The wrong injection
“I mixed up my pens.”
In a flash I knew what happened. You just took fast-acting instead of basal?
“Yeah. I’m scared shitless.”
No fear. We can fix this. How many units did you take?
“Seventeen. Of NovoLog. I can’t fucking believe that I did that.”
This guy is pretty insulin sensitive. Seventeen units is more fast-acting that he usually takes in the better part of a week. Bygones. Shit happens. Don’t worry about it. Tell me what you’ve got to eat in the house that’s sweet.
He had a few glucose tabs, a pint of Ben and Jerry’s chocolate ice cream and granular sugar for his humming bird feeder. No juice, soda, honey. OK, start eating the ice cream… No, all of it... then to Deb, Bade, fetch my lap top.
I don’t let any fear creep into my voice, but I know this is damn serious. I’ve got to stay clear headed and figure this out; and I gotta do it right. I’m thinking I need to get about 300 carbs into my guy to soak up the insulin.
He tells me the package of sugar he has reports four carbs per teaspoon. I call up the recipe math web site. OK. Three teaspoons in a table spoon…so 12 carbs per tablespoon…four table spoons in a quarter cup….so 48 carbs in a quarter cup….four quarters makes a cup…so a full cup of sugar has 192 carbs. I want you to mix a cup of sugar into four cups of water and dink it down. I chose 4 cups to make it quick and easy to get the sugar into solution. I stay on the phone while he mixes the concoction and drinks it down.
“It’s pretty nasty,” he reports.
Deb tells me you could have made some awesome lemonade if you’d only had fresh lemons. Do a fingerstick.
His BGL is 126. I wish like hell he had a CGM. Every diabetic should have CGM. And every pre-diabetic too, maybe it’d make them think more about what they are eating if they could see what the food choices they make are doing to their bodies.
We chat about marine archeology, a passion of his, while we wait to see what happens. He’s home alone. The hospital is too far for a safe drive with this much insulin coursing through his body. An ambulance ride will bankrupt him. And I know we can fix this.
In fifteen minutes his sugar is 218. I’m relived he’s going up.
My cell phone battery is giving out, making a strangled beeping noise every ten seconds. I ring off, promising to check on him every fifteen minutes until I’m positive we’ve got it under control.
Then I go off to find my emergency phone charger. This is a really handy little device. It’ll set you back about twenty bucks, but it can bring a cell phone back to life in under a minute using a pair of AA lithium batteries. Made by Energizer. Oddly enough, I found them at Home Depot. Amazing what you can come across buying paint for your mother.
I read a few pages of a biography of Sir William Mathew Flinders Petrie, the early Egyptologist. We recently took in a Santa Fe exhibit of artifacts he excavated. Very cool.
I call fifteen minutes later. He’s at 277.
I call fifteen minutes later. He’s at 294. This turns out to be the crest.
I call fifteen minutes later. He’s down to 243.
It’s getting late, things are looking pretty good. I instruct him to stay up until 1 a.m., to check his sugar every fifteen minutes. Thank God we were able to get a cheap strip program in place for our low income folks (ten bucks for 100 strips), and that he had just stocked up. If he was above 150 at 1 a.m. he could hit the hay. If he dropped below 150 at any time before that he was to call and wake me up.
I put the phone on top of the Petrie book and turned out the light. It had been a very long day.
The phone did not ring.
In the morning I called. Good morning, just wanted to see if you were still alive.
“Yeah, turns out you can’t get rid of me that easily,” his voice the normal gruff-but-friendly that I was accustomed to; no underlying tone of fear and borderline panic that had tainted it the night before.
Well, I think you’re worth keeping around for a while yet, where did you land in the end?
At 8 a.m. he was at 146.
So all’s well that ends well. But what if he had not realized his mistake? On the one hand we’ve got personal responsibility to keep our shit together, on the other hand the damn Novo flexpens all look alike. How many D-folk have killed themselves by taking the wrong injection? I doubt we’ll ever know, but recently there has been an interesting change in the pens.
It use to be that the only real difference in Novo’s three flexpens was the color of the injector button on the very tip of the pen. The label also had a very small patch of color: orange for Novolog, Teal for Levemir, and…. What the hell color is the Mix? Huh, we script so little of the mix I can’t recall the color off the top of my head. I’m thinking its some sort of blue, but I could be wrong. The buttons also have some brail-like ridges so you can tell the difference in your pens when you are trapped in a coal mine at midnight during a lunar eclipse. Always best to be prepared.
Recently, however, the pens have a new label, that takes up a full third of the pen, with prominent color. Hmmmmm….. I wonder how many wrong injections silently lead to that change?