First time I’ve had DKA – Don’t want it again!

Well, first time for everything and all that. But DKA finally paid me a visit in all 34 years of dealing with this. And frankly still annoyed over it.

The day started pretty well. Early rise, all kitted up and prepped for the event today (62 mile cyclocross with 8824ft of climbs). Bloods were pretty perfect for it, 6.2 (111 in US money) had breakfast on a 60% bolus as usually and off rode to the start of the event. Was a little slow getting away so by about 8 miles into the event bloods where up to 16.2 (291) and I corrected partially and by the first food stop at 22 miles in bloods where down to 5.6 (101). For the remainder of the event everything was fine blood wise with little deviation (5.2-5.8 throughout) and completed it at 5.6. Was a hard slog, shaved a good chuck off my previous best time, met a load of folks who I got chatting to, and over all really had a good time.

Rode home, bloods where 5.2 (94), washed bike and back tyre went flat grr. I’ll sort that later so kind of ignored it and finished up cleaning and got myself cleaned up for the coating of mud I was covered in.

A few hours later checked for dinner and eep BG was up to 16.1 (290), corrected, had a little feed and waited and had a splitting head ache which was odd and BG was 20.4 (367). Massive correction and an couple hours later 17.1 (308). I started vomiting which was odd and couldn’t work out why. Didn’t seem to be dinner related but made me think anyhow but blamed being so high for it. Really fed up with it all now changed vile, infusion set and usual things and started again. Did a correction and waited an hour and now 17.8 (320). Utterly fed up even tried using pens, BG now 17.2 grr. Ok this has lasted long enough lets check for ketones..ACK 5.0. That’s it, something not working, I feel awful and I need help so got a lift to hospital.

By time I got to hospital BG was still 17.8 (320) but ketones where now up to 5.8. Blood pH had now dropped to 7.33. BG kept around 17 for the next 4 hours or so and ketones raised to 7.8 before everything started to come down. Took 23 attempts though to get cannula’s into me for insulin, food, and hydration mix (massively low potassium in blood it seemed, blamed on possibly lack of hydration in ride but thought I had drunk enough *shrug* with over a couple a bottles) due to veins collapsing though.

ECG and Xray wasn’t showing a possible cause and blood work up seemed to only indicate white blood cells high attacking something. So some dodgy infection caused it.

Anyhow, long story short. They fixed me up, got me switched back to my pump. And back home. Ketones have been fluctuating for today between 0.2 and 1.8 with the bloods being kept pretty steady in the 6’s. But eating little and often and drinking loads and should be flushed out of me by tomorrow or so’s the plan. Arms are a mess now due to the attempts to get stuff into me, and blood out of me.

Utterly annoyed though about needing help! Theory is currently the ride weakened me enough for the infection to cause some mayhem but not over sure which is a concern. Still haven’t had the usual recharge moment off the ride which is very odd also. But it’s another day being T1. Always finds something “fun” to throw at you and learn from 😛

Lakeland Monster

Just done the Lakeland Monster Miles bike sportive with a difference. The difference being its “only” 68 miles long. Not bad really (or so I told my mind). The issue being 54 miles of those are off road. Thankfully my trusty steed LM is a cyclocross bike, so on went the knobbly tyres and off I went.

The start was nice and dry, down an old railway line and up a few hills then came the first off road bit. A very nasty climb, lots of gravel, wheelspin nastiness really. Riding through a river was a first fit me, although not the last of the day, had to do four by the end of the day. But the first one threw me off, and the guy in front, and the two behind also, so kind of made me feel better. The downhill was nasty, and all us crossbikers suffered badly without suspension like the mountain bikes, but we got our own backs on the flat and road sections.

By the first feed stop, my bloods were keeping stable so picked up a few supplies. Must admit I was a bit curious about my levels due to the dancing lemur… turned out to be a kid in fancy dress since the feed station was in an animal park. But had me questioning my meter for a bit 😛

The path from the park was very nasty. Very muddy and it just kept getting worse. Some parts with over a foot deep of mud, how I never came off I have no idea. Heard a pile up behind me as it seems some weren’t as fortunate. But didn’t escape the nettle stings along the side the the path.

The ride was split up into named sections… Approaching the “stairway to heaven”, or hell as the riders renamed it, I put on my jacket (hate doing it as it covers my JDRF shirt), was a really evil slog. Halfway up I stopped to eat some supplies as I was well in hypo territory. Once righted I pressed on and eventually made it over the top of the 495m climb and down the another which was a nasty descent with this one being made from pot holes of varied potholiness, a lot filled with water hiding the depth.

Around the lake at the bottom was nice and fast, and stopped at feed station two. Bloods were now very low (in US money 39, or 2.2 for us Brits). My drinks were low, so had to switch to using the drinks at the station. Questioning them on does the drink have carbs or was it just electrolytes in it received a blank look. Took some pressing till I got a kind of answer of yes, but no idea how much. Got to love flying even blinder. The biscuits and flapjack was easier to manage and had me back up after 20-30mins or so.

And then came more hills, but home was only another 18 miles to go. The unknown energy drink had to keep me going along with my remaining did stores. Even small ascents became a slog now but the end was in sight.

Crossing the line a bit too fast I bypass the medal hand out (yes we all got medals) and got jumped on by family. Bloods were down to 75 (in US or 4.2 in British) but left it alone as I had that much in me from drinks and snacks it was going to bounce high soon… 30mins later it topped out at 184 (10.2) but that’s expected. Will have to keep a close eye on it tonight but a fun ride and a good ride.

Diabetic stats for the ride: no CGM (couldn’t wrangle one in time which is still annoying me), 18 test strips used on ride, 320 carbs + unknown energy drink consumed, pump on 33% basal throughout but had to suspend it for 90mins in middle of ride between the two bigger hypos, 1.2u insulin used throughout + a small correction of 0.3 for the 10.2 (40% normal corrective amount).

We maybe diabetic but we can do anything anyone else can. We just think I little bit me is all 🙂

My primary fuel is my drink which are a stronger mix of the SIS carbohydrate drinks, I tend to aim for 60-90g of carbs per 750ml bottle (have two attached to bike) depending on ride (was on 90g mixture on this one). Usually throw into that 1 and a half tabs of SIS hydration tablets, along with 2 tablets of the High 5 caffeine blocks. I also always have a packet of Lucozade tablets in my BG meter case as a extreme backup solution (when riding find they take 15-20mins to kick in sadly so mostly of use on normal days).

For munchies, tend to carry 3 or 4 of the Clif Shot Bloks as they are so much nicer than gels, and you can just eat a chunk as and when without having to down a full gel. And also a Clif Peanut Butter Bar for something a bit more solid if necessary.

Everything else food wise I tend to acquire off the feed stops which usually have fresh fruit, biscuits, gels, energy drinks of an unknown mixture which can sometimes just be hydration drinks. I tend to find picking up random drinks are a bit risky due to having now idea what’s in them, but sometimes needs must.

I got asked a bit about what my carb use when biking is, an interesting one really and a lot of it comes from practice more than anything and even then weather and things can really mess it up. But in a “person with a normal working pancreas” on a ride, scientific data shows they need roughly 1g carbs per hour for every 1Kg the person weighs (so if you weigh 60Kg, that’s 60g of carbs per hour) for the necessary energy output. We are a bit different from that as have to deal with fiddling our insulin levels depending on what’s floating around our bodies, but we can’t go without it at all as we need to keep some insulin in there to metabolise our fuel. So that’s always a lot of practice.