Surviving a Mysterious Battle with Ketoacidosis on Mount Everest, Returning Home a Diabetic
It’s early morning in Los Angeles, and I’m sitting in the waiting room of the Marina Del Rey hospital. Few people are around and it’s relatively peaceful, but there’s still an air of tension that I can’t avoid. Maybe it’s the particular shade of pastel pink on the walls, or the audible ticking of the wall clock. Maybe it’s because I’ve always hated hospitals and count myself lucky to have mostly avoided them until now. More likely, it’s the gathering realization the of how truly shitty I feel as I sit here, waiting, worried and confused.
A nurse appears from behind a parted door and gestures at me to follow her, I nod as I attempt to get up from my chair, using my arms to clumsily prop myself up to a standing position. This is a must at this point because my thighs have been burning inexplicably for days, the usual briskness of my walking pace reduced to a pathetic shuffle. As I try to make up the short distance to the door, my left leg gives out like a limp noodle, sending me nearly to the floor and in the process knocking over a full display of informative brochures on the waiting room table. Something’s seriously wrong, and it’s just become clear that I may need more than a casual sit-down with a general practitioner. Before I can even grasp what’s happening, I’m being rushed to the the unknown world of the ICU in a wheelchair, my face planted in my hands, trying in vain to hold back tears, and wondering what it means when I overhear someone nervously shout out my blood glucose level in the 600’s.
Just two weeks prior, I was standing at the fabled base camp of Mt. Everest, looking out across an impossibly vast expanse of glacial ice, punctuated by tiny yellow tents. Triumphantly posing for photos with my friends and our Nepali guides, we hugged and cheered ourselves for our achievement and tethered traditional Tibetan prayer flags to piles of stacked rocks. We’d just made it to the bottom of the top of the world. At that moment, I felt like anyone else might feel after days of grueling hiking at altitude — an equal mix of elation and exhaustion.
Few feelings come close to the emotional high that comes from pushing one’s body and mind to extremes and coming out the other side unscathed. What I didn’t realize at that moment is that I wouldn’t make it out unscathed. Or at least my pancreas wouldn’t.
What‘s less understood about climbing to base camp is that the trek down the mountain can be just as challenging as the trek up. This realization hit us almost immediately the next day as we began the tedious journey winding back through same small villages that we’d passed through and lodged at just a few days prior. After nine days playing cards, eating unseasoned tomato soup, and warming our un-showered bodies by yak dung ovens, we were eager to get back down to civilization and decided to pick up the pace. I’d spent most of the preceding days feeling energized, often hiking out in front of our group, and quietly flattering myself for the months of preparation and endurance training I’d racked up swimming and jogging stairs. But as my hiking companions began to shake off the effects of altitude and feel stronger upon decent, my stamina began to fade. It was on a particularly grueling and rainy day hike between the villages of Gorak Shep and Dingboche that I started to feel that something was off. Trailing about a half mile behind my group, I began to feel waves of nausea, light headedness, and extreme exhaustion. It was like one of those strange dreams where every movement exists in a frustrating state of slow motion.
Of course these symptoms were easily explained away by the fact that we were still relatively high up (above 10,000 feet) and contending with all the rigors of the Nepali wilderness. It wasn’t until later that I would understand that the fatigue and fogginess I was experiencing on the mountain in those final days was not the result of normal hikers strain, altitude, or poorly purified water, but the early stages of Diabetic Ketoacidosis. To anyone living with diabetes, this fancy medical term describes a condition that is well understood as a worst nightmare scenario — the point at which one’s body, starved of its natural ability to process glucose, begins to essentially eat itself alive.
It was still four days of downhill slogging until we reached the final village of Lukla, and another two days until we reached relative comfort of Kathmandu. In this time, we’d all been loudly contemplating the many food-related cravings we’d indulge in when we got back to the city, and now it was finally time to dig in. For some of us, this meant pizza, beer, and burgers. For others it was realizing dreams of fresh salad. I indulged in all of the above, but my cravings also took on a strange turn as I developed an unholy appetite for all things sweet, cold, and liquid. Coke floats with vanilla ice cream were a particular favorite, and became a staple food group for many days. Of course, this was perhaps the worst possible combination I could have chosen, especially since I no longer could rely on the miles of daily trekking to burn off some of the excess sugar that was now accumulating in my blood. One of the symptoms of DKA of course is that it severely dehydrates you as you lose fluid through excessive urination. For those who don’t realize what is happening, it can become a vicious cycle — feeling dehydrated and depleted, seeking out sugary drinks to satisfy the thirst, which sends the blood sugar higher, making you even thirstier for sugary drinks. Inevitably, as my blood sugar unknowingly skyrocketed, my situation began to worsen.
Somewhere between obsessive trips to the local store to stock up on soda, I finally had a chance to take a proper shower and shave the pathetic excuse for a beard I’d been sporting. Over the course of our trek it had grown in patchy blotches but with a definite volume that was almost passable as real facial hair. Yet getting rid of it now only revealed what it had been hiding — a gaunt and skeletal version of my face that stared back at me in the mirror like a stranger. Upon closer inspection, the rest of my body seemed equally foreign as I realized with some concern that I’d lost a significant amount of weight — over 30 pounds in just three weeks. Further rationalizing this transformation as yet another result of the extreme physical duress we’d just put ourselves through, I tried to move on without alarm and enjoy what was left of our the final days in the city.
The 20 plus hours of plane travel back to Los Angeles from Kathmandu found me frantically headed back and forth between the bathroom to pee, and the flight attendant’s cabin to beg for yet another glass of water or juice to combat my extreme and insatiable thirst. It was also at this point that my limbs began to throb with unrelenting pain, and the disorienting “brain fog” which began days earlier now washed over me with a renewed intensity.
I still had no clue what was happening to me, and I grew increasingly worried about what I might have contracted. Malaria? Swine Flu? My thoughts floated amid strange and panicked scenarios
By the time I arrived back home, I felt like a frail shell of my former self. I could barely walk, and my thirst only worsened. The DKA that began to set in on the mountain was now full blown, and if left untreated could have easily sent me into a Diabetic coma, or worse. The day after we landed I was admitted to the hospital, where I was immediately diagnosed with Type 1 Diabetes. Although I spent three days in the ICU, I was lucky enough to be surrounded by loving and supportive friends and family, and great team of dietitians and specialists who helped me begin the slow (and at times scary and awkward) transition into a life of insulin injections, finger sticks, and carb counting.
I’ve been living with Type 1 diabetes for almost five years now, and it’s become a normalized and well managed part of my daily existence. I want to share my story because I know that it parallels the experience others who’ve developed Type 1 Diabetes later in life after traveling throughout remote areas of the world, and I remain very curious about hearing similar stories. I’ve been told by my doctors that the reasons for these environmentally triggered cases of Diabetes are inherently hard to pin down to a particular cause, and I may never know what actually led to my body reacting the way it did. It’s sometimes said about Type 1 that “genetics load the gun, but environment pulls the trigger.” I found out the hard way.
