3 ms·

I've never had DKA in 12 years. How does it happen? I've been on CGM (Libre/Dexcom) and it's impossible to get high enough values unnoticed to end up with ketoa

I've never had DKA in 12 years. How does it happen? I've been on CGM (Libre/Dexcom) and it's impossible to get high enough values unnoticed to end up with ketoacidosis for me. Even before with sticks, I just measured often enough. Would be really curious to know more how DKA happens to you!

gumby 2y ago
Just living my life in an urban setting it’s never been a problem. Had a serious episode about a month ago (ketones at 9 mmol/L). I was on a short backpacking trip with some friends: four 15 mile days. I don’t carry a lot of carbs. My pen became hot despite my best efforts. Had another episode earlier in the year in a similar trip backpacking in the snow — shorter distance, harder work; my meter froze and stopped working so I don’t know BG level. On the second day my pen got “slushy” even though I carried it next to my body/in sleeping bag. My understanding is that in these cases your liver starts out dumping glycogen into the bloodstream but reserves are exhausted and so you start going into ketosis. I don’t understand the mechanism under which my glucose then hikes — some stress reaction? This is generally scary for my companions but not for me as I am a bit confused, falling over etc. The only feasible way out was to hike. Fortunately on the first trip we had adequate water access so I drank (and pissed out) about a litre a mile.
- croemer 2y ago
  Thanks that's great context! I don't think I've been out as long in similarly harsh conditions. I always carry plenty of backups, usually duplicates, because CGM sensors can fall off and it happens that I screw up the insertion, so having at least one is good. Also I always carry some old-style sticks with me as backup. To prevent freezing/overheating of insulin, I'd probably pop some vials into a small thermos filled with room temperature water. Just dropping into a bottle of water is also better than leaving exposed to air.

gumby 2y ago

Just living my life in an urban setting it’s never been a problem. Had a serious episode about a month ago (ketones at 9 mmol/L). I was on a short backpacking trip with some friends: four 15 mile days. I don’t carry a lot of carbs. My pen became hot despite my best efforts. Had another episode earlier in the year in a similar trip backpacking in the snow — shorter distance, harder work; my meter froze and stopped working so I don’t know BG level. On the second day my pen got “slushy” even though I carried it next to my body/in sleeping bag. My understanding is that in these cases your liver starts out dumping glycogen into the bloodstream but reserves are exhausted and so you start going into ketosis. I don’t understand the mechanism under which my glucose then hikes — some stress reaction? This is generally scary for my companions but not for me as I am a bit confused, falling over etc. The only feasible way out was to hike. Fortunately on the first trip we had adequate water access so I drank (and pissed out) about a litre a mile.

croemer 2y ago
Thanks that's great context! I don't think I've been out as long in similarly harsh conditions. I always carry plenty of backups, usually duplicates, because CGM sensors can fall off and it happens that I screw up the insertion, so having at least one is good. Also I always carry some old-style sticks with me as backup. To prevent freezing/overheating of insulin, I'd probably pop some vials into a small thermos filled with room temperature water. Just dropping into a bottle of water is also better than leaving exposed to air.