So, I was prepared. Really prepared. Tons of supplies and insulin. Blood ketone meter. Lots of back up, so running out of stuff wasn't an issue.
|Playa Pelada, Nosara, Costa Rica by Wendy L. Morgan|
One of those days, we had afternoon surf session and I guess I hadn't had much to eat at all that day. Couple corn tortillas and some avocado. It was hot and I wasn't hungry.
My BG was 130 going into the water, so I didn't bolus any extra as I was worried I'd go low. By the time we got back to our room, I was feeling high and indeed I was about 300 and felt like I had ketones. I had moderate levels and felt pretty crappy for an hour or two. I got my BG down and realized that that was a pretty weird episode. I reviewed my day and wondered if my lack of food and seriously increased activity, along with a hour and a half of no insulin made my ketones spike.
Unfortunately, that wondering didn't stick. Three days later, we had a morning surf session and I did the same things. No bolus for basal. No breakfast. We were also out there longer than I planned. Two hours later I stood on that beautiful beach wrapped in a towel and felt the ache of ketones spread across my chest, across my shoulders and into my back. I felt nauseous and my body felt sick. It came upon me incredibly fast!
We got back to the room and I began to drink a ton of water. This was hard and it felt very serious. I was in a tiny village in Costa Rica. I checked my BG and it was 250 with 1.2 blood ketones, so I book used. Then 20 minutes later I was 350 and at 1.9.
I had piled a towel on the table in front of me to lay on because I was afraid to move. I laid my head down between sips of water. I took a total of 15 units with three different injections, then worried I'd taken too much. I was worried I'd need an IV. I was worried. Period.
I drank and drank and tried to Google (we had wifi in our room) "DKA self care," and got results that indicated I could really be in trouble. That's when I began trying to reach a diabetes educator friend on Facebook messages.
I typed by desperate plea for guidance and realized I was killing time. As I typed, I think I even wrote that I was waiting for the water and insulin to work and trying not to puke. I needed to be doing something to help myself, so writing to her was it.
She responded promptly! She asked if I had Zofran, the anti-nausea medication, and of course, I did! She suggested I take that to keep from throwing up all the water I'd drunk.
By the time she responded everything was beginning to work, so I didn't taken the drug, but knowing I was doing everything right was a big relief. I asked her if I should take more insulin, but she said wait two hours and see where I am.
I trended slowly down over the next two hours and my ketones dropped to 0.2. This was great news, but that whole thing scared the holy crap out of me. Ketones from exercise, lack of food and no basal insulin, was new to me.
Most the websites I found during my Google-medical-care-abroad session talked about such basic stuff like don't exercise with high BG or ketones, but nothing described what I had just done to myself.
I ate a big lunch and loaded up for future trips to the water with plenty of food and insulin on board. Lesson learned 30 years into this pain in the ass disease!
Next post, my flight home! Diabetes adventure número dos!