Fire In My Veins: A Story of Ketoacidosis

Katherine Marple -Author of Wretched

| Jul 17, 2012

I've had type 1 diabetes for 14 long years. During that time, I have had five episodes of ketoacidosis, two of which were brought on by emotional stress.  The one that happened eight years ago, shortly after the meltdown of a serious relationship, lives vividly in my memory.

Usually I jump out of bed to start the day, but when I woke up that morning, I felt like the bed was on top of me, the weight of my chest too heavy to sit up.  My mouth felt full of cotton and my tongue was swollen and useless.  I sat up on the edge of my bed and supported my wobbling weight with my arms stretched out at my sides.  Suddenly, the heartburn was so strong that it felt like a volcanic eruption from the middle up my chest up to the back of my throat.  I think I tasted blood.  I needed water.

As I stumbled slowly down the stairs to the kitchen, I remembered that the night before, I had gone to bed with my glucose level in the low 100s.  I was so distraught about my recent breakup that I couldn't eat any dinner, but had forced down a few peanuts and a slice of cheese to avoid the ketones that can develop after not eating for too long.  I knew that my post-breakup emotions were getting the best of me mentally, but was surprised when the effects started coming at me physically as well.

It felt like my veins were on fire.  I drank nearly a gallon of water, and I could almost hear the flames sizzling as my veins cooled down.  Have you ever had the illusion that you could feel every single vein under your skin?  Now imagine that each vein has scorching lava coursing through it instead of blood.  Even my skin felt too tight for my body.  

I wanted to believe that I could flush the ketones out of my system on my own by not eating any carbohydrates, drinking lots of water, and urinating as much as possible.  After all, when I was first diagnosed at age 14, I had an A1C level of 17.1% and my running glucose level was over 1200.  I didn't feel ill at the time, but I was dropping about ten pounds every day despite eating huge meals and drinking as much as my belly could carry.  Since I didn't feel physically ill at diagnosis, the doctors saw me daily for a week and gave me instructions to bring my glucose levels down at home.  They said that by flushing my system with two liters of water every hour, I'd pee the ketones out and bring myself out of ketoacidosis.  It had worked during diagnosis week, so I hoped that I could do it again this time.

Today, I had to drive to work within the next half hour.  I didn't yet have that cushy desk job with an understanding boss.  Instead, I had a boss who believed that diabetes was just a diet and exercise regimen.  If I needed to leave work early or come in late for an endocrinologist appointment, she would reprimand me and give me a hard time, no matter how much advance warning she had.  No amount of explanation would do with this woman.  I was 20 years old and, in her misinformed eyes, still a kid.  I desperately needed to keep the job so that I could keep my health insurance, so I dragged my body upstairs to put some dress clothes on.  As I buttoned my slacks, I noticed they were much looser than usual.  I appeared to have lost about ten pounds overnight.  No matter. I pulled on a suit jacket that felt layered in shards of glass.  Even the air touching my skin was painful.

My body ached, but my head, I thought, was clear.  Nowadays I would never drive in that physical state, but back then I was young and desperate and under the false illusion that the worst will never happen.  I thought that I could make it through anything if I just tried hard enough.  During the half hour drive to work, I had the air conditioner blowing on high with the windows down, but the cool air didn't calm the fires that were still coursing through my body.  The heartburn was so intense that my mouth tasted like I was sucking on a piece of metal. I pulled the car over twice on that drive to vomit everything I had eaten in the past day, and then I chugged down some more water. I just needed to get to the office. Once there, I could calm down in the break room until the place opened for business.  Hopefully, I would have enough time to get the ketones (and fire) out of my system.

I drove my car into the parking lot and gathered all of my strength to get myself out of the vehicle.  I carried a gallon of water in one hand, my purse in the other.  As I watched my feet step across the pavement, I noticed that I had splash-back from the roadside vomiting episodes on the cuffs of my pants.  Normally I would have been disgusted, but then I was just too tired to care.  Maybe no one would notice.

I checked in with my supervisor, who immediately noticed that I was feeling under the weather.  Unlike my boss, my supervisor was understanding, partly because she had been recently diagnosed with type 2 diabetes and understood that managing it takes a lot more than just eating vegetables and going for a 15-minute walk every day.  She told me to sit in the break room until I felt better.  An hour passed as I sat with my head on my hands at the table in the break room.  I fell asleep almost as fast as I sat down.  When I woke, I groped my way down the hall to the bathroom to splash water on my face.  I drank more water and tried to pee.  At this point, my body was feeling hot to the touch and my organs had begun to feel bruised.

My supervisor told me to go home, saying that she would deal with my boss's opinion on the matter.  She offered to have someone drive me, but I declined.  At 20 years old, I was still embarrassed, ashamed, and too protective of my reputation to allow other people to see me sick.  Now that I'm older, I know that accepting help when you need it is the smartest way to live life.  

Despite feeling like I could keel over and die on the spot, I drove to the closest house I trusted: my ex-boyfriend's place.  It was empty, but I still had a key, so I let myself inside and lay on the couch.  I checked my glucose level and it registered in the 300s.  I drank more water, hoping to flush it out, and checked again a half hour later. This time, it registered in the 400s.  I drank more water and called the doctor.  The nurse who answered my call simply told me to rest and call her the next morning.  I've since pulled my medical records from that office and switched to a new endocrinologist.  A half hour later, when my glucose read in the 500s, I called my dad to come pick me up and take me to the ER.  Then, I passed out.

When my dad came, I could no longer support my weight on my own feet.  He put my arm around his shoulders and helped me into the backseat of his car.  I lay down in the seat and waited the agonizing 26 minutes it took to drive to the hospital.  Every bump in the road made me wince in pain.  My organs felt completely bruised, and every muscle in my body ached.  My chest heaved with every breath.  By the time we got to the emergency entrance,  I couldn't stand on my own, so my dad picked me up and literally carried me through the automatic doors.  By that point, I could barely muster enough breath and energy to speak.  Somehow, I told the admissions nurse that I was in the middle of ketoacidosis before I slumped into the wheelchair, unable to say any more.

I was so extremely thirsty that I actually cried for water.  I pleaded for ice chips to suck on, anything to cool my boiling blood and wet my parched throat.  The ER staff was afraid to give me anything to drink because if I vomited again, it would be even harder to bring my glucose levels down.  After they worked on me for six hours, pushing IVs of saline solution and baking soda through my veins to combat the acidic levels from the ketones, they admitted me to the ICU for five days.

In intensive care, they regulated my glucose levels and monitored my insulin dosages.  After a few days, I began to feel a little better.  I had lost about fifteen pounds in three days and my organs still felt bruised, but my glucose levels were back to normal.  The nurses said that if my dad hadn't brought me to the ER when he did, within two hours I would have been dead.  All that pain because a dumb boy broke my heart.

I learned that even if you are extremely careful with your diet, exercise, and medication, emotional stress can act as poison in your body.  Get rid of the stress, and you will surely bring your average glucose levels down.  I try to keep my life as stress-free as possible because I never want to experience another bout of ketoacidosis.  It was by far the most painful experience I've ever had to deal with, even more painful than unmedicated child labor.  But that was all in the past, and life is good now. It's been two years since I married my best friend, and I have never had a more stable or lower A1C.

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Categories: A1c Level, Blood Glucose, Blood Ketone Levels, Diabetes, Diabetes Health, Diabetic, Ketoacidosis, Type 1 Issues

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Posted by Anonymous on 17 July 2012

It doesn't say anywhere in this article that you took insulin when your sugars were rising so rapidly, is there a reason for that? I'm in the UK, but I'm pretty sure you would know about dose adjustment for high sugars? I'm a bit confused! If you can drive a car surely you can take a shot of insulin? Forgive me if I have that all wrong. Been diabetic for 38 years and when I first got it I was regularly admitted to hospital, but it was because no-one had a clue back then, they didn't even do blood sugars, just urine analysis.

Posted by Anonymous on 17 July 2012

Glad to hear it ended well. I was extremely stressed until I gave up Being employed last year to work for myself - far less stress and better control.

Posted by Anonymous on 19 July 2012

I am puzzled. How could Catherine have Ketones when her levels were in the 100-500 range? I have Type 1 for 22+ plus years the only time I had Ketones was during the time of my diagnosis 22 years ago and she has had Ketones 5 times?? Is she aware how dangerous that is???

This is not only a careless act but she should perhaps re-take Diabetes courses to have a better knowledge of taking better care of herself for now and the future.

Posted by Anonymous on 19 July 2012

Strangest story mention of taking insulin to combat the high blood sugars. The standard in our home for our son when his blood sugar is really high is double the correction bolus, retest in 1.5 hours and correct again if needed. And yes, drink lots of water...but water in and of itself is not going to bring your blood sugar down...

Posted by Anonymous on 19 July 2012

I must say i hope better education is available to this young lady. As a cde i find this very sad. Somewhere along the diabetes road something is lacking. I find it tragic this young person has had dka so frequently.

Posted by Anonymous on 21 July 2012

I'm type 2 so I'll admit I don't understand all there is to know about type 1, but I am surprised that she could go to bed with a level of 100 and overnight shoot up so high that her body was out of control with ketones? Does something not sound right there? Actually the whole article sounds strange! I'm glad it all worked out but holy ****!

Posted by Anonymous on 23 July 2012

I think people should not put other people down for not having the best control over their diabetes. Taking 'classes' is not necessarily the answer, but to listen to a story about the effects of stress rather. I was curious if you did take extra insulin to fix the problem, but am familiar to times when stress overtakes your body and it is hard even with insulin to fix a high blood sugar due to stress. Thank you for the article. It is nice to read stories that relate to you.

Posted by lizmariposa on 24 July 2012

Katherine, I really want to, again... thank you for writing this story. As a diabetes advocate, I deal, on a daily basis, with persons (whether young folks, or the newly diagnosed), who just DON'T understand how dangerous it is to be this high -- to not come down -- and to ignore the body's symptoms of ketoacidosis. I often have to IMPLORE THEM to go to the hospital, often bypassing ignorant medical professional advice. It's also NOT EASY to develop the courage to face the ignorant people -- with power -- in our lives, when it comes to taking care of ourselves... especially when we feel some level of shame. I think we all go through this, to a degree, and they are hard lessons to learn, sometimes. I've had to face awful bosses before, some who wouldn't even let me have breaks to eat, and who threatened to fire me because I didn't 'confess' I had diabetes in the interview! Unbelievable, right? This was hard for me to face at 33 -- I can't imagine at 20! It's hard for ANY young adult, without chronic illness, to come into their own... diabetes just throws a big wrench in things.

Also, I'd like to add here, that there are a LOT of generalizations that folks WITH diabetes like to make about others with diabetes:

1. That you have to be extremely high in order to get ketones: Yes, ketones can happen over a long course of time, if you are very high, BUT, if you are over stressed, dehydrated, and dealing with other illness issues, ketones CAN happen literally over night, and put a person in a dangerous spot. This is why it is SO IMPORTANT to monitor for ketones when we are sick. The numbers on the glucose meter can be deceptive, and it's always best to go by how we feel, physically, and to test for ketones every time.

2. People like to assume that what will work for them, will also work for others. Not all high blood sugar situations respond to insulin -- especially when ketoacidosis is in the works. This is why there comes a time we need to recognize that we need to go to the hospital, instead of keeping on fighting against the current.

3. Diabetics right stories ALL THE TIME, about their past struggles, and hard learned lessons. This does NOT MEAN we are currently ignorant of things, or need 'diabetic lessons.' We share this here, in all honesty... to help educate other diabetics who might be currently in that spot. It's not easy to admit to these errors... And it's so EASY to judge someone many years after the facts of their errors in judgement. I am SURE that many of you made many such errors in your youth, or in your early years of diagnosis. Please be KIND. If you are confused, ask questions... but learn to read the TIME PERIOD of this story -- it was in the long past, a long time ago... And Katherine is an EXEMPLARY, well tight controlled, person with type 1 diabetes TODAY.

4. Just because Katherine didn't dwell on all the times she may have dosed for insulin, does not mean she didn't dose any. But even if she hadn't, and was under some thought that just eating protein would help keep her from continuing to go higher... you have to understand -- A LOT OF YOUNG FOLKS WITH DIABETES MAKE THESE MISTAKES! Am I saying it's okay to do this, or is SHE saying it's okay to do this? No! To the contrary... She is saying LEARN FROM MY PAST, BAD MISTAKES... And she's also saying YOU ARE NOT ALONE! I'VE LEARNED TO CARE FOR MY DIABETES, AND VALUE MY LIFE, THE HARD WAY, TOO!

I am more than THANKFUL that there are folks like Katherine being VERY REAL about their hard learned lessons, and journey with diabetes... because while I don't wish this on anyone, it makes it easier for me to show another new, young person -- "look, you are NOT a bad person! you are NOT a failure! Diabetes is HARD. It's sometimes, not so easy to make the best decisions... but together we can LEARN, and grow to stand up against the pressures."

Katherine... Don't fret. Some of these folks might seem judgmental, but I know they're just showing some genuine concern, even if it's in a NOT so kind, and rather mean, kind of way.

You are a HERO to me... and give me, and many others, courage to keep going... and a voice of acknowledgement, that yeah... this IS a challenging journey.

Lizmari M. Collazo
The Angry Type 2 Diabetic

Posted by Anonymous on 3 September 2012

Great and scary article. But how do you keep life as stress-free as possible? It isn't always that easy or even completely in our control.

Posted by Anonymous on 20 June 2013

I went through exactly the same type of experiences after I was misdiagnosed as a Type II when I retired from the Army in 2010. I was put on Metformin and told very little about anything. I cannot tell you how many times I was sick from June of 10 through December of the same year. I went from 175 pounds to 126 when I was finally released from the hospital. Many of the posts here have stated they don't know why she didn't take insulin. Unless you know her exact story then don't venture to guess. When I finally got to a competent Endo in Germany he asked the same questions. I responded that the military had taken me off of my short acting insulin because they said it was not needed due to Type II. I have since been with this Endo and only had one incident of DKA and that was becasue of an illness and my poor response to it. I know that I couldn't have felt any worse if I was dying and in fact in a way I was. The pain in my abodomen and not to mention the constant vomitting of bile and undigested food. In my initial phases the pain was treated with narcotics and by the fourth month of this the military was calling my a junkie and drug addict even though before becoming sick I had never had a narcotic in my life. I grew up with a mother who abused prescription drugs and hated any use of them even if needed and justified. Thank God I have a wife who pushed for answers when things didn't make sense and who has had the patience to walk away from arguments because whe has done the research and knows that stress will only make things worse. Anyways God Bless and good luck.


Posted by Anonymous on 16 July 2014

My mother suffers from Diabetes, and I just specifically searched for Veins on fire and came across this post. As that is what I have just experienced for the second time in 2 days.
My veins swelled right up on my lower arms..yesterday morning it was just around the fold of my inner left arm. but tonight as in 20 minutes ago I had a worse experience on both arms from the folds of both arms to both wrist..
The burning was a really itchy type at first, so of course I began to gently scratch it.And then I could feel the blood in my veins beginning to heat up, till it got the point of feeling I was going to pass out.
Slight tension in my chest as well, for which I still have as I am typing this out.
My body aches everyday, my legs and knees are throbbing , and really achy where it makes me want to wimper...the soles of my feet feel painful to walk on, as well as serious joint and muscle pain.
My kidneys feel like I have done 5 rounds with Boxer..
And I am also going through a torrid time with my girlfriend, so stressed to high heaven at the moment.
And My spinal column is very painful, over the past couple of weeks my vision is starting to suffer as it's taking allot of concentration to focus on any pictures or text.
I have suffered from depression as well, but I feel this is my body starting to fail, I am 44, male. slim built and toned, I smoke about 15 rollups with filters a day, but eat crap due to finances , but don't drink alcohol, I got a doctors appointment to book up with a kidney specialist due to having a dilated kidney 9 months ago..
Had 2 kidneys stones but I passed one of them after going through the worse pain last september. This was my second bout of kidney stones last time was 7 years ago.
I used to play so much sport but now I wouldn't last a game of snooker. So fed up with feeling so shit physically, it affects my moods everyday for which my girl aint very sympathetic..I feel the doctors ain't listening to me as my health seems to get worse everyday, oh, and I walk about 5 miles a week on average, and carry shopping so i do exercise.. so its not like I ain't trying.. really can't see me living on much longer as this pain will drive me insaine. Could it be all down to diabetes?
I must admit I am getting scared that its heart disease or whatever.

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