Mortality and a bloody mess

[ar_wahan]

I've been feeling rather down emotionally the last few days. I think part of it was because I got some lab tests back that set a new standard for the "oh cripes!" reaction. (more on that toward the end) I have Type I diabetes. I went on an insulin pump last Feb. 28 and generally like it very much. But it's not working as well for me as it is "supposed" to. And last night I may or may not have had a close call.

FYI: The insulin pump does not test your blood sugar for you. It's amazing how many people think it does! I've read a company in CA is working on a pump/continous glucose monitor combo that would do both, but it's not available yet. So I have to prick my fingers many, many times a day and then tell the pump my results. Then it neatly calculates how much insulin I need to "fix" any baddies, and sends it in to my body. Pretty cool. One wears an insulin pump on a belt, or carries it in a pocket. or even tucked inside a bra. I prefer the belt carriers. I found a white lacy garter with a satiny white pocket that you can wear on your thigh (made me laugh when I saw it in a catalog; looks like something a bride would wear and the groom would remove and throw at the guests!). It's allowed me to wear dresses again.

The pump itself sends insulin into my body fat (NOT directly into the bloodstream) via a catheter and a little cannula that I have to insert with a needle into my belly, leave for two days (some folks can leave them for three days, but not me -- it starts to clog up under attack from my body's defense forces), and remove. Then I insert a fresh one in another spot.

So last night, it was time for me to "change insertion site."

I inserted a new one, then went to remove the old one -- and blood starting GUSHING out! (Not supposed to happen.) I must have nicked a blood vessel inside and it was just waiting for an opening. What freaked me out is that this happened to a friend of mine not long ago. He simply could not stop the bleeding. EMTs in the ambulance could not stop the bleeding. It wasn't until they got him to a hospital 40 minutes from here that a ED nurse applied pressure in just the right way. They made him stay overnight.

So now it was happening to me -- moments before I was supposed to head out the door for a rehearsal (and bring snacks for the mid-rehearsal break and snack fest). The way my blood was pulsing in time to my heart, I don't think this just was a capillary. There was too much, too fast.

My husband and child were home; I grabbed a wad of Kleenex and called for help as I lay down on the floor of the bathroom. Not a pretty or refined sight, with my fly open and panties and jeans pulled down so I could get at my belly. My husband is really squeamish about blood; I needed to connect the pump/insulin to the new site I'd just put in, so I asked him to apply pressure to the old site with the Kleenex while I did this. I told him if we couldn't get it to clot soon, he'd have to call 911. When my daughter popped in the door, I asked her to look for some big gauze pads and tape (I remembered later I'd bought them when I had to dress a horse's wound on a twice-daily basis a few years back!). She found them. I then realized she was a lot calmer than spouse... but of course. She remembers being wounded as a samauri in Japan. And as a soldier in other places. So I told spouse to call the music director to tell him I wouldn't be at the rehearsal due to an emergency and to say I was sorry that I wouldn't be bringing the Sacred Snacks.

With him safely out of the way, daughter applied pressure with one pad, then I had her put another on top and add tape while I held them both down. Meanwhile, I can hear him telling the director on the phone simply that I wasn't coming and wouldn't be bringing the snacks. So I'm yelling at him from the bathroom to tell him that I'd had a slight accident and that's why I wasn't coming! I didn't want him to think I was blowing off my responsiblities! (In hindsight, my yelling at him was rather funny. Were my priorities straight? Probably not. Still...)

After a few minutes, blood was slowing down. Spouse stuck his head in the door to inform me there was no way I was going anywhere that night, unless to the ED. And today I'm fine. I also emailed the director to explain (very briefly) that I'd suffered an injury last night that kept me home, but am safe and sound.

Still, I don't know what I'd have done if I'd been alone. I wouldn't have been able even to open the package of gauze pads, or tear the tape, with just one hand (with the other holding Kleenex over my wound).

Meanwhile, looking at my future down the road (?!)  . . . There's a test that measures your average blood glucose ("sugar") over the past three months, more or less. Mine had been going down, but the new number that arrived in the mail on Saturday was way up. I knew I'd had more high readings (taken by me during the day, many many times a day) lately, would bolus for them (have pump send more insulin into my system to "correct" them), but I was still surprised by how high the lab number was.

Then there were two other results I had never had before. (For anyone who has diabetes or is interested in these details, they were for microalbumin and creatinine.) These indicate that the diabetes is damaging the filters in my kidneys. Never had this result before.

Gloom and doom.

Old book I have says all you can try to do is "slow" diabetic kidney damage; once it starts that you can't stop it. More gloom and doom. But then I notice copyright is 1996. OLD, in medical terms! So I go on line, and am mildly cheered to see on the American Diabetes Association web site that "tight control" can reverse kidney disease. I'm trying to have tight control anyway. So maybe there's some hope.

Then I remember that my January lab tests for the three-month glucose average are always the highest of the year, and the numbers drop in in the April test. (And it is not because I'm over-indulging over the holidays. It has to do with body rhythms or something.) Another reason for the high glucose readings may be that I've been trying to program the pump to prevent some very high readings at 3 a.m. But the results have been that I end up with very low readings (34, 36) at 6 a.m., which then triggers a "rebound" high, and I'm zigging back and forth. I fiddled around with the programming some more the other day, and the last three nights at 3 a.m. my readings have been very respectable -- 113, for example, vs. a horrid 319. This morning I woke up at 6 a.m. at 72, which is on the edge of too low, but a lot better than 36! So I've played with the programming again. We'll see how things look tonight and tomorrow a.m.

Comments

[spider--woman.livejournal.com]

forgive my ignorance but do all people with diabetes need to test the blood so frequently? when did you discover you needed insulin?

[ar-wahan.livejournal.com]

I developed gestational diabetes in 1989. My mother had Type I diabetets since age 22, so I guess genetically I was vulnerable, and the pregnancy pushed me over the edge. At first they said I was a "lean Type II," and I managed on diet alone, then on the pills. I decided to throw in the towel and start on insulin oh, I can't remember when exactly -- I think 1993. The pills basically stopped working when I started having hot flashes. (Hormones really do a number on diabetic women.)

I actually need very little insulin compared to some Type Is, and much less than those Type IIs who decide to take insulin.

At some point along the way, the doctors changed my diagnosis and told me I *was* Type I, after all.

As for testing . . . conventional wisdom is that people with diabetes, at least Type Is, should test glucose 4-8 times a day. (Type IIs really should test, also, if not as frequently, but most don't.) Type Is are a lot more likely to end up with low blood glucose than Type IIs -- that's one reason for testing. Some people lose the ability to sense when their glucose is falling dangerously (that was the case with my mom), so testing helps. Also, if you're on insulin, you need to know what your BG is before meals so you can compensate with the right about of insulin (that's one reason the pump is so cool -- it does the math for you if you tell it what your BG is). Type Is are also at risk of ketosis or ketoacidosis from high BG.

Because I'm still trying to fine-tune my pump settings, I test closer to eight times a day. Maybe even more. If I tell the pump my BG is high and ask it to send a bolus, it "beeps" at me 1/1/2 hours later and asks me to check it again.

There *has* been a lot of advancements

[be4u.livejournal.com]

in the treatment of diabetes since 1996. Good thing you caught that copyright date!

My ex-bf's daughter has diabetes, along with a whole lotta physicological disorders, and it was always a challenge. SHE was always a challenge, because she would fight us every step of the way. I learned as much as I could about diabetes in general, read labels, counted carbs. Last I heard she was doing much better getting more shots through the day rather than 3.

There *is* hope sweetie, and lots of it. You're intelligent, informed and a fighter. Me thinks the disease doesn't stand a chance ;-)

Re: There *has* been a lot of advancements

[ar-wahan.livejournal.com]

Awww... gee, thanks!