Living with insulin-treated diabetes requires us to navigate between severe hypoglycemia on one end of the spectrum and hyperglycemia and diabetic ketoacidosis (DKA) on the other end. The penalty for poor or untimely insulin decisions can lead to either extreme, both of which can be fatal.
This steering between two evils that diabetes presents us, however, is a concept well known by people without diabetes. It is, in fact, a classic part of the human condition. In Greek mythology, Homer writes about this topic in metaphoric fashion using the passage of a sailing ship between the twin dangers of two monsters, Scylla and Charibdis.
Scylla and Charybdis were mythical sea monsters noted by Homer; Greek mythology sited them on opposite sides of the Strait of Messina between Sicily and the Italian mainland. Scylla was rationalized as a rock shoal (described as a six-headed sea monster) on the Italian side of the strait and Charybdis was a whirlpool off the coast of Sicily. They were regarded as maritime hazards located close enough to each other that they posed an inescapable threat to passing sailors; avoiding Charybdis meant passing too close to Scylla and vice versa. According to Homer, Odysseus was forced to choose which monster to confront while passing through the strait; he opted to pass by Scylla and lose only a few sailors, rather than risk the loss of his entire ship in the whirlpool.
This fundamental human challenge has embedded itself in our language. Have you ever used the expressions, “between a rock and hard place,” or finding yourself stuck on the “horns of a dilemma,” or even, “damned if you do, damned if you don’t”?
Does this sound familiar? We must choose which monster to challenge. Do we want to sail closer to severe hypoglycemia or closer to DKA? I choose steering closer to severe hypoglycemia because it’s much closer to the sweet spot of diabetes management, normoglycemia.
Wil Dubois over at DiabetesMine, himself a long-term type 1 diabetic, wrote about his recent, first, and unexpected experience with DKA. Will had never experienced DKA before this and when he presented with the symptoms, he was in complete denial about it and refused to play the “DKA card” when he showed up in the emergency room for help. This lead to him being triaged as a less important medical issue and he waited hours for medical attention.
Wil’s account certainly got my attention. I’ve lived with T1D for 35 years now and I’ve never experienced DKA. In fact, this long term success with avoiding DKA has lulled me into unjustified sense that “it just won’t happen to me.” I now see my overly confident attitude about avoiding DKA as adding to my vulnerability.
Back in 2012, when I established my low carb way of eating, I was fascinated by the concept of nutritional ketosis – not to be confused with DKA, by the way. I convinced my doctor to prescribe to me blood ketone test strips. I would only get 10 or so in a prescription and while I can’t remember the exact price, I do remember that they were expensive, not something I could afford to pay full price out-of-pocket.
Reading Wil’s account caused me to assess what I could do to better my chances of avoiding DKA. I conclude that having blood ketone test strips handy and using them at the appropriate time would be a good practice for me.
Since 2012, I have failed to pursue securing a steady supply of ketone test strips due to the hassle of the whole prescription process. I considered contacting my doctor about getting a new prescription and the thought occurred to me that I should check and see if these strips were available over-the-counter.
I checked and they are. Not only that but the price has dropped a lot. Amazon sells 30 Precision Xtra blood ketone test strips, individually foil wrapped, for $28.54 USD. I went ahead and ordered them; I already have the needed meter.
I see this tactic as a pragmatic one that will help me steer my preferred course between the two diabetes monsters. Living with insulin treated diabetes means we must navigate the mythical Strait of Messina each and every day.
Anyone else employ blood ketone testing?