Tag Archives: hyperglycemia

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.

170821cortisone1

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.

fcveb

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 quitting allowed

I thought for sure when I set out on my run yesterday morning, I’d be leading this post off with a big fat ugly “Ugh!” By all accounts this run should have been a disaster. Everything that could go wrong did go wrong… that is, except for the run itself 😀

Because I was scheduled to run 45 minutes, I decided Saturday evening that this run would be a practice run for next Sunday’s race. I had intended to wake up at 5:15 a.m. (not as early as I’ll have to next week, but early nonetheless), down a Z-bar and some water, and be on the road by 6 a.m.. I had intended on getting a great night sleep. And I had intended on running with perfect blood sugars. None of that happened.

I had a horribly crummy sleep, waking up every hour from 10:30 to 2:30 fighting an over-active bladder and low blood sugars. At 2:30 a.m. I ate half an apple to combat the low. It was also at this time that I decided it ridiculous to get up at 5:15, I mean seriously, who was I kidding? I opted for 6 a.m. instead, meaning I would not get on the road until after 7:30, after Little Ring fed, meaning the practice run was thrown out the window. I wouldn’t be running super early; I wouldn’t be running on a Zbar and water; I wouldn’t be running with full, heavy breasts. C’est la vie, I thought. Sleep, after all, is also a pretty important component to a great run.

When the alarm went off at 6 a.m., I tested my blood sugars right away and was hit hard in the heart with a nasty high: 14.6. Holy freaking crud monkey, this was not good. I knew my blood sugars weren’t done their climbing, that they’d go up at least two more mmol, if not more, post breakfast, which they did. I left the loft with my BG sitting uncomfortably at 16.4. Damn you rebound, damn you! 😦

And maybe I should have thrown in the towel then and there, maybe I should have quit. Hyperglycemia can cause lethargy, dehydration, muscle cramping, nausea, etc.. The deck was stacked so high against me and this run. But that new mantra of mine “No Excuses” kept playing over and over in my head. I had to tough this run out no matter how hellish it would surely be.

And you know what, I am so glad I did – I had an awesome run despite the potential obstacles standing in my way. The sun was shining. The music in my ears was drowning out the sounds of my strained breathing. The cool morning breeze felt good on my face. I had not one thought of quitting. And while I didn’t go the practice run pace I had hoped for, I did surprise myself a few times looking down at my Garmin and seeing a strong 5:00 min/km and 5:15 min/km pace looking back up at me.

So there you go, just another reason not to quit before you start because you just never know when your body will push you through a super duper fantastic run! No excuses indeed 😀

130429runningroute
When the sun is shining, not much beats the beauty of my running routes 😀

YESTERDAY’S RUN:
7:20 a.m. BG before: 16.4
Temp. basal: none
Distance: 7.49 km
Average pace: 5:55 min/km
Time: 45 minutes
8:30 a.m. BG after: 11.9
BG correction: 0.75 units

Wish upon a rainbow

I don’t know what it is about Big Ring and the fondos he signs up for, but it seems I’m just not destined to see him cross the finish line. One out of three times is not a very good track record.


And because of that, I’m forced to “borrow” this watermarked shot

When he did Whistler two years ago, I was stuck in traffic trying with all my might to will the vehicles in front of me away so I could get there in time, but to no avail; I was 15 minutes too late. When he did the Levi Leipheimer last year, I made a point of standing at the finish line for hours to ensure I did not have another Whistler no-show repeat. And this past weekend, when he did the Axel Merckx, there was no doubt in my mind, I would be at that finish line.

You see, unlike the other fondos, we had the live tracking option this time around, so when I saw that he had passed through the 72 km mark, I booked it to the finish line figuring he’d surely be in within the hour if not sooner. I picked my spot; had my camera ready; and was practicing my vocal exercises in preparation for the most perfect finishing moment.

But after just 20 minutes, a combination of low blood sugars and sweltering heat mixed with an uncomfortable pregnant belly, nearly knocked me out. I started to sweat, had the shakes, got woozy, and could hardly stand up without feeling like I was on the next train to Pukesville. I popped some sugar tablets, ate a granola bar, and tried standing off into the shade, but to no relief. Finally, I succumbed, and sulkingly shuffled off to a shady spot on the grassy knoll.

Within minutes of doing so, Big Ring crossed the finish line. Are you freaking kidding me???


All smiles (and caked-on sunscreen) post fondo.

To say I was disappointed, is an understatement. After last year’s fondo, seeing him with a huge smile on his face come across that finish line, me cheering so super loud, and running up to embrace his chalky, sweat-ridden body, I have never before felt such excitement and pride and happiness for another being as I did in that moment. I wanted that again.


He and RDM didn’t seem too phased I wasn’t where I should have been.

Don’t get me wrong, I was still extremely proud when he made his way over to my shady spot, and still super happy to see that buoyant smile on his face, and thrilled that he was able to ride a fondo with his 76-year-old uncle 10-speed Pete (Big Ring’s got a long history of cycling in his family; in fact, that’s how his parents met :D) but I wanted to be there for him like he’s always been there for me.


Big Ring and 10-speed Pete before fondo and post fondo.

So hear me now Big Ring, I will see you cross the next finish line; I will cheer for you louder than anyone else on the concourse; and I will have a little Thumb-Sucking Alien Baby posse excitedly screaming along with me!


That is my wish upon the rainbow!

Insulin, insulin and more insulin

Holy mother of I don’t know what, but I’m going through insulin like you wouldn’t believe. They kept telling me this would happen, that the hormones in my placenta would eventually slow down my body’s ability to efficiently absorb insulin,  and while I didn’t necessarily not believe them, I never thought I’d be registering total daily doses that are more than double what I was taking pre-pregnancy!


Going through insulin like mad.

It’s a bit of a pill to swallow. I’ve long prided myself on the small doses I take in, and when I get that shocked, holy crap, how do you manage that look from fellow Type 1s, or the wow, you must have super insulin sensitivity comments from medical peeps, I humbly smile, but inside am doing a freaking awesome party dance. I love my small doses.

But now, my gawd, it’s an embarrassment having to spill the beans every two weeks on my total daily doses, which are currently stacking up to anywhere between 40 and 60 units! Are you freaking kidding me? Pre-pregnancy, I was averaging 20-24 units a day!

I used to be able to get through four days on 130 units, now I’m filling the canula with 180 units and am barely getting through two and half to three days. I’ve had alarms going off telling me my insulin cartridge is nearly empty (I never used to go past less than 20 units before changing the infusion) and the last two site changes have had to be done emergency style in the evening instead of the mornings when I usually change them.


Ten units won’t get me through the night these days 😦

I’m told not to worry about it. I’m told this is normal. I’m told this is the sign of a healthy placenta – that if this wasn’t happening, then I should be worrying. But you know what else it’s a sign of – higher blood sugars. Not cool.

I have been struggling with post breakfast highs, and it seems no matter what I do, they just keep creeping on up. I’ve switched back to super fibrous bread for my toast (now that my belly can withstand it) which doesn’t have a quick-acting glucose release like white bread does; I’ve increased my protein intake; I’ve postponed my smoothie and fruit bowl to later in the day, as apparently those can cause glucose spikes first thing in the morning. I’ve also majorly increased my morning basal rates, starting an hour prior to breakfast, and have seriously decreased my insulin-to-carb ratio for breakfast; down from 1 unit of insulin per 24 grams of carbs to 1 unit of insulin per 5 grams of carbs. That’s some major wheeling and dealing there, but to no bloody avail.

And yesterday morning, I was told by the medical peeps at the pregnancy in diabetes clinic that it will only continue to tax my system. My blood sugars will continue to rise. My body will continue to pork out on insulin. My adjustments will continue to work one day and then majorly fail the next for no apparent reason at all.

It’s a roller coaster ride, the nurse told me, buckle up!

‘Jam tomorrow, jam yesterday, but never jam today’

Two things.

Number 1: I’ve still got this bloody cold. My nose is still stuffed up, my voice is nasally, my ears feel like they’ve got cotton balls stuffed in them (I CAN’T HEAR!!!). I’m hacking up a lung (usually when trying to sleep or  trying to conduct an interview), I’ve got a chest full of congestion, and you wouldn’t believe the amounts of clear snot I’m blowing out of my nose. Where the hell is this stuff coming from? It’s freaking ridiculous!

Number 2: The insulin shooting through my blood stream seems to have gone on holidays the last two days. My blood sugars have been so disgustingly high. I thought at first it was because of the jam I had on my toast yesterday morning. Normally when I have toast, I opt for peanut butter, which doesn’t generally spike my blood sugars, but yesterday, I wanted strawberry jam. And it’s not like this jam was packed with sugar, it was half sugar with 5 carbs per tablespoon, meaning it had easy insulin manageability. Or so I thought.

Not two hours later, my BG had skyrocketed from 7.4 to 16.3. What the? I was freaking mad, like scrunching up my face, yelling in my head mad. But I wasn’t yelling at me, oh no, I was yelling at that damn jam.


Bad jam! Bad jam!

This morning, though, I had to apologize. I did not have jam this morning, I had sworn off the jam, promising never to allow its yumminess in my mouth again. And yet, it was like groundhog day for my BGs. Despite not having jam, despite eating something that never spikes my blood sugars, three hours post breakfast, I was fighting numbers in the 14s. Are you freaking kidding me? These are not numbers I like. These are not numbers I’m used to. These are not numbers that are in line with good diabetic numbers. What the frick is going on?


The peaks and valleys of my day 😦

I changed my infusion when I got home from work, hoping that maybe that was the problem, but I didn’t see any unwanted air bubbles in the reservoir, and the canula was still perfectly straight, not bent, not hooked, not munched up. So no, don’t think that was the problem.

Seriously frustrated…

Diabetes on colds

I try not to whine and complain about this disease of mine; I spent far too many years doing so and it never got me anywhere. So instead, I try to pretend we’re friends all the while fighting to conquer it behind its back. But some days Dear Diabetes gets the upper hand. The last five days, it’s had the upper hand.

I’m sick. I’m miserable. And yes, I’m whining a bit too. So please, allow me this:
Why the F is everything WITH diabetes so bloody complicated?

Last Monday, I was exhausted. After dinner I crashed on the couch not having any energy to pull myself up and get things done. By 9:30, I was out for the night. Tuesday, I hadn’t yet clued in, but my blood sugars had. They were having a hyperglycemia party in my veins. Wednesday, I had tired voice the entire day. Thursday, I was full-on sick: meek, crackling voice, throat felt like jagged knives were being shoved down every time I swallowed, stuffed up nose, head pounding so hard I can’t even turn the lights on, enough snot coming out of my nose to fill a pool, burning eyes, wheezing, hacking cough, and cravings for Lipton Chicken Noodle Soup (ever wonder why it’s called chicken when there’s no chicken in it?). Oh frick!


Two boxes and counting!

And when I get sick, I get emotional. People say it’s just a cold, princess up, stop being a wimp. But for me, it’s not just a cold – it’s a friggin’ nightmare on my diabetes. Ninety five per cent of the time, my diabetes is in tip-top shape. I’m averaging BG readings between 4.7 and 7.7 mmol on a consistent basis, which is awesome. But diabetes on colds, my readings skyrocket at all times of the day and night. It doesn’t matter how much I increase my basal rates, I’m getting readings of 11, 13, 15. I wake up in the middle of the night with a cotton mouth, a fuzzy head, sickness in the belly, splitting headache, and all over sweats – all because of high blood sugars. For those of you without diabetes, just imagine your early 20s, the morning after closing the bar. Worst hangover ever!

So no, it’s not just a cold. It’s hell. And to all those people who feel like heroes going into work when they’re sick, or who just need to get out into the outside world when they’re hacking up slimy green grodies, all the while infecting everyone around them – YOU SUCK!

The blood cannon

Crazy thing happened to me this morning. Well actually, to be honest, a couple crazy things happened. First, I decided to set the alarm for 5 a.m. which NEVER happens. See, I was recently challenged by Big Brother (unbeknownst to him) to workout in the mornings. He’s been boasting all about his new found love of morning workouts, how they make him less scary in the morning, more talkative, and energized for the whole day. And so, I thought, if he can do it (he is NOT a morning person) I can do it. So last night, I set the alarm fully intending to ride the bike trainer for 45 minutes before going to work.

But when I got up to use the washroom at 3:40 a.m., I was already negotiating my way out of the plan. And when the alarm went off, the last thing I wanted to do was jump out of bed. Mario turned the light on. I laid motionless as I tried to figure out an excuse not to get up. I decided to check my blood sugars. Now, here comes strange thing No. 2 and the excuse (weak as it may be) for me shutting the lights back out for another hour: When I poked my finger with the lancet, and subsequently squeezed the blood upwards, a little globule did not form, oh no, it was more like a cannon shot of blood splurting from one finger all over two other fingers – on the other hand! That’s never happened before!


Totally like this (Anish Kapoor’s blood cannon) 😉

So you know that surprise party, that super fantastic, ultra amazing, fabulously joyous surprise party (you know, the one that I kept a surprise!) which was filled with great friends, great family, great surprises, great eats, great memories? Well, that wasn’t the only thing it was filled with. It also featured a war on my blood sugars. Oh crud!

It seems my body does not function so well on appetizer style meals. Because my every day meals are sit down meals, where for the most part, I can weigh and measure and calculate the carbs in my food to a tee, thus calculating my insulin dosages to a tee, a meal full of appetizers proved to be a great challenge for me. Can you say hyperglycemia?

The nature of the meal was the furthest thing from a sit-down meal. A whole range of super yummy appetizers were on the menu, which extended over an hour and a half to two hour period. And so, I couldn’t give myself a full bolus right away, I had to do little spurts here and there. But because my BG was borderline low to start (thank you blood sugar gods) I waited on the insulin spurts. When they started going up, I started bolusing for the risotto cheese balls, shrimp puffs, chicken sliders, leek soup, etc.

But it was too late. An hour and a half in, my BG was at 14.4. YIKES! For those of you unaware, the good numbers are less than 7.0. Insert a night full of rage bolusing here 😦

While I choose not to eat like this on a regular basis, I do enjoy the appetizer feast every now and again, especially when my parents who are amazing cooks are manning the stoves. So, here’s my question to you, is there a surefire strategy to avoid rage blousing? Or, do I have to avoid dinners like these forever?