T1 for 23 years, Apidra with Revel Pump & intermittant CGM. Intermittant insulin resistance thought to be caused by hormonal changes (female cycles)
This is my 4th bout with DKA over the 23 years of being T1. The first time was from the flu, the other two times were directly related to being overstressed (19 hour days, not paying attention to food intake, and high stress work environment). THis time is different though - I don't know what the cause is nor do the docs, but we have a few guesses.
I'm wondering if anyone else has experienced anything similar. Still in the ICU as I type this, but on my way out once I can appropriately demostrate that I can sustain my own bloodsugar levels with just me and the pump. Here's what lead up to this mess.
Been eating the same diet for 5 weeks for weight loss and BS control:
Organic, veg fed, no antibiotic eggs
preservative/additive free,uncured bacon
Lunch & Dinner:
1/4c - 3/4c organic pinto beans, red kidney beans, or lentils
20-30g protein - usually organic, clean chicken or grassfed beef
Salad - veggies only, no dressing OR broccoli/green beans
Sunday ("Free Day"):
Brkfast: Same as above
Lunch & Dinner: Food at will, but not exorbitant, meaning I may
have a chocolate chip cookie or two, and a slice of pizza, but not
the whole bag of cookies, or the whole pizza etc.
Last Tuesday, eating regular weekday menu, I woke up at 280. All day I fought to keep it from continuing upward. Increased basal to 125%. Tuesday evening, the insulin resistance subsided, figured whatever it was had passed.
Wednesday evening insulin resistance started again and proceeded to get more resisant throughout the day. Started with an increased temp basal of 110% and throughout the day ended up at 140% which would only keep me around 250, couldn't get it any lower than that. Happened to have 3 month check-in with Endo who put me on Metformin which I had never had before. Took 1 - 500mg tab before bed and set my basal to 130%. Throughout the night my BS remainded around 350. I turned up the basal rate back to 140% and told the BF to make sure he woke me if any pump alerts went off. By 3:00am I can't sleep and BS won't come down below 350. Throughout the night I'm also doing finger sticks besides watching the CGM and taking boluses accordingly. By 6:30am it is clear I'm headed for DKA with the physical discomfort I'm now feeling (nauseau, dizzyness, all over body-aches).
Go to Hospital and DKA is coming on FAST. After the first day of my pump and IV treatment they say no more pump, IV with Novolog only. Primarily b/c BS isn't moving much. The DKA is reversing, slowly, but my numbers aren't coming down. Once they take me to 100% Novolog, BS responds as it should. We are getting consistent 100/110 BS readings for several hours, serum keytone levels are back to normal and electrolytes are pretty again. Now this is were it gets funky. At this point I am stable. My body has demonstrated that it is no longer in DKA and my BS is responding favorably and as expected, so they put me back on the pump exclusively - no more IV treatment, just Medtronic and me. Early morning today, I start out with 102 BS from the IV therapy, then switch to pump/Apidra only set-up and self-evaluate my BS. BS is going up. I haven't had anything to eat or drink except water. BS is going up, and not just kind of up, but up, up up - to just under 400. I Take my basal rate to 3 units/hour which showed great results with the novolog IV therapy, no results with my Apidra/Pump set-up. Get bf to run home for new, sealed Apidra, to rule out the posibility of a bad bottle - same thing, no BS changes.
At this point we, the nurse, doc, bf and I, are all grasping at randoom unknown factors. We end up switching back to 100% novolog, no more Apidra via my pump. Dramatic, favorable results ensue. Discharge is geting closer. BS was 87 at last check.
So - what the heck? Once I'm home I will check the batch numbers on all of my Apidra bottles to see if they are from the same batch. But if they are from different batches... is it possible that a certain type of insulin will not "play well" with my body when it has for 2+ years before? And what about this coming on so suddenly? Has anyone else experienced anything like this? This all seems so strange.
Notes: Metformin was stopped by ICU doc siting Metformin sometimes causes acid/base problems. This doesn't appear to be the issue here, but might have contributed
BS prior to this unexplained episode have been below 200 and predictable.
I'm female and hormones were thought to possibly be the catalyst for insulin resistance, but that doesn't explain the favorable results with the novolog vs. Apidra.