Saturday, June 16, 2012

3.5 Hours

The term insulin dependent isn't used all that much anymore. When I was first diagnosed with diabetes, my new Medic Alert bracelet said insulin dependent diabetes mellitus. Now, it says Type 1 diabetes. Many people don't think about the fact that they are dependent on various hormones their body produce on a continuous basis for survival. I am vaguely reminded of it every time I change my pump site, feeling a few drops of the life-sustaining hormone that my body is unable to produce itself fall onto my hand as I fill my pump tubing. Usually, this system of motors, tubing, and computer chips that I rely on works flawlessly and I barely think of the fact that, were it taken away, I would quickly find myself in trouble. But, a few times each year something goes wrong and interrupts the flow of insulin into my body, and I get a stark reminder of what insulin dependent means.

I change my infusion set every two days, and usually fill my pump cartridge only partially so that I can change that at the same time. Today was a site-change day. So, around 11:30 I ripped out my old infusion set, disinfected a patch of skin on my left arm, put down some Tegaderm, and poised my hand with the new infusion set above the correct spot before holding my breath, adjusting the angle, and sliding it in. I withdrew and disposed of the introducer needle, filled a new pump cartridge, primed the tubing with insulin, snapped the tubing to the infusion set, and finally filled the tiny cannula now nestled under my skin with insulin.

Then I tested—a perfect 4.7—and bolused for my standard Saturday lunch of 25 grams of carbohydrates. I ate lunch as I worked on my master's thesis.

An hour later I felt a bit off, and my first instinct when I feel off is always to check my blood sugar. I found it at 11.1, which I bolused a small correction for. I thought it was a bit odd that I had risen so much in just an hour, but then again I'd also just eaten, and 11.1 is not an alarmingly high reading for me, so I didn't dwell on it.

Soon I needed a break from my thesis and ventured out into the rainy weather to go to the mall for a bit. I stopped at Starbucks briefly and got my standard drink, bolusing for 10 grams of carbohydrates but not testing because it had only been about an hour since I'd tested last, and I wasn't feeling particularly high or low.

An hour and a half later when I got home, however, I definitely felt high, which is never a good sign. I tested, and knew what the result would be even before the 21.9 flashed onto the screen.

My mind immediately ran back through the past few hours. I hadn't missed a bolus. I hadn't eaten anything ridiculous. I wasn't stressed or sick. The only thing I could think of was that I had changed infusion sets three and a half hours earlier.

I checked for ketones, as is standard when dealing with "unexpected" highs. The strip darkened to the second-to-last colour, meaning I was producing a large amount of ketones. Clearly, something was not right with the insulin delivery system. Either the insulin wasn't being delivered, wasn't being absorbed, or wasn't potent.

And so, I pulled out the newly-inserted infusion set and stuck myself with another needle in a completely different location. The infusion set I'd just removed had a small kink at the very tip of the cannula. A kink like that is all it takes to completely cut off the flow of insulin. Snapping the tubing onto the new infusion set, I programmed a big correction bolus. And then the process of waiting and monitoring to make sure my blood sugar comes down started.

Three and a half hours ... Those few hours without insulin is all it took for my blood sugar to soar from perfect to four times the normal level. That's all the time it took for my body to begin the process of breaking down fat as fuel and producing ketones as a byproduct—a process that happens when the body can't access glucose due to lack of insulin; the start of the process that, if not interrupted, leads to diabetic ketoacidosis then death.

An hour and a half after giving myself a correction with the new infusion set—insulin now being delivered properly—my blood sugar is down to 13.2. Still high, but definitely heading in the right direction. I think about the amount of insulin I take each day, which adds up to about half a cubic centimeter of liquid. Such a small amount, and yet I am dependent on it each day not only to keep good control of my blood sugars, but just to stay alive. Even a few hours without it and things fly out of control. It makes me feel a sense of awe at how such a small thing can be so important, and grateful that I have easy access to insulin every day.

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