Sick Days

Ketones for Christmas

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Yes, Christmas was a month ago. This post has been sitting unfinished in my drafts folder for some time now. I’m sharing today, because I still think its an important one not to forget…

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My Christmas Day began in the bathroom at 1.37am, staring into the depths of the toilet basin.

I wasn’t drunk, nor was this the outcome of a good night.

It started on Christmas Eve when I woke up feeling extremely nauseous, extremely dizzy and extremely full. I’m not sure what possessed me to go to work that day, but I did. As I watched my blood sugars creep closer and closer to the 4mmol mark throughout that morning, I knew I absolutely wouldn’t even be able to stomach a glucose tab and suspended my insulin.

I literally collapsed onto the bed the moment I arrived home and slept right up until dinner time. When Mum and Dad asked me if this had anything to do with my diabetes, I thought it would be a good idea to pull my retired meter and expired ketone strips out from the drawer.

If the meter was reliable, and my gut was telling me that it was, I had ketones of 1.2. Which made sense, considering I’d barely eaten all day.

One thing my diabetes educator had drummed into me was that nausea was a warning sign to look out for where ketones were concerned.

After my first bout of sickness that evening, I knew I had to get some glucose and some hydration in me ASAP so that my body would stop burning fat and producing starvation ketones.

The most I could stomach was 50ml of orange juice, diluted with a glass of water. I struggled to sit through dinner, and ended up retiring again soon after.

After another bout of sickness and a few more glasses of diluted juice through the night, ketones were finally down to an 0.4 by Christmas morning and I was starting to feel better.

I’d eaten some roasted lamb at a family get together a couple of days before Christmas. The really rich, really fatty, slow roasted kind that I never have at home.

I only ate a slice that night, but I did indulge in a fair bit for lunch the following day.

Roast meat has given me terrible indigestion two or three times in recent years.

The only problem is, I don’t eat it often enough to remember exactly what it does to me.

It probably took a good 24-48 hours to get it all out of my system, but this bug left me feeling bloated and lacking my appetite. The most I could stomach for several days afterwards was a morning coffee, a very small lunch and an afternoon treat.

One thing I was extremely grateful for throughout all of this was good basal rates. I did have to be really cautious around my insulin thanks to the heightened sensitivity from less food, not to mention the fear of whether I’d be able to keep it all down. I happily ran blood sugars that were higher than I’d normally like. But for the most part I didn’t have to worry about warding off lows and having to eat when I didn’t want to.

This is only the second time I can remember having to navigate ketones since my diagnosis, so it was somewhat unfamiliar territory in managing my diabetes.

If there’s one thing this ordeal has taught me, it’s never to touch a piece of roast meat again.

Ten Things I Wish I Knew About Being Sick With Diabetes

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I wish someone had told me that infections trigger the liver to dump additional glucose into my bloodstream. Then I may not have felt so frustrated over high blood glucose levels.

I wish someone had told me to increase my long acting insulin dose to combat the sick day insulin resistance. Then I may not have gone stir crazy when my levels wouldn’t budge despite correction after correction.

I wish someone had told me that work would be able to survive without me for a day. Then I wouldn’t feel riddled with guilt for spreading my germs over keys and pens and phones. Or live to regret the miserable sight that I am to be around when unwell.

I wish someone had told me that a statutory declaration is sufficient evidence for not being present at school or exams or at work. Then I may have saved myself a few unnecessary trips to the doctor.

I wish someone had told me that putting the Vicks under my nostrils before bed might just help to relive my congestion. Then I wouldn’t be left tossing and turning through the night, plagued with blocked nostrils and piles of wet tissues.

I wish someone had told me that keeping hydrated might just help manage high blood glucose levels. Then I might not end up sculling fluids down when I’m on the borderline of ketones.

I wish someone had told me to get into a habit of washing my hands after coming into contact with others, and especially before food. Then I might not find myself off sick all that often.

I wish someone had told me that I could treat my hypos with juice. Then I wouldn’t be forced to endure jellybeans on a sore, bone dry throat. Or have to worry about keeping my hypo food down.

I wish someone had told me that it’s okay to sleep. Stay in pyjamas, watch Netflix or comfort eat.

I wish someone had told me that I’d weather the storm. The high blood glucose levels, the misery and everything far from the norm.

Travelling With an Insulin Pump

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My latest column is now up over at Diabetes Daily, and I’m tackling the topics of travel and insulin pumping.

When I first started on insulin pump therapy last year, I was given an overload of information in the space of a day and a half. At the time, I was still trying to get my head around the strange new device that was attached to me. I took all of the information packets away with me and tucked them into my diabetes file at home. However it wasn’t until I embarked on my first flight with an insulin pump earlier this year, that I began to consider some of that information in more depth.

You can read the rest of my column over at Diabetes Daily, so grab a coffee and settle in.

Troubleshooting

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A few days ago, I had settled into a certain level of comfort with my insulin pump settings. After a week of relentless hypos, I was close to nailing my basal rates at work. I successfully rocked a temp basal rate on Saturday while I was in the kitchen cooking lunch, and on Sunday when I was gardening.

On Sunday evening, I went out for dinner. I thought I had been fairly sensible – two slices of pizza for entree and a steak with steamed veggies on the side for main. I was bolusing insulin under the table as I was going – thank you for your convenience, Mr. Pump. I’d estimated 30g for the pizza and another 10g for the veggies on the main dish. All was good.

When I returned home, I was 14.2. No problem. I entered my reading into the pump, and administered the recommended correction bolus.

By the time I was ready for bed, my glucose had jumped to 18.8 (insert your favourite swear word here!). I gave another correction bolus. It was nearing 10.30pm, and my lower overnight basal rate was about to kick in. I decided to set a +30% temporary basal rate for 2 hours to help get things moving along.

I was trying to be cautious with the use of my temporary basal rates, not wanting to overdo it and go low. The rest of my night was spent checking my blood sugar level, swearing at the result, correcting, setting another temporary basal rate and setting the alarm on my phone to wake myself in another hour to check.

After trialling an hour without a temporary basal rate, I woke up at 4am to discover my BGLs had skyrocketed. I finally decided that I could safely go to sleep with a temporary basal rate switched on for the remainder of the night.

When nothing had changed 24 hours later, I began freaking out. I’d changed a perfectly good looking site, suspecting possible insulin absorption issues because it was too high up on my stomach. I’d checked my temperature, which was a perfectly normal 37 degrees. I checked for ketones that weren’t there. Stressed? Not that I was aware of. Sick? I felt fine. Change in activity? Nothing out of the ordinary.

I was correcting with very little effect, and temporary basal rates were creeping up to very abnormal levels. In a moment of anxiety, I reached out to the Twitterverse to find out if there was anything that I could have missed.

The first one was dehydration. It has been absolutely freezing cold this week. When I think about it, I don’t think I’ve drank a lot of fluids that didn’t contain caffeine these past few days.

The second one is that perhaps I’m coming down with a virus, and my glucose levels are responding before I am.

The final one was lack of physical activity, but I ruled that one out because my job is quite an active one. 

Today, not a lot has changed symptoms-wise. But I’m confident that a 30% temporary basal rate across my entire day is enough to keep me somewhat stable. I’m trying to drink lots of water, and pre bolus as much as possible to avoid blood sugar levels from going out of control after meals. I’ve talked it over with my diabetes educator over the phone, and I feel somewhat reassured in my thought processes.

I hope I’m not going to have to start all over again with basal testing. But for the time being, I’ll just have to wait it out and see what happens…

If only all the problems of the world could be solved with coffee.


My Lousy, Flu-Ridden Friday

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My Friday had gotten off to a terrible start. I’d had very little sleep thanks to a wonderful cold, and it wasn’t until 5am that my drowsiness finally overpowered my congestion. My alarm went off at 5.30am, and I angrily hit the snooze button for another half an hour. By 6am, I knew that I had to get up.

Thankfully, nothing crazy was happening blood sugar level wise and there was no signs of ketones. But I felt absolutely terrible. It was cold, grey and raining outside. And I wanted nothing more than to call in sick to work and stay in bed. I knew that nobody would really think I was just chucking a sickie a day out from the weekend. I knew that I would easily have been able to guilt them with diabetes excuses if I really had to.

But I knew that we are always short staffed on Fridays, and I felt guilty for my workmate who would be left on his own if I didn’t go in. I also had to grab the key off of him as it would be my responsibility to open up next week. And being a day out from the weekend, I knew I might be asked for a doctor’s certificate if I didn’t go in. So, against all stupidity, I decided to get up, shower off all traces of Vicks that I’d rubbed on my chest through the night, and went to work.

For most of the day I was quiet. I was short. I didn’t feel like talking. I gave one word, unenthusiastic, I-don’t-really-give-a-shit-answers. People asked me what was wrong. I felt guilty sneezing and blowing my nose in front of others, despite doing my best to do it over in the corner. The day seemed to absolutely drag as I watched the rain pour from the miserable grey sky outside.

Honestly, my biggest regret of the day was that people had to see my shitty, flu induced mood. I felt so guilty and so embarassed that people had to see me like that. I don’t like to bring my problems to work and dump them on others. I go to work with diabetes every single day. I never let it interfere with what I have to get done. I never use it as an excuse to get out of something. I test, inject, correct and treat hypos in private. I rarely complain about it. And my colleagues always forget that I have diabetes whenever I bring it up in conversation in the staff room. And in a weird way, I’m kind of proud of the fact that I don’t make diabetes anyone else’s problem.

So why couldn’t I keep it together on Friday? Why was an innocent cold the thing that brought my world crashing down? I guess I was pissed that I guilted myself into going in. I guess I was pissed that I didn’t stay home in the first place. And I guess I was pissed that I didn’t take the time to look after myself.

And as it turned out, going home at lunchtime to look after myself was the best decision I made all day.

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