Sky High: Diabetic Ketoacidosis on Mount Everest

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. Maybe it’s the particular shade of pastel pink on the walls. Or the ticking of the wall-mounted 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 of how truly crappy I feel as I sit here waiting, worried, and confused.

A nurse appears from behind a parted door and gestures for me to follow her. “Okay, Mr. Phillips, we’re ready for you now.” 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 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 is 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 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 that my blood glucose level was in the 600s.

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Two weeks earlier

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 a high 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 is 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 the same small villages we’d lodged in just a few days earlier. After nine days playing cards, eating unseasoned tomato soup, and warming our unshowered 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.

Friends and guides at base camp (author is in front).

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, lightheadedness, and extreme exhaustion. It was like one of those strange dreams in which 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 were not the result of normal hikers’ strain, altitude, or poorly purified water, but were the early stages of diabetic ketoacidosis (DKA). To anyone living with diabetes, this fancy medical term describes a condition well understood as a worst nightmare scenario — the point at which one’s body, starved of its natural ability to process glucose, begins essentially to eat itself alive.

Back to civilization

During the last four days of downhill slogging before we reached the final village of Lukla and another two days to reach the relative comfort of Kathmandu, we’d all been loudly contemplating the many food-related cravings we would indulge when we reached the city. 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. Cola 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 now accumulating in my blood. One of the symptoms of DKA 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 skyrocketed, my situation began to worsen.

Back in Kathmandu, post-trek.

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 shaving 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 been through, I tried to move on without alarm and enjoy what was left of our final days in the city.

Heading home

The 20-plus hours of plane travel from Kathmandu to Los Angeles 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 also was at this point that my limbs began to throb with unrelenting pain, and the disorienting “brain fog” that had begun 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 veered between strange and panicked scenarios as I decided that I probably needed to see a doctor as soon as we landed. By the time we arrived in LA, I felt like a frail and crumbling shell of my former self. I could barely walk, and my thirst only worsened. The DKA that had begun to set in on the mountain was now full blown and, if left untreated, could easily have sent me into a diabetic coma, or worse.

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Symptoms of diabetic ketoacidosis

While traveling, it’s important to be able to spot the signs of diabetic ketoacidosis (DKA). According to the Mayo Clinic, these include:

• Excessive thirst
• Frequent urination
• Nausea and vomiting
• Abdominal pain
• Weakness or fatigue
• Shortness of breath
• Fruity-scented breath
• Confusion
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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 a great team of dietitians and specialists who helped me begin the slow (and at times scary and awkward) transition to a life of insulin injections, fingersticks, and carb counting. When I asked my doctors and endocrinologists why this happened to me, they said the specific causes for the emergence of this form of diabetes are inherently hard to pin down, but that my case seemed to reinforce the adage that “Genetics loads the gun, but environment pulls the trigger.” My personal combination of environmental triggers and antigens could have stemmed from any number of factors and sources I was exposed to throughout the course of my six weeks of travel. Were they novel bacteria within a slice of yak cheese or virally delivered through the bite from a pesky mosquito? Were they floating in a glass of morning tea or inhaled in a grain of dust? Could any of this have been avoided?

I just marked the two-year anniversary of my diagnosis, and it’s become a normalized and well managed part of my daily existence. But it’s only now that I have been able to write the story of how I mysteriously developed it. My story parallels those of others who have developed Type 1 diabetes later in life after traveling throughout remote areas the of the world. But becoming diabetic (despite the initial hiccup) hasn’t slowed me down or made me any more fearful of travel. In the past two years, I’ve lugged my portable cooler full of insulin pens with me for extended travel through Italy, Morocco, and Hungary, and currently I am preparing for a year in India. I am fortunate to have traveled throughout places such as Nepal, whose beautiful people, rich cultural heritage, and stunning landscapes have enriched my life in ways that are immeasurable. The friends I met and the trails we traced among cities and mountains form a movable feast that I continue to revisit in daydreams, without a tinge of regret. This is why we travel, knowing full well that we embrace the allure of the unknown, and the inevitable shocks to our system, to emerge better versions of ourselves on the other side. Whether we’re already living with a medical condition such as diabetes, or are worried one might someday emerge, fear tends to shut us off from the possibilities of new experiences. I’m glad I didn’t — and still don’t — let that happen. With base camp behind me, it’s this spirit that will continue to push my future adventures — unlike my blood sugar — to new peaks and valleys.

Want to learn more about diabetic ketoacidosis? Read “Diabetic Ketoacidosis: A Preventable Crisis” and “Hyperglycemic Crises: What They Are and How to Avoid Them.”

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