The diabetes journey has its unexpected twists and turns, and this weekend I found myself in the intensive care unit suffering from a potentially deadly complication, diabetic ketoacidosis (DKA).
In retrospect, I can see how things may have gone wrong.
I had good intentions in resisting long-acting insulin, seeing it as a sure-fire way to gain excess weight which would create issues with blood pressure, heart health, joints and other issues. I figured I could get by with higher glucose numbers because, well, I’m enjoying good health 20 years after my initial diagnosis of T2. Last spring, that diagnosis changed to T1, which means my pancreas has completely crapped out. The diagnosis didn’t change how I handled my high glucose. I figured the short-acting stuff was good enough.
Last week, I started a new drug, Jardiance, which lowers blood glucose by shunting it through the kidneys. Excess glucose is peed away. I saw instant results on a dose of half a 25 mg pill, a drop in morning blood glucose from 20 mmols to 12 mmols. I was thrilled, seeing less insulin usage as a benefit. Instead, three days in, I fell off a cliff. I awoke on Friday feeling vaguely unwell. I put it down to fatigue and thought a day of rest would help me feel better. Instead, after a few hours I had my face in the toilet, throwing up.
I thought it might be DKA, since I’d had it in 2019. But my glucose was at 8 mmol, far from the higher numbers you’d expect for a DKA diagnosis. Regardless, a second bout of vomiting convinced me I had to go to hospital, ASAP. I texted my friend Kim to let her know where I was headed. She was out on a walk, and when she replied I was in the ER waiting area. “On my way,” she said. The triage nurse scoffed at my suggestion I had DKA saying my glucose was far too low for that. Regardless, I moved on to the next waiting area. A blood test escalated things dramatically. The diagnosis was confirmed and I finally got to lay down on an ER bed.
I kept getting needles poked in my arms, hands and even feet. My veins were weak from dehydration, and tech after tech tried to get intravenous lines into my body. When I complained about the poking, the ER nurse said, “You’re very sick — we’re really worried about you.”
In other words, we’re doing our best. Suck it up while we save your life.
The delay in getting an IV drip meant the nausea continued. I was panting like a dog, as my body tried to rid itself of ketones, a chemical produced by the liver when it breaks down fats. I have more ketones than most people due to a low-carb diet. Our bodies have evolved to use ketones for energy. This latest move to high-carb diets has us packing on excess weight.
By midnight they moved me to the intensive care unit, where I was the only patient. There was no sleep. Every two hours, they took blood. My veins continued to make things difficult. IV lines that worked fine for awhile had to be replaced when the veins broke apart. Meanwhile lab techs did their best to get blood draws to check my status.
Kim and a neighbour took over care of my dogs, each taking a morning walk and afternoon walk. The pups were alone in the house by themselves overnight, but at least they were safe. I found myself laying on the edge of the hospital beds, a habit honed by years of making space for dogs. I missed them but had to focus on my recovery.
Soon the IV insulin drips morphed into injections. I watched in dismay as nurses injected 24 units of long-term insulin in my belly. It seemed like a lot. It seemed I had no say in my health choices. For a short while, I fell into despair. The ICU doc came by and we talked. It’s no coincidence that I got sick three days into the start of Jardiance. He said he’d contact the prescribing doctor and air his concerns. He stressed that the sudden illness was not my fault.
He also heard my concerns on wanting to maintain a healthy body weight. “But your body needs insulin. Everything after that is secondary.”
The long-term insulin puts on weight. It takes glucose from the blood and stores the energy as fat. But the doc said the long-term insulin is essential, whether I’m a T1 diabetic or, as he suspected, a T1.5. (Google the various types of diabetes).
I had a conversation with Kim over how we harshly judge our bodies. We all want to look healthy and be healthy, but sometimes things are out of our hands. In order to have good glucose numbers (that will keep me out of hospital) I will need to take long-term insulin. That means I need to re-evaluate how I see my body. It will be a struggle, but I gotta give up on being thin and healthy. I can be healthy and full-bodied, or I can be a thin corpse. It’s as simple as that.
After two nights in the ICU, I was transferred to the main hospital for a night. It was noisy and chaotic but I used the opportunity to see how well the insulin injections stabilized my glucose. Kim picked me up the next day and brought me home to my overjoyed dogs. Now I am feeling drained from the intensity of being surrounded by too many people. I need to return to my normal introversion and rest.
I have no plans for today, other than do as little as possible.