Don’t leave home without it: your American Express Card and your Insulin

I needed a fasting blood draw. So no pills, no breakfast; but black Starbucks Rift Valley coffee is OK. My co-workers know better than to mess with my coffee.

After 5 months, I finally paid off the lab bill from my last round of blood tests. Now that my credit standing is restored with the hospital’s lab, I can finally do the next round of over-due blood tests. It never ends. Sigh.

We want to see if my thyroid and my Synthroid are still getting along. I’ve been draggy, but I don’t sleep enough and I worry too much, so it’s probably unfair to blame the lumpy little gland in my throat.

We want to see if my liver is happier with the Lipitor, or if my numbers are still getting worse. While we’re at it, we want to see if the Lipitor is doing its job of lowering my Lousy Darn Lipid. New research show’s we D-folk might live to be as old as anyone else if we could get our LDL under… gulp… 70.

We want to see if the ACE is helping my kidney’s, or if they have gotten worse too.

Of course, we’re running an A1C, which most likely won’t be pretty.

The night before I laid out a spoon and a little bag of walnuts. The plan was to grab some sugar-free yogurt on the way out the door, for a late breakfast after one of my colleagues drew a Lavender tube, a Red Tiger tube, and a Green Tiger tube from a vein on my “AC.” That stands for…. Well crap, I’ve been out of school so long I don’t remember what it stands for, but it is the opposite side of your elbow where all the juicy veins lie just beneath the surface.

So just before the doors opened, “E” stuck me with a Butterfly and drew the tubes. She had the bad luck to get the tip up against a valve. It was slow going, but not slow enough to justify a second stick. As I walked out of the clinic’s lab to get my yogurt I remembered that it was still sitting in my fridge almost 80 miles away. Crap. Got the spoon. Got the walnuts. But no yogurt.

The sun up, but still cold at over 7,000 feet above sea-level, I scoot across the parking lot to the “Annex,” the small grey construction trailer left over from building the clinic that is now home to the diabetes program. I’m hoping my assistant has the heat on. Despite my best efforts, I can’t make her understand how a thermostat works. When she’s cold she slides the needle all the way to the right; when she’s hot she slides it all the way to the left. It probably makes no difference, it’s one of those buildings that’s either too hot or too cold anyway.

Nice and toasty in my office, I open my fridge to grab a Slim-fast Low Carb Diet shake. I slide my Go-Bag off my shoulder to grab my grey pen and…. Where the hell is my insulin pen? Then, in my mind’s eye, I see it. It is sitting on the kitchen table 80 miles away. It’s been there since dinner last night. I normally hook it to my bag after breakfast, which I didn’t have today ‘cause of the blood draw. Double crap.

Well, at least I work at a place with a pretty good supply of insulin. Thank God I don’t work in the Dove Chocolate Factory. I stick my nose back in the fridge to review my samples. Triple crap. I gave my last Lilly sample pen away last week to a “between jobs” Type-1 who was having real problems affording her insulin.

I dash back across the cold parking lot to the main clinic. I short-cut through the administrative offices and enter my magic code to open the pharmacy door. We’ve recently added Humalog to our formulary through a special program that makes it not only affordable, but a hell of a good deal. My co-pay from Pres is $55 for a one-month supply. Now I can buy it at the clinic, out of pocket, cheaper than that. (Yes, I’m directly responsible for this program as a direct result of the near-heart attack I had the first time I was told my co-pay was $55. So I was not only able to help out the uninsured, but the sub-insured like myself as well.)

I snitch a pen out of one of the five-pack boxes, promising the pharmacy guy to replace it with one of my own the next day.

Back across the cold parking lot to my office, which is now roughly the temperature of Aruba in July. Hey, swing the little lever on the thermostat to the left. No, no. Left… Izquierda.

Pop the pen cap off. Tear backing sheet from pen needle. Screw it on like the cap on a tire. Pull off cover and throw it to floor. Oh wait. No cat here to play with it. Memo to self: pick up the damn cover so no one slips on it. Twist, pull, click-click. Remove needle sheath with teeth, slip needle into skin—tiny little 31 gauge needle, no pinch up required. Depress plunger smoothly with thumb and……..Owwwwwwwwwch! Oh damn! I forgot how much cold insulin stings.

So that’s the reminder lesson for today. Veteran D-Folk often still keep their insulin in the fridge out of habit from the old-days when you had too. If you are using any of the modern analogs (Apidra, Humalog, Novolog, Lantus, or Levemir) you don’t need to keep it cold once the vial is breached or the pen capped with a needle for the first time. Keeping it cold doesn’t extend the life of the juice and sure as hell makes your life worse. Clarification: of course, keep your unopened vials and pens in the fridge until first use.

I take a sip of the shake. Yuck. Vanilla. They were out of creamy chocolate at Sam’s Club this last time. Time to start the day. I type in my username and password and call up my schedual. Pumpless. Insuinlinless. Liquid breakfast. Thank God being a bad example is just as powerful a teaching tool as being a good example. I don’t think the words “role model” are likely to be part of my eulogy. I’ve got 15 folks coming in today. I’ll tell them what I did, make fun of myself, and remind them not to keep their juice in the fridge.

Tomorrow the lab will FAX us the results of the blood tests. In about six weeks I’ll get the bill, and I’ll have to call the hospital billing department and arrange a payment plan. The cycle of medical economics and the accompanying functional poverty begins once again. Not quite as romantic as Disney’s Circle of Life in the Lion King; but the reality we all live under in our country whose leaders espouse a “culture of life.”