Today, something happened that made me hate diabetes. I mean, really hate diabetes. This is not to say that I’ve ever regarded diabetes in a positive light, but yet, somehow the knowledge that “at least it’s not cancer” has helped me begrudgingly tolerate its presence in our lives. Up until today, that is.
I made a very stupid mistake. Stupid, stupid, stupid. There are no room for errors in diabetes management. At all. Yet, they are bound to occur; after all, I am a fallible human being dealing with a multi-factored treatment protocol that is unbelievably complicated to administer.
Here’s what happened. Madeline was eating her lunch and we were preparing for a trip to our local beach for the afternoon. A flurry of activity ensued as my three excited kids ran this way and that, barking questions and whooping it up as they got ready to go. In the midst of the controlled chaos, I set about to calculate Madeline’s lunchtime insulin dose. This one involved a calculation for carb coverage, a correction for (chronically!!) high blood glucose, consideration of insulin-on-board, and the always head-scratching prospect of factoring in heightened physical activity in advance. Oh, and did I mention that I also needed to load up a new insulin vial in the pen? Yes, the typical multi-factored treatment protocol was underway.
Because of the newly loaded insulin vial, I had to “prime” the needle. I did this; I dialed up 2 units and discharged it on a paper towel, and observed a small bead of insulin emerging from the needle’s end. With the pen ready to go, I dialed up 10.5 units. I prepped Madeline’s upper arm with an alcohol swab, blew it dry, and administered the dose.
As I depressed the end of the pen, I noticed somewhat absent-mindedly that there was much less resistance than usual. That’s strange, I thought, amidst Madeline’s squawking at me to hurry up Mommy! I want to go swimming! Only, I did not notice the lack of resistance until said resistance actually kicked in. I pulled out the needle and quickly descended into a state of panic as I read the pen’s dial: 1 unit.
I panicked because I had absolutely no idea how much insulin Madeline had received.
Seeing as how she was above 300 at the onset of lunch, and had eaten 62 carbs for lunch, this situation represented a significant problem. It’s a problem under any circumstance, really, but if she had been within target range before eating and if she had not eaten much carbs, I would have been ok with seeing how the error played out. I stood there, racing through the scenario and trying to figure out if there was any way I could reasonably deduce how much insulin Madeline had received. My panic deepened as I came to the conclusion that I had No. Frigging. Idea. How. Much. She. Got.
I had to guess. That’s just great, just great indeed, when managing diabetes. Guessing sucks. I do it all the time, and I hate it. I seethed hatred toward diabetes. I welled up in tears and tried to keep my nausea at bay. I hate diabetes.
After several minutes of burning hatred, frustration, and fear pulsing through me, I cleared my head enough to decide perhaps Madeline got about 3 units in that dose. I can’t tell you why I thought this was reasonable. It was a guess. Because she was supposed to get 10.5 units, I was stuck trying to decide if I should administer more insulin, or just wait. I knew that 3 units was a fraction of what was needed to treat her, and yet, well, 10.5 units is a hell of a lot of insulin, and I did not feel comfortable giving her another 7 units to make up for what she might not have received. I settled on giving her an additional 5 units, committing to glucose checks every 20 minutes to monitor her response.
Though we are chronically fighting highs, this time, I hoped that her glucose level would remain high. I proceeded with our plans to hit the beach, packing up her kit to take along while praying very hard that I would not need the glucagon. It was a scary prospect to turn her loose in the water, but I decided that it was necessary. It was necessary to maintain a normal life even in the midst of a treatment crisis.
As it turned out, Madeline’s level did, in fact, remain high. She was still in the 300s three hours later, when we returned home. She ate a snack, I treated her again, and all was reasonably well. It’s a mistake I will never, ever make again. If I have to waste 20 units of insulin making triple sure that the insulin pen is properly primed, so be it.
I hate diabetes.