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A Lovely Night, and Hyperglycemic Woes

March 2, 2014

Friday night Meg and I had a long-planned date night. For Christmas she got me tickets to see Mike Birbiglia perform at the Merriam Theater in Philly. We had dinner. We had drinks. We saw the show. We laughed, a lot. We went home. And then my blood sugar did some unprecedented things, that really, really sucked.

We had planned this night for a while. Meg’s sister and stepmom, Sissy and Gigi, came over to watch Owen. We had reservations at La Viola, our favorite Italian restaurant, and I picked up a nice Cabernet to share with my lovely wife.

We ordered: shared antipasta for our appetizer; penne alla Caruso for Meg; orecchiette alla Romana for me; shared tiramisu for desert. I did as I was taught about my basal dose when alcohol consumption is concerned: I cut back my insulin dose to 60% for two hours per alcoholic beverage. Since we were splitting the bottle, I estimated three glasses of wine; therefore, I cut my dose to 60% for six hours, and did a bolus for about 10g of carbs per drink. I also did an individual bolus for each course, estimating about 60g of carbs for the oriecchiette, and about 30 for the half order of tiramisu.

(Note: This was not a diabetic-friendly meal, but it’s what I wanted to eat. Judge me if you want, but my A1c is probably better than yours.)

I checked my sensor glucose readings, and they were good (ranging from the high 120s to the low 140s through our two-hour meal, as well as the almost two-hour show).

We went to the Merriam, and found our excellent seats, located in the first balcony. The Merriam, for those who have never been there, was designed for people who are short. I’m 6 feet tall. It wasn’t comfortable. I tweeted this to Birbiglia: “seats at the Merriam were designed for someone approximately 4’9” tall. @birbigs had better make this pain worthwhile.”

I was thrilled when Birbiglia favorited my tweet. He started his show, and he actually mentioned my tweet, by name, and then made life tough for anyone who arrived late.

(Note: I also tweeted “Advice: Don’t be late to an @birbigs show. He’ll make you pay.” The comedian also favorited this one. He’s now officially my favorite comedian.)

We got about an hour and 45 minutes of comedic genius. We laughed. I felt like I was hyperventilating a few times. We had a great time.

When the show was over, we returned home to allow Sissy and Gigi to return home. Owen was asleep, we were tired, and we were going to bed around 10:30 p.m. All was right in the world. At this point, my sugar, according to my meter, was 143. My CGM sensor told me 135 and rising rapidly, so I turned the temporary basal (60%, which still had about an hour and change to go) off. The wine made me a little dehydrated, so I had a big glass of water and settled in for a good night’s sleep.

Or so I thought. (Another note, for those who are unaware of the target blood glucose ranges: When I was diagnosed, it was the standard goal to have glucose levels of 80-120 mg/dl. It’s been opened up a little, so readings between 70-140 are considered the ideal. I’m personally OK with readings below 170. High glucose starts with anything over 180.)

I woke up around 1 a.m. to see my sensor glucose was high; around 240. I thought “This is annoying, but my overnight sugars had been pretty steady over the past couple weeks, so I thought I could handle a night at 240, and correct it in the morning.

Then I woke up again at 2:30. My sensor said 370 and rising. I had to pee desperately, and took the opportunity to test my sugar. It was true. My sugar was over 370. My pump estimated my corrective dose to be 7.1 units, which I programmed for immediate delivery. I also programmed a temporary basal at 160% my normal dose to try to bring my sugar down. After this I had another glass of water, as I felt completely dehydrated, and went back to bed.

Then I woke up again at 4. My sugar was over 400. I had to pee again, and was completely dehydrated again, and my feet were hurting, and my kidneys were hurting, and, for some reason, my liver kept pumping out glucose. (And I was stressed, which causes the kidneys to pump out even more glucose. It’s a vicious cycle.)

I obviously needed more insulin, but knew the pump wouldn’t deliver it because it would take the 7.1 units already working, and say I didn’t need any more. Therefore, I manually programmed 10 units and changed the temporary basal from 160% to 200% and had more water. Back to bed, with little hope of getting rest.

At 5, I woke up to foot pain, kidney pain, feeling like I had to pee, a burning sensation in my nostrils (one of my most common tell-tale signs of high sugar), and sugar that was still over 400. After peeing, again, I relocated downstairs with our baby monitor. (Meg was awakened every time I got up; also, Saturdays are my morning to get up with Owen. Meg is a saint.) I figured (through 31 years experience and simple inductive reasoning) that the problem was either with the infusion set or the insulin, which may have gone funky. Therefore, I threw out the vial I had been using, the 120 units left in the reservoir I was currently using, and started from scratch. After starting the new reservoir and infusion set, I administered a 16 unit corrective dose, I kept hydrating and hoping my sugars would finally start dropping.

Owen woke up early Saturday, and I kept a close, close eye on my sensor glucose values through the morning while trying to keep him entertained. Each hour, if there was no improvement, I gave myself another 10 units and tested my sugar about 20 minutes later.

(I was aware that when sugars started dropping, they’d drop rapidly, so I also had VitaminWater available to halt any crashes.)

My sugar finally started dropping around 9 a.m., much to my relief, and I was able to take Owen to soccer and had no after effects due to my crappy blood sugar episode.

A final note: Lately, I’ve been averaging between 55 and 60 units a day in total insulin consumption. Saturday, after all the corrective boluses and temp basalt, I consumed 119.875 units. I hope this crap doesn’t happen again, because hyperglycemia sucks.

To my readers who are PWDs (people with diabetes): As I mentioned, I can tell when my sugar is rising by a burning, almost ammonia-like smell in my nostrils. What are some of your tell-tale signs (other than testing your sugar) that your sugar is high?

(Update, 1:46 p.m., March 3: I am fine. I feel fine. My sugars for the past two days have been back to normal. Don’t read this post and think I’m in danger or trouble. This is just describing one incident that occurred.)

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