Dodging DKA: What Happened and What I Learned From It

In 23ish years of life with type 1 diabetes, I’ve never really experienced DKA…and I feel wildly fortunate to have avoided it.

But the other day, I came extremely close to it, and it’s something I won’t soon forget.

Here’s what happened: It was the wee hours of a Sunday morning. I woke up because I had to use the bathroom. My pod was on my thigh. I was due to change it that Sunday evening. I noticed that the pod’s adhesive folded up in the exact wrong way (it was crinkled up by the cannula), causing the cannula to bend and dislodge itself from my body…

…except I didn’t make that super-important observation until around 11 A.M., after several hours of tossing and turning in bed, unable to sleep because I was battling both a headache and stomachache.

What’s more is that around 10 A.M., I noticed that my CGM had been reporting a high blood sugar since about 5 A.M., and I simply hadn’t heard it alarming. When I saw that I was high, I took a bolus, but I didn’t bother checking on my pod because to my knowledge at that point, there was nothing wrong with it. Fast-forward to one hour later to when I did discover the dislodged cannula and I was feeling downright terrible: My stomachache turned into full-blown nausea, my head was pounding, my throat was drier than the Sahara, I couldn’t unfold myself out of the fetal position, AND I was feeling incredibly stupid for 1) missing my CGM’s blood sugar alerts and 2) not checking my pod to make sure it was secure to my body.

What bothered me more during this whole ordeal: my headache, my stomachache, or my anger at myself for letting this happen? (If you guessed the latter, then you’d be right.)

Fortunately, I did have a back-up pod and insulin with me, so I went about activating the new pod as quickly as possible. I felt a fleeting sense of relief when it was on me, but that relief turned into panic when I felt a swooping sensation in my stomach that indicated I was about to be sick. I ran to the bathroom and retched once, grateful that nothing actually came up, then sank down on the floor in shame, wondering how I could let myself get to this point of obvious borderline DKA.

The next few hours passed in a blur as I crumbled back into bed. I drank as much water as I could stomach, gave myself bolus after bolus, increased my basal rate, and tried to settle into a comfy position. I was extremely lucky that I wasn’t alone during this whole ordeal: My significant other was very concerned and doing everything he possibly could to help me. I was and am still so grateful for his care and attention. I didn’t admit it to him, but I was a little freaked out by the whole experience, but I took consolation over the fact that it didn’t come down to him having to bring me to the hospital.

By 4 o’clock that afternoon, my blood sugar was finally below 180 again and I was able to eat a little food, though I wasn’t overly hungry. I spent the remainder of the day beating myself up for letting this happen, but I guess that if I learned anything from it, it’s that I need to remember to 1) keep the volume turned up on my CGM so I can hear the alarms going off overnight, 2) check my pod immediately after hearing a high alarm so I can rule out any obvious pod issues, and 3) bring a syringe with me wherever I go so I can inject myself with insulin/get it in my system faster than a pod would be able to.

The experience also taught me a couple of other things…DKA is very real, very dangerous, and should be taken very seriously. The fact that I just barely dodged it is a jarring reminder that I should never underestimate it. On a much lighter note, though, I also proved to myself that I’m able to take control of a situation like that the moment I become aware of what’s going on. Thank goodness I was at least prepared enough that I had an extra pod and insulin on hand. I hope there isn’t a next time, but if there is, I know exactly what to do in order to take care of it as quickly as possible, thanks to this icky experience.

When Carbs Collide with a Bent Cannula, Chaos Ensues

Sushi. Wine. Not one, but two slices (I swear they were slivers, honest) of cake. A pod with a cannula that got bent out of shape accidentally due to clumsiness.

The above sounds like some sort of weird laundry list, but it’s really just all the factors that contributed to a night of high blood sugars and relative sleeplessness.

Let me explain what happened: The night started out fabulously! I got sushi for dinner from a local spot that I was trying for the first time. I was excited about it because sushi is a rare treat for me, and I figured the occasion warranted some wine – my first glass(es) that I’ve had in about 2 months (I gave it up for Lent).

Those two things right there are definitely a “dangerous” duo that can cause carbohydrate calculation errors or prolonged blood sugars, but I tucked that in the back of my mind because I wasn’t done with indulgences for the evening.

I want to say I regret nothing about this carb-o-licious evening, but…

That’s right, I kept up with the carb-loading by enjoying some cake (white chocolate blueberry cake that I made myself that is just as decadent as it sounds) soon after dinner was done. My problem is that I thought I’d curbed the impact of the carbs by setting a temporary basal increase and stacking a small amount of my insulin, but no such luck. I’d destroyed my second piece (it was just a tiny sliver, people) and noticed that I was creeping up. I took more insulin and soon forgot about my high blood sugar as I immersed myself in episode after episode of Impractical Jokers, which, side note: It’s a series I just discovered and it’s hilarious cringe comedy that is the perfect thing to watch after a long day.

A handful of episodes later, it was time for bed. Or so I thought…because soon after I was settled in bed, I twisted around in just the right – or in this case, wrong – manner that was rough enough to loosen my pod from its allegedly secure location on my back. The smell of insulin was pungent and indicated to me immediately that the pod would have to be ripped off completely and replaced. And the sooner, the better, because my blood sugar was getting closer and closer to 300…definitely not a level I want to see before I go to sleep.

By 12:30 A.M., the new pod was on my arm and a temp basal increase was running to combat my lingering high blood sugar. I also gave myself yet another bolus and crossed my fingers, hoping that the combination would be enough to bring my levels down overnight.

At around 2 A.M., my PDM started beeping to let me know that it’d been about 90 minutes since the new pod was activated, so in response I woke up to silence it and glance at my CGM. My blood sugar barely budged! Frustrated, I gave myself more insulin and fell back into a restless sleep.

Several hours later, my alarm was blaring, far sooner than I wanted it to. I hit the snooze button, also taking care to check out my CGM yet again before I made an attempt at 15 more minutes of sleep. And guess what – I was still high. Quite high. Not 300, but in the mid-200s.

It was official: My blood sugar was punishing me for my night of careless carb consumption and reckless pod-handling. I shouldn’t have been surprised by the resulting chaos, but at least I was able to restore peace again the next morning…eventually.

Precarious Pods and Pure Paranoia

Here’s another previously published blog post from October 5, 2018. What nugget of useful information can you find here? Well, it all has to do with trusting your gut when it comes to an insulin pod that’s dangling precariously off your body and the subsequent paranoia that happens when you’re not sure whether it’ll still work properly…

I’d only been wearing my new pod for about an hour when my arm brushed up in exactly the wrong way against a chair. Riiiiiiiip!

My pod tore right off – not from my arm, but it lifted up from the adhesive that it was glued to and dangled precariously from the still-intact adhesive stuck to my arm.

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Would you have kept the pod on, or changed it?

After cursing loudly, I asked my mother for her opinion. I wanted to know if she could see the cannula, because that was the component that made me most concerned. As long as the cannula was still stuck under my skin and delivering insulin, it shouldn’t matter that my pod was a little loose – right?

She tried to peek under and around my site, but it was virtually impossible to tell whether the cannula was where it should be. I thought about it for a few moments, and decided that it would be wise to just change out the pod. The notion of tossing one that had only been in use for an hour was unappealing to me, but I know myself pretty well, and I know for damn sure that I would’ve been super paranoid about the pod functioning properly for the following 72 hours. I also figured that it couldn’t hurt to try calling Insulet to see if they would replace the kaput pod. The odds were slim, but why not try?

So after I changed my pod, I dialed up Insulet and described the situation to the customer support representative. And…I got a replacement! I was pleasantly surprised by the rep’s empathy towards the situation and how easy it was to get my replacement. She reaffirmed that I did the right thing, noting that if she’d been in my shoes, she would have called it in, too. It goes to show that when in doubt, change the pod – and don’t hesitate to call for a replacement.