Tag Archives: cortisone

Diabetes vs. Cortisone

This has not been a good week for me and Dear Diabetes.

In the last five days I have had 55-60 total units of insulin shooting through my body. Of that, 30 units is continuos basal.

That’s a lot.

To put it into perspective, normally I average 17-21 total daily units of which 12 is basal.

Right now, I am triple dosing.

Yet, my blood sugars are high.

Abnormally, dangerously high, unable to crack below 13 mmol most of those days.

Generally, I am rarely above 10.0 mmol.

The resistance is strong.

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This photo was compiled late Friday afternoon. By end of day, my total daily dose was at 57 units.

The culprit: a cortisone injection in my right hip joint that was administered Thursday morning to counter the effects of a labrel tear.

Apparently it is well known in the medical field that cortisone (and other steroids for that matter) can often wreak havoc on diabetes management. Yet, I was never made aware.

Not from the surgeon who booked the appointment.

Not from the nurse who prepped me for the cortisone.

Not from the doctor who administered the injection.

They all knew I had Type-1 diabetes and that I was on an insulin pump.

When I met with the surgeon, our initial conversation was about surgery, and I flat out asked how surgery would affect my diabetes. He told me, minimally. When it was decided a cortisone shot would be the best course of action, I did not ask about my diabetes. Maybe that was my fault, but given that I had asked about it for the surgery side of things, you would think, if it was an issue, the surgeon would have notified me.

He did not.

Prior to getting the cortisone, when sitting in the radiology waiting room, the nurse had me fill out a form that asked if I had diabetes. I checked yes, and added that I had type-1 diabetes and am on insulin pump therapy. (A similar form had been filled out at the surgeon’s office as well.)

In the exam room, I asked the nurse if I should remove my insulin pump. She said no.

She did not tell me the insulin would essentially be like water going through me following the injection.

When the physician came in and informed me of the procedure and the effect the cortisone may have on my joint, and the small chance of infection, he said not a word of my diabetes. He had every opportunity. I had to move my insulin pump out of the way. When the procedure was done, I got tangled in my insulin pump wiring and he helped untangle me.

No one said a word.

Thursday night my blood sugars had crept up to 13.7 mmol. after dinner. It was a burger dinner, and I thought maybe the ketchup or bun had an effect. By the morning, they were at 16.4 mmol. I thought my infusion was faulty, maybe there was an air bubble in the line, or the canula had bent. I switched it out. Two hours later, they were at 16.9 mmol.

I was beyond frustrated.

I do not do high blood sugars. I rarely have them. I do not know what to do.

I raged bolus. I increased my basal by 100%. I ran the insulin through the line, checking that it was actually going through. I questioned every dose I had administered. I re-reviewed everything I had eaten. I switched out the old insulin, for a new, in-the-fridge bottle.

None of it worked.

Nothing made sense.

By dinner, I was near tears. I had no idea what was going on with me.

I was scared.

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12:30 a.m. Friday: scared.

I was worried about ketones. I was worried about the incessant itching of my legs, so bad I drew blood. I was worried about my perfect hemoglobin A1c.

Big Ring asked if the cortisone could have had an effect.

Light bulb.

My fingers swiftly tapped over the Google keys and sure enough it was there.

Cortisone is a beast for diabetes.

Are you effing kidding me? Why did know one, not one of those doctors, inform me? Why?

I posted on Facebook asking all my T-1 peeps for advice on how to deal. So many suggestions. So many expressions of shock that I was not notified ahead of time.

It’s still not perfect.

My basal has been set at a continuous +200%, which is the maximum basal dose for Animas pumps, for days; if it could go higher, it would. I’ve been testing my blood sugars every two hours, and at nearly every test, I’m doing bolus corrections. Since getting the cortisone, I have dosed, both by pump and syringes, 235 total units. I go hours without eating. I fear food, and the effect it will have on my blood sugars. I’ve cracked the extreme highs for the most part, now sitting between 8.0 and 10.0 mmols, but that’s still with the crazy increase in insulin. I feel sick inside. I feel lethargic, winded. Even talking is an effort.

I don’t know when it will come down.

I don’t know when I will feel better.

But I do know, every step of the way, I was failed by the medical system.

That is not acceptable.

 

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No Surgery for Labral Tear

I was sure surgery was the only option.

Last week I received word that my MRI came back positive for a small labral tear in the right hip. I suspected this would be the diagnosis, and frankly I was happy to finally have a diagnosis after a year of suffering the chronic pain. Back when I was still going to physio, he was treating me as though I had a labral tear. After a couple months of weekly appointments, sometimes bi-weekly, there was minimal improvement. That’s when we decided it was time for x-rays and an arthrogram MRI.

Time has not healed. Physio has not healed. Like I said, I thought for sure surgery was my only option to heal.

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Friends gave me teary eyed emojis at the mention of surgery, family tried convincing me otherwise. But the thing is, I don’t want to spend my life in pain. I don’t want to be the mom who could only play a few minutes with her boy before succumbing to the aches. I don’t want thoughts of a rapidly aging body to cloud nearly every movement I make. And frankly, I bloody well want my once extremely flexible body to get that gum-like stretch back.

Surgery was not scary for me. A life of a pain was.

Still, I thought I would have months to mull it over. Surgeons usually have crazy long waitlists; the doc told me to expect at least a four-month wait before even talking to the surgeon. But then, just one day after meeting with the doc, the surgeon’s office called. Apparently one of the benefits of going through the university hospital is students get preference. Five days after learning the diagnosis, two days after seeing the doc, I was in the surgeon’s office.

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“I would HEAVILY caution against surgery,” the surgeon said, almost right off the hip, er, I mean hop 😂

Hip arthroscopic surgery is a straight-forward procedure for the surgeon, he told me. It’s day surgery, just 1.5 hours, no biggie – for him. For the patient it sucks, he said.

Because the hip is tricky, he would have to dislocate the joint to get in and have a look around. I got queasy just hearing it. Patient recovery is extensive. Inflammation is severe. I would be on crutches for a month, no running, no weight-bearing activities, no carrying my kid for at least three months. Full recovery would be a minimum six months.

I suspected almost all of that and had come to terms with most of it – if it took the ache away.

There’s a high probability it won’t, he told me.

There’s a very real chance it could make things worse, he told me.

You may be even more limited than you are now, he told me.

Possibly no running at all.

Whaaaaaat?

So here’s the thing no one told me: labral tears are common. Sixty to seventy per cent of the North American population in their 40s (not quite there!) suffer labral tears, sometimes without even knowing.

My labral tear is small. The MRI, which scanned eight sections of my right hip, detected “focal detachment of the anterior-superior labrum” in images seven and eight, which indicate a tear. The rest of the labrum appeared intact. What this means is I can’t squat for long periods, I can’t sit criss-cross apple sauce, or plain just sit for extended periods without my body painfully revolting. Yet, it does NOT prevent me from running. Running causes it no pain, not during, not after.

Surgery could take that away.

That’s not cool.

The surgeon spent a good 20 to 30 minutes going through the surgery process, recovery rates, alternatives. He told me he would do the surgery, but every two seconds (or so it seemed) cautioned against it.

I listened.

Instead of surgery, I have opted for the less invasive procedure of getting a cortisone shot injected into the joint to see if that helps take the annoying ache away. It’s not a perfect solution. Apparently I am limited to a total of three cortisone shots in one joint in my lifetime. Cortisone can eat away at cartilage, which also really kinda sucks. We’ll wait and see what happens.

In the meantime…

I run!!!

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