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.