Thursday, February 5, 2015

A Bizarre Evening with Dear Diabetes

There are plenty of adjectives that can be used to describe diabetes.

It's not often that I would choose the word 'bizarre' but the other night, that's exactly how I would describe what happened. 

I had a very tight window between the end of my workday (5pm) and my CoreFit class (5:30pm). I had to drive home, change and then drive across town in those precious 30 minutes. 

Problem number one: I had gone to work with what I thought was enough insulin but ended up being down to 1 unit in my pump at 5pm. Not enough to get me until 7pm when I would be home again. 

Solution? I turned my basal rate down to 10% for one hour. I figured I was working out anyway so I wouldn't go too high. Plus it was only one hour so I could just take a bit of extra insulin with dinner to make up for that difference. 

It worked. My pump didn't alarm during class to tell me that it was out of insulin. In fact, it waited until I walked into my kitchen before making a peep. Unfortunately, just as I walked into my kitchen, it alarmed for three things, one immediately after the other. 

Alarm 1: pump is out of insulin
Alarm 2: blood sugar is above 10.0
Alarm 3: blood sugar is rising quickly (double arrows up)

Alright, the blood sugar spike was a little dramatic but I figured I'd be fine as soon as I changed my pump and took an extra large dinner dose. 

Problem number two: I removed my infusion site. That's the part of the pump that is stuck to my skin like a bandage and there is a tiny plastic tube inserted under my skin so the insulin has a way to get into my body. Usually I peel back the infusion site and either nothing happens or a small droplet of insulin leaks out. This usually happens if I change my pump too soon after taking a dose of insulin.

Never in my life have I removed the infusion site and seen blood gush out. And by gush I mean a spurt followed by an alarming amount of blood leaking down my abdomen. I grabbed a nearly tissue and pressed it hard against my side. Doug passed me the box and I added about five more to the pile. I soaked through all of them. More tissue. More pressure. It was a good five minutes before the bleeding stopped to a trickle and a few more before I felt confident that I could put a bandage on and not ruin my clothes. 

In the meantime my pump kept alarming. The no insulin alarm and the blood sugar rising too quickly alarm. I was now 14.8 and still double arrows up. 

Once the gushing stopped, I put a bandage on and then proceeded to refill my pump and put in a new infusion site. I bolused 1 unit for dinner (it was pretty low-carb that day) and 5 units for my spiking sugar. 

By the time we were finished dinner I was 20.9 and still climbing.

It took me three more insulin doses and several hours to climb back down below 10.0 resulting in a rough night and a missed morning run. 

None of it makes any sense to me. 

One hour of reduced insulin is not enough to cause that kind of spike. My numbers were fine at 5:30pm so it's not like I was high to begin with. My CoreFit classes usually cause a dramatic drop in sugars, not a spike. 

And what the eff was up with that gusher? It's like I had hit an artery and the only thing holding in the flood was a tiny plastic tube. Remove the tube and, well, it looked like a scene from Dexter. 

At the end of the day I am grateful that my site didn't decide to gush before I pulled it out. Like in the middle of CoreFit class or during my work presentation. How dramatic would that have been as a bright red mark slowly worked its way across my shirt while I stood in front of a group of horrified onlookers completely oblivious?

1 comment:

  1. "Congratulations" on your first gusher! Sometimes I nick a blood vessel and then blood goes all over the place. It makes changing sets at the office fun. So fun.

    I have a hypothesis about your spike in blood sugar. I suspect that you were actually not delivering insulin for a bit longer than you think. It takes 1-2 hours for BGs to rise in the absence of basal insulin, so you wouldn't see it right away, but given how much you rose, it seems like a plausible explanation. (There's an excellent graph I once saw that showed this, but I can't seem to find it right now.) Throw in the fact that blood was likely pushing back against that last bit of insulin in the canula, and that could have amplified the out-of-insulin reaction.