It’s DKA Again…
Wednesday June 19th started out fairly normal. I awoke at 4 to check my blood sugar to make sure I would be in a good range to hit the gym at 6am. I was in the 160s and felt confident in that decision. It was my first day of swim training and I was feeling a bit anxious. I got in the pool and swam a few laps. It was SO. MUCH. HARDER than I’d anticipated. I got out of the pool still feeling anxious (I was very out of breath from the 300m I swam & was struggling to catch my breath which naturally made me feel MORE anxious – joy!) so I decided to sit in the hot tub and try to calm myself. I spoke with a very kind gentlemen who called me out on being a swimming newbie. He gave me some great tips and lots of inspiration. I showered and met Ryan in the car to head to work.
I checked my blood sugar again in the car. Still the 160s. Hmmmm. I figured it would have gone down at least a little but since I was maintaining a number that isn’t terrible I figured I’d ride it out and test again in an hour. I was still feeling VERY anxious about how poorly the swim training had gone. I even mentioned to Ryan I felt especially weepy over the whole thing and I couldn’t figure out why. We talked about taking some deep breaths and letting it all go. I tried. I really did.
I got to work and immediately went into a meeting I was NOT happy about. I could feel my blood boiling and my anxiety starting to spill over. I tested again about 9:30. 300. What the fructose?! I hadn’t eaten and hadn’t even drank my coffee. I chalked it up to my anger & anxiety and took a rage bolus. Half an hour later I was sick to my stomach and up in the 330’s. Something told me I was in trouble. A coworker gave me a ride up to the ER about 11am.
Ryan was in a meeting he couldn’t get out of so my sister, who is a nurse case manager at the hospital, met me in the ER to try to help calm me down. We had a long convo about how anxiety is also a chronic illness and maybe I should start thinking about meds (this is a whole other blog post really, and one I plan to address, when I’m ready). She made a lot of good points and when she had to get back to work, I felt a little better. I was still vomiting mind you, but my mind felt better.
Ryan showed up about 1:30 or so. I still wasn’t feeling awesome. I’d had 2 bags of IV fluid and 2 doses of what’s normally my wonder drug, zofran. The doctor decided to step it up and gave me a dose of reglan with a dose of benadryl (Reglan & compazine are both known for causing strange side effects that mimic a panic attack so they give Benadryl to counter act that). After a nap and more fluids, I awoke feeling…hungry! Hooray! The docs had warned me I was acidotic but they were confident we could get the situation turned around and have me discharged shortly. I was able to have some crackers and diet sierra mist and when the doc came in to check at 4:30 he couldn’t believe he found me smiling, laughing and wanting to go home.
They decided to check my labs once more before discharging me. When the nurse came back in to draw my blood, all hell had broken loose. I was vomiting again and feeling very awful. My anxiety had begun to pique just knowing what was in store if I couldn’t get all this to stop (clearly I was that sick I though I had control over the situation – ha!). And then it happened. I had the most massive panic attack of my entire life.
I couldn’t breathe. I couldn’t stop crying. My chest felt like an elephant was sitting on me. They gave me a dose of ativan and some more zofran. Half an hour later another dose of ativan after I was informed I was being admitted for DKA. I begged for a shower. The nurse assured me the ICU didn’t care if I hadn’t showered. I explained it was how I self soothe during an anxiety attack and if I could just get a few minutes alone in a shower, I could calm down. It wasn’t easy but this wonderful nurse made it happen. She gave me 10 minutes to get my shit together and when I got back to my room, Ryan said it was a different person. I was relaxed and my color was better.
I got up into my room in the ICU (only the ICU is trained to administer insulin – which is crucial in the management of DKA) at about 8:30. Ryan stayed for about half an hour as I got settled and then left to get some rest. I was woken up every hour for finger sticks and had labs run every 4 hours. I was awake for the day by 6am.
I was feeling MUCH better. My throat was sore and my head hurt but those symptoms made sense with everything I had gone through the day before. I spoke with SO MANY DOCTORS that morning. I spoke with an endo team. Ryan came to visit. My sis came to visit. My cousin who was in the hospital receiving chemo came to visit. A family friend who works at the hospital came to visit. I ate. I used the restroom (or commode as there are no private restrooms in the ICU – I’ll take a commode over a catheter thankyouverymuch). I was able to start pumping again about 9am. By lunch time I was begging for a discharge. I had heard I would be out that day by some docs, Friday by another and Saturday by one poor nurse who saw my fangs and claws come out (Ryan & I were having our engagement party that Saturday). I was aware that normal hospital protocol did not allow for a discharge directly from the ICU. But I was insistent that I not be transferred to a regular hospital floor as my last experience there was extremely frustrating (as anyone with diabetes can tell you – no one at the hospital understands diabetes. When I was being held for observation after my last DKA incident, I was not allowed to use my own glucometer. I requested a fingerstick before breakfast and was told they would check it after. I explained I wanted to be able to correct before eating if necessary and to plan my breakfast around my blood sugars. They were flabbergasted. And still wouldn’t do it. FACEPALM!) I was very vocal and explained, “I am using my pump independently and without observation. I am doing my own fingersticks. I am eating. I am using a restroom. I would walk if you would disconnect me from these two IV lines and heart monitor. I drank that nasty Potassium drink you gave me and my labs are completely clear. WHY AM I STILL HERE?! And you know what? It worked! I was discharged from the ICU about 5:30pm and went straight home where I ate mashed potatoes and vanilla ice cream before getting what felt like the best night’s sleep of my life (if you need sleep, don’t try to get it at a hospital – it won’t happen. Guaranteed). My sugars have been well behaved since (Knock on wood!) and I’m feeling very much back to myself. I still don’t know what happened or why it was so fast. The docs think I had a pump failure but I think my anxiety had a lot more to do with it. I will be talking to my endo at our appointment next week about how possible this is and I’ve begun researching some meds that might be the solution to this problem. Until then, I’m done with DKA. And the hospital. XO