A shot in the arm
Damn it, I thought, I must have missed-bloused my half-cup of morning cereal. Or maybe I’m just stressed out. Or overly exhausted. I slept poorly last night, logging less than an hour of sleep the entire time the sun was down (I go through phases of insomnia, but this latest bout is epic, lasting much longer than usual).
I dialed in a correction bolus and escorted the first patient of the day out to my office, a forlorn-looking fifth-wheel circa 1975 camper trailer in the back parking lot (space in our clinic is at a premium). As I started to review her food log, I felt a vibration on my waist. The pump said:
Double damn. Excuse me, I told my patient, blushing, I seem to be having some diabetes technology issues today.
I pulled the infusion set hose from my waistline to ensure it wasn’t kinked, and tried to re-start the pump. No dice. Then I noticed I was having some vision issues. I unzipped my meter case and pulled out the OneTouch meter.
338 mg/dL. Up from 116 an hour and a half ago when I… oh crap. I changed the infusion set this morning. Obviously, the set was bad. I’d probably been an hour and a half, maybe two, with no insulin at all. Plus I’d eaten a bowl of Sunbelt Bakery Fruit and Nut “whole grain” granola cereal (hey, it was on sale). And I drank my large cup of commuting coffee on the way over—caffeine raises my blood sugar—my basal rate is adjusted to compensate, but of course, there was no basal to the bod today.
Amazing how quickly things go to hell in the absence of insulin, I thought, as a pissed-off porcupine poked holes in my stomach. Oh. Hooray. The ketones are here already. I recognize their painful signature.
I excused myself, locked my computer, and grabbing a spare infusion set from my Go Bag, headed in to the uni-sex bathroom in the main building. After a brief internal discussion: to throw up or not the throw up; I decided not to throw up, and pulled the infusion set.
Sure enough. The cannula was bent. Musta’ tagged some muscle tissue under the skin. I’ve shed another ten pounds, and even though I don’t think I’m overly lean, I’ve had a few painful experiences putting in my ultra-short 6mm infusion sets over the last month or two.
Anyway, I put in a new site and chucked the tubing into the trash.
As soon as I got back to my trailer the next alarm came:
You have got to be fucking kidding me.
On its heels, a third alarm:
Rise rate: two arrows up.
I was at the very beginning of a bona fide medical emergency.
What a great way to start the day.
I excused myself from my patient a second time and went back to my Go Bag. This time I didn’t take out the spare-spare infusion set (yes, I carry two spares). I took out my emergency Novolog Flex pen. I returned to my red command chair, slid the cap off the pen, screwed on a pen needle, and took a shot in the arm.
“Hey,” said my patient, “that’s a pretty color of orange. I like that better than my green pen. Can I have one of those?”
Sorry, no. Different juice altogether.
I barely made it through two more patients. My vision cleared but the cramps in my stomach got worse. I pulled the rip-cord and bailed for the day.
Next time: More pump woes