This is a companion piece to Maurie's discussion on his Low, called "Sobering...". Last night I was well and truly Sobered by Highs. When I was about to get ready for bed, I monitored and was 508! (I've been Type 1 for 21+ years.) Clearly my Apidra pen, which was mostly used up, had gone bad. I corrected with a new pen and a half hour later my BS had gone up to 537. I told my husband that we'd better consider the ER, but it finally, slowly, started going down. I drank 1 1/2 quarts of water and monitored until 3:00 AM, when my BS had gone down to 338; took a shower and went to bed. I woke up to a reading of 143 at 7:30 AM.
I learned a few things from that incident. One is that my Apidra kept working well beyond it's usual 3 1/2--4 hour active time. I didn't have any ketone strips, but I doubt that there were many ketones when I'd only been without insulin for about a half day. I found that I could in fact treat a bad High in this early stage of DKA, if in fact I got as far as being in DKA. Remember: never, ever forget to Test! Test! Test!
I find highs tough to treat accurately. Some of them seem to just hang on ... until they don't. Your change to fresh insulin was smart and prompt. Your drinking all that water helped thin your blood; that's a move I often resist when faced with high BGs.
I use a pump and if I find my BG finally diving, but too fast, I'll just do a 30-120 minute 0% temp basal rate to counteract. Or I'll even eat something very light to slow things down, like a few nuts or some cheese.
Your post reminds me to restore my supply of ketone test strips. It's excellent data to have if considering a trip to the ER.
Wow Trudie, I'm so sorry you went through that. I'm glad you were able to manage it. I agree that the fast acting works a lot longer than we realize a lot of the time. I have never been that high, 363 was my highest recorded when I went to the er in dka . I have gone to 299 maybe once since then and I felt really god awful, no ketones though and I was able to get myself down. I would be very careful though if you think you are in dka and you're sick etc.- I read about someone online whose wife died in dka while she had a virus after already thinking she was out of the woods.
Hi Terry. About drinking all that water--I've found my insulin just doesn't seem to work unless I'm hydrated. I really don't drink much water ordinarily, I like tea and beer better! Since I'm on MDI, I could have skipped my evening Levemir, but my thinking was so poor that I went ahead and took my usual dose (sigh). I am actually going to buy some ketone strips, which I haven't used in years. I'm also going to be much more careful as I approach the end of an Apidra pen.
Hi meee. I've never recorded a BS that before, either. I've seen too many 350s, and they scare me. Yesterday was the day after the episode, and I wasn't worth much, but I don't function well after only four hours of sleep under the best of circumstances. I paid a lot of attention to testing and keeping hydrated; it led to homemade pumpkin soup from the freezer for dinner:) I do believe that I caught it early enough to avoid many after-effects. I haven't had any other experiences with DKA, and I hope to keep it that way!
Please don't jump me for this question. But I'm trying to learn on all types. I'm type2. But I have a cousin that I can remember taking insulin when we were growing up.So,I'm constantly trying to learn things. You guys mention keytones strips. Is that something that 'all' type1's have to test or just some? I tried reading on this but none of what I found made any sense. So please again, don't take offense and come after me with a baseball bat. It's my nature to try and understand things.
I have a sister who I think is type2 because she started out on oral meds and then had to take shots unless she was misdiagnosed at first(doubt it, she don't take help from anyone). She's gone to extreme highs and also has had extrememe lows.
So I'm just trying to gain knowledge and I figure the best way to do so when nothing makes sense from reading is to ask the ones that it pertains to as long as I don't offend. Believe me I never try to do that. As far as I'm concerned we're all in same boat but some are a bit off more than some of the others. All suffer in own ways. So, please don't misunderstand my trying to learn.
Hi Georgia boy. The whole point of testing for ketones, I think, is to avoid going into DKA, when your body just won't respond to the insulin that you're injecting. Then you need medical help with an IV, and probably a stay in the hospital. It's serious; without help you can go into a coma, maybe die. It's probably a good idea for anyone who is insulin-dependent to buy ketone test strips, just to have them available if needed.
Your question is polite and reasonable... please don't feel you've offended anyone.
As a general threshold, Significant keytone concentration in the blood can show up any time BG gets over 250, for any diabetic. However, type 1's are far more at risk for progression to diabetic ketoacidosis -- DKA -- if these bg levels persist, or climb higher. DKA can be life-threatening.
Because of this, keeping keytone strips in the arsenal for testing keytones in urine is a must for T1s. While T2s can also develop DKA, it's very rare at the 200-300 mg/dl level, which generally consitutes the highest "bad" days that most controlled diabetics have, so it's not nearly the concern for T2s.
I'm a T2, pumping insulin, but I don't have keytone strips. I keep putting it "on the list" to get some, but it's just not a high priority for me.
I'm a total slacker about ketones as I don't run that high very often and will be as aggressive as I need to be to get rid of elevated BG maybe a couple times/ year that I run into problems.
I thank all of you for the information. I've always wondered about this whenever reading about Keytones. Just wasn't making any sense when looking up. So, figured I'd go ask you guys on this. As I said, I try to learn things and share with others.
I'm glad you're feeling better now, I'm useless on four hours too. That is so high, for me too anyway. Maybe next time just go to an er to be safe? I'm not surprised you felt depleted after that too. I think hydration is key when we have high bg. That is good you did catch it- we are open to a whole host of issues being too high also, like dka, blood clots and so on. I hope you never go to dka too.
My bg has been high today and I think just to be safe I'm going to switch out my levemir pen and see if it makes any difference.
GB, type 2 don't go to dka very often,(statistics I found said of the 100,000 or so cases per year maybe 25% are type 2) it is much more rare, unless they're ketosis prone type 2. But you are still at risk especially with an infection, dehydration and high bg.
There was a man when I was in the er who had longterm type 2 and kidney failure, he was in dka and he was sicker than I was according to one of my nurses.
I think hyperosmolar hyperglycemic state is more of a risk for type 2 as well as going into a coma from high bg. I met someone who has type 2 not long after I got out of the hospital who told me he had no idea that he had D until he went into a coma from high bg.
Sometimes I think some of my insulin may have degraded while traveling and got too hot in the vehicle. That last bit of insulin I was convinced did not work. I went to a newer pen and it seemed to work better. On the directions it states for the insulin not to get above 88 degrees. That goes for those testing strips too. I try to be more careful now.
Learning a lot since asking. Thanks guys. I'm glad I found out early that I'm type 2 and not late like that individual was. Gives me a chance to at least try to take care of myself.
Dearest Trudy. I'm so sorry you had to go through this. But as usual, you stayed calm and figured out what to do. And also as usual, you are an inspiration to us all.....Blessings. Many, many blessings......Judith
I'm impressed with your willingness to stick it out at home and to get down to 143 by the next morning. I often find that when I'm going high that I'm essentially flat one hour post correction and don't start making significant progress for 3+ hours.
You write that you were without insulin for about a half day. Don't you use Lantus or Levemir as well as the Apidra pens?
Anyway, I'm glad you're OK and were able to learn a couple of things from what must have been a very scary situation.
I find extreme highs take forever to bring down, usually there is no movement (or a rise) for about an hour before I start to see it gradually drop. But if you take a basal insulin then you did have insulin on board and probably didn't have ketones and weren't at risk for going into DKA. I find if my pump is not delivering inslin I have high ketones within 3-5 hours. Your experience illustrates why I think it's important to have ketone strips (I know some here don't have them) - even if you don't get regular highs you never know when you might have pump or insulin problems. I think ketones make a big difference when considering how serious a high is. A high with high ketones is usually more serious than a high with no ketones. I'm glad you got your blood sugar down and are hopefully feeling better!
I believe that if you drink alcohol Ketostix (at least) will register ketones, even though there aren't any there.
At least I've just tested both my own (bg 184mg/dl) urine and my non-diabetic wife's (bg 113 mg/dl) urine and we both registered between 5 and 15 mg/dl of ketones. This is a couple of hours after drinking.
