Diabetes has a way of keeping us humble. Wednesday of this week was a reminder that just because I have a low A1c right now doesn’t mean diabetes won’t occasionally kick my ass. I’m still tired today, thanks to Wednesday’s shenanigans. And to think, it all started with the good intentions of going for a run.
Wednesday morning around the wee hour of 4am my DexCom blared “HIGH,” showing a 200mg/dL. Normally, I’d correct that and go back to sleep, but I had plans to get up at 6 and go running. Not wanting to be low in two hours, I decided not to correct the high, thinking I would hit the pavement without lowering my basals and end up at a nice comfy number post-run. I cliced OK on the Dex, and slept for another two hours. A fingerstick confirmed that at 6am I was still right around 20omg/dL. I chugged some water, a shot of espresso, strapped on my shoes and headed out the door. When I got home 3o minutes later, I had two poached eggs, more coffee, and then showered and headed out to work.
By the time I pulled in to the parking lot of my first customer, I had that sick to my stomach feeling that only comes from a nasty high blood sugar. Fingerstick. 346mg/dL. Barf. I dosed six units, chugged the last of my water bottle, and headed in to my appointment. As I sat waiting for my customer though, my stomach felt worse, not better, and a headache was creeping in. I left her office about 30 minutes later, and checked in on the BG. 363mg/dL. Hhhhhm. I knew from my stomach ache that this was a “lack of insulin” high (as opposed to a “I ate too much high” which feels very different to me), and normally I’d rip my pump and get a fresh one on but I had a monkey wrench: the run. I’ve blogged many times before about morning exercise pushing my BGs sky-high sometimes, and past experience was hinting that this was the issue here too. Just to be sure, this time I took out my back-up Humalog pen and dosed a few more units, thinking that might help me understand if it was my pump, or something else, that was wrong. If the injected units helped bring me down, then it had to be the pump. I stopped in a convenience store and bought a large water and a sugar-free Gatorade to help me stay hydrated. And, out of morbid curiosity, I bought some ketone test strips. I stopped and checked for ketones at my next customer’s office. They were already medium sized and hinting at large. Now I knew there was a problem, but I just didn’t know if it was the running or my pump. In hindsight (which is always 20/20), I think I should have changed my pump at the first sign of ketones, because those are generally a sign of insulin deprivation, not just a high blood sugar. But I didn’t. And I had an important lunch meeting to get to.
By the time lunch rolled around, I was feeling like utter and complete crap. I was tired, cranky, and had both a head ache and a stomach ache. I checked my sugar though, and it showed I was down to 288mg/dL. I decided I wasn’t ready to give up on my pump yet, and that maybe this was one of these really stubborn, liver-induced high blood sugars that would just need a few hours to come down. I’ve read that when you have ketones, you should actually have a little bit of carbohydrate because that helps the insulin on board get to work and therefore remove sugar from your bloodstream. So I forced down a little lunch, and forced myself to present my salesperson self to my customers. I was exhausted by the end of the lunch meeting, but I stopped for a large iced coffeee and powered on.
At 4pm, my DexCom was still blaring and I still felt like the floor-mat of a taxi cab. My meter told me I was still in the 300s and I’d had it. I had taken almost quadruple the amount of correction units I was used to and I was still hanging at 350mg/dL. I pulled a fresh bottle of Humalog out of the fridge and filled a syringe with 1o units and injected. I then deactivated my OmniPod and ripped the pod unit off my back, which was hard to do because I’d just put it on the night before, and the adhesive was still strong.
And there it was. The maddening culprit that had caused me to wonder all day long if I was losing my mind. The little teeny issue that had caused me spend the last eight hours feeling like crud. There, in the cannula of my OmniPod, was a wee bit of blood and tissue that was causing a partial occlusion. It wasn’t enough for the pod to detect, so the occlusion alarm hadn’t sounded. And it had let just enough insulin through that I never went above 400mg/dL, which had caused me to second guess myself all day. If I’d seen a continuous rise for a few hours, I would have changed out that pump right away. But no, I hemmed and hawed and wondered and postulated all effing day long because just enough tissue got stuck in there to drive me nuts but also keep me alive. Awesome.
It’s days like that where I get so pissed that I wasted so many hours feeling awful because of diabetes. I didn’t present my best self to my customers because felt crappy, and the mental energy I spent trying to figure out what was wrong was exhausting. My body felt worn out, beat up, and tired. And all becuase of a little tiny particly no bigger than a pinhead got stuck in an itty bitty tube.
Diabetes never lets us forget that even when we’re in the best control of our lives, there’s going to be days where you feel helpless. There are days where you feel like diabetes has won, and you can’t do anything but wave the white flag of defeat while you sip your sugar-free Gatorade and skip dinner. But I know that diabetes doesn’t get to win the war, even when it kicks my ass in a battle. I’m so lucky that the next day, I get to get up and try again. And the next time I get that tummy ache and start wondering if its me or the pump, the pump is getting changed out immediately, just for peace of mind.
Happy Friday folks! Wishing you a weekend of diabetes playing nice with your numbers.