DKA, Dehydration or something else

This has happened before, but there’s a variation this time. I suspect DKA, but I’ve never really got my head around it. The symptoms arise an hour or so after a run: general achiness, dry breath, nausea, fatigue, high BG. I generally treat by taking insulin, hydrating and resting. Here’s what happened today:

I’m training for the Long Beach 1/2 Marathon;

6:30 a.m. get up, get dressed, BG 89, eat a slice of bread with peanut butter and a tangerine - about 30 g.

7:00 a.m. - run seven miles - no incidents except a case of runners trots about mile 5. BG 14 at 3.5 miles. No pump attached either.

8:20 a.m. - cool down and stretch - shower an shave. BG 167. Hmmm. I had two sips of watered down gatorade during the run but that’s all.

9:10-9:15 a.m. - start to feel the achiness and nauseau come on. BG 227. Take a correction bolus and start drinking water.

10:15 a.m. - sharp wave of nausea with mild dizziness and sweats. BG 179 - on the way down.

11: 15 a.m. - repeat above - milder symptoms, BG 134!!

So, I know you’re not doctors, but I’m curious if these symptoms seem familiar to anyone. I thought DKA was always accompanied by grossly elevated BGs. I consider 227 elevated but not grossly elevated. Maybe it’s dehydration?

My real goal is to avoid these symptoms at all.

Thanks for any insight or leads you might offer.



The key component of DKA is that there is little or no insulin circulating in your system (which is your case, since you aren’t bolusing and don’t have your pump connected). While it normally is associated with a BG over 300, that’s not always the case. You can get DKA when sick, with a normal BG level. Or you can get DKA when fasting and not taking any (or very little) insulin.

I suspect that since you’re not taking any insulin until after you run you’re body isn’t able to utilize the carbs or stored glucogen properly for energy. So it starts utilizing stored fat and protein for energy. This is where DKA gets started and also a process called muscle wasting. This isn’t good.

You can fix the situation by either adjusting your basal or bolus. You could keep your pump on. Or you might try bolusing for 1/2 of the carbs you’ve consumed. In any case, you definitely need to have more insulin in your system during this time.

I hope this helps,

Thanks, Ken. That’s a helpful insight.

I’m going to try the technique I read in blog by the diabetic marathoner (Ms. Chin. Was it you who linked to her story?) by cutting my bolus in half before the run for a few hours and restoring to normal bolusing during the run.