulin."

I'd believe the Dexter myself.

I LOVE the movie Big Fish! Since you brought up that movie that is all I will think of when I guzzle for a high. :)

I love it when you describe how you feel when you are high or low and the varying degrees of each. My T1D is 8 and is a pro at feeling the lows, but not so much the highs. We're not quite a year in to this journey, and it helps me remember to tread lightly and with much patience and grace because she isn't herself during these times.

Your descriptions are so spot on, it's as if you described exactly what I encounter! I have had quite a few TLS's this week...and I am definitely guilty of RAGE bolusing with the subsequent hypoglycemia...comes with wearing a dex!

Love this post! The WTF highs are def the worst and can throw me for a loop for most of the day. I have had them from both a bad vial of insulin, a bad site (when I was a little too stubborn that was the cause) and a pump malfunction. The pump malfunction actually put me in the hospital for a week due to DKA. It's one of the cons a pump - those WTF highs can sneak up on you pretty quickly.

I had an amazing 30th birthday party last night. Except that my bsl was wte high for hours, refusing to come down. I look at the photos and I can see I was a bit out of it. I felt pretty sick..despite big insulin boluses. I hate wte highs :z

I'm also curious how you can nail it down to bad insulin. My daughter has had a couple wte highs and we changed the pump site even though it looked okay everything came back down. So I figured the site was still bad as in we just hit a bad spot.

I'm nervous about the insulin spoiling because sometimes I forget to put it away for hours after I get back from the grocery store/pharmacy. Then I was looking to donate a few boxes of Humalog cartridges since we can't use those with the pump and the Insulin for Life website actually says they find you don't need to add a cold pack during winter because the few days it takes to get there isn't enough to damage the insulin.

We have used the term "hungover" after a bad wte high. Which felt weird telling that to my 8 year old.

8 year old: Mom, I really don't feel good. I feel nauseous and kind of dizzy but my blood sugar is fine.

Me: Oh honey, you're probably just hungover from being so high last night. Um, don't repeat that!

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