Diabetic Inconveniences and Insulin Shots

I’m back to measuring everything I eat.  My blood sugars have been completely out of control since starting chemotherapy in April 2010.  The initial chemo didn’t seem to have the impact that the 50 doses of arsenic, and then the year of tretinoin, methotrexate, and M6 mercaptopurine had.  Those really messed things up.  This morning my ‘fasting’ blood sugar was 161 mg/dl. That is beyond unacceptable, and I’ve been off of all chemo for roughly 11 months.

Before the leukemia my blood sugars were those of someone without diabetes- but that doesn’t mean I wasn’t diabetic.  My diabetes was just in control.  Diabetes doesn’t go away; it gets controlled.  For 12 years I didn’t take any medications at all. I went from an A1C of 10.2 at diagnosis (random blood sugar was 389 mg/dl) to an A1C of 4.7 and fasting blood sugars between 65-85mg/dl about %95 of the time; rarely over 100 in the morning.  Even when my A1Cs started to rise and I started on metformin my numbers were still doing OK- but I saw that they were starting to go up, and asked to do something before they got ‘bad’.  I didn’t want to wait until things were in a higher risk range.  Proactive, not reactive.

The metformin ate my stomach. I couldn’t keep taking it, so I was started on Lantus (long-acting) and NovoLog (rapid acting, for right before eating) insulins.  My numbers went back to where they had been almost immediately.  I could see my risk for blindness, amputations, and dialysis going away. That was my whole point for starting insulin.  Keep the risk for complications as close to nil as possible.  I already have an autonomic nervous system disorder, so didn’t want that getting worse.  And it has since my blood sugars have been out of control.  I don’t know for sure if there’s any correlation (it could ‘just’ be progressing), but I don’t want it to keep going in the wrong direction if there’s something I can do to avoid that.  I need to get my blood sugars back under control.

When I hear people talk about their resistance to starting insulin, I do understand that.  I’d given countless insulin shots (and IV doses) to patients over the years I worked as an RN before becoming disabled.  That helped a lot in knowing how and where to give the shots.  But I didn’t realize how little the needles had gotten. They are tiny !  They are so easy to get used to, and the vast majority of the time I don’t feel the injections at all.  Initially, the Lantus burned some but my numbers were so much better I didn’t care.  Now, the shots don’t hurt at all.  There may be a bit of discomfort for a second or two, but it’s no big deal. 🙂 I’ve had worse fingerstick soreness than I have had with insulin shots.

Anyway, while on chemo, it didn’t matter what I ate or how much insulin I took- nothing helped keep my blood sugars ‘OK’.  I wasn’t supposed to ‘diet’ during active cancer treatment.  I was gaining weight, taking more insulin (which stores fat), and had high blood sugars which makes ones appetite weird.  Hyperglycemia causes increased appetite. I didn’t need that.

Now I’m getting used to the ‘new’ normal.  I’m having to recalculate my insulin-to-carbohydrate ratios.  I had been at a steady 1 unit for every 4 gms of carbs pre-leukemia. Now it’s a crapshoot.  SO back to measuring, weighing, and doing before and after meal blood sugar checks.  It’s annoying, but I’m guessing dialysis, getting used to a leg prosthesis, and learning Braille would be much worse.  I’m also having to tweak my Lantus dose, and am doing a trial of twice daily Lantus.  I’ve got to DO something !

I’ve got a nice digital food scale (measures in grams and ounces), multiple sets of measuring cups, and various measuring spoons. It’s a pain in the butt to have to measure out everything that goes into my mouth.  But it’s necessary.  I’ve got to get things back in check.  Surprisingly, my A1C was under 7 during my annual physical and diabetic lab work in February of this year.  I want it under 6- where non-diabetics live.  The closer to normal I can keep my blood sugars, the greater chance I have at not developing the big complications.  So it’s all a pain in the butt for a very good reason. 

What Do You Mean I’m Diabetic?

As an RN for 10 years in the summer of 1995, I knew the symptoms of diabetes.  I had them all. And I ignored them.  I peed a lot, couldn’t get enough to drink (non-alcoholic, thank you), was losing weight (a good thing), and had times when my vision was so blurred that I couldn’t differentiate the words on a page- it was all just gray blur.  I figured it was just because of a recent diet change (to lose weight), and I’d be fine.  *palm forehead*

I started (or restarted) a job at a community hospital in the Texas Hill Country.  It was their practice to do a urinalysis, drug test,  back x-rays, and have one of the ER docs do a viability check once the offer of employment tentatively had been made (adjusted if anything came back on the back x-rays, or drug test in particular).  I’d worked there before; I knew the drill.  I got a message to go talk to the employee health nurse. That was odd.  I knew Patsy (pseudonym) and she didn’t just call people to her office to chat.  She had something to tell me.

I got to her office, and she was her usual friendly self, but had a look of ‘this is business’ on her face.  She had me sit down across from her desk, and handed me my urinalysis.  She asked me if I saw anything wrong.  It was glaring.  There should be no glucose in urine.  I had a level over 2000.  There was only one logical deduction. I had diabetes.   I just looked up and started bawling.

She told me they’d get me into the diabetic teaching classes; being a nurse taking care of someone was way different than having the disease (boy, she wasn’t kidding).  She’d get me in contact with Charlene (not her real name, either), the in-house diabetic support person (who also taught the classes). And, they’d get me an appointment with a family practice doctor to get this all seen and verified with fasting lab work.  My random fingerstick was 389mg/dl- with no symptoms, and on a basic, ordinary day. Not good.

I saw the doctor, who ordered a fasting blood sugar (240mg/dl) and A1C- 10.2 (should be below 6 for a non-diabetic, and ideally below 7 for a diabetic).  She didn’t want to start insulin until a trial of diet and exercise was done.  She also didn’t want to start any oral diabetic meds.  I was fine with that.  I did well on diet and exercise- and before long had my blood sugars in the normal range for a non-diabetic.

I went to the classes and learned a LOT.  Charlene was a major advocate for diabetics, and knew a lot from having a diabetic son.  She had invaluable information.  She taught the day to day living stuff. As a nurse, I knew the clinical stuff. There’s a huge difference.

I’d been taught the signs and symptoms of low blood sugars in school, and one of my supervisors would go running for a half of a pimento cheese sandwich if I ever said I felt tired, edgy, shaky, had a headache, or felt my heart racing (never mind I’d be running around all over the hospital floor where I was the charge RN- and ONLY RN on an acute surgical floor w/heavy ortho).  She was taking NO chances 🙂  Never mind that the sandwich would have only been good after a carb source, as protein and fat slow the carbs from raising the blood sugar.  Not horrible if it’s a ‘high’ low, but if it’s a ‘low’ low, it could be real trouble. I also had been running such high blood sugars that a 150 would have me trembling and sweating- took time for my body to adjust. Fortunately, insurance had just started covering monitors and test strips for Type 2 diabetics.

I lost weight to the tune of about 100 pounds total, from the weight loss before being diagnosed, and then by not so healthy ways when I tried to lose weight after being diagnosed (focusing on food and weight loss had been an additional factor in relapsing into eating disorders about 5 months later).   My blood sugars were normal nearly all of the time. A1C dropped to 5.2.

I want to emphasize that this didn’t mean I was no longer diabetic.  I was in control of the diabetes.  There’s a huge difference.  I still had to monitor my blood sugars (though not as often), and let doctors know I was diabetic if I had to have any medical testing done.  I couldn’t go back to my pre-diagnosis state, and just ignore that it was there.  I did have episodic lows, which isn’t that common, but can happen in type IIs not on medication.

It took 12  years before I needed to start medication. That pill made my stomach a mess initially.  I started insulin later in 2007 ( a few months after the common pill) , and that was the best thing ever for my blood sugar control.  It was some work initially to figure out the dosage of the long-acting ‘basal’ insulin (Lantus for me), and the rapid acting (NovoLog) for before meals.  I had to do a lot of testing before and after meals to get the right ratio down, and I found that the more tightly I calculated my carbohydrates, the more flexibility I actually had.  Things were going well until I was diagnosed with leukemia, and have had bizarre blood sugars on, and now off,  chemo.  I’m still working on getting it back to a reasonable level.  It gets frustrating.

I’m a stickler for numbers. When I saw my AIC going up prior to starting insulin, I wanted something done. I didn’t want to wait until it got into the ‘bad’ range.  I saw no reason not to  be proactive, and waiting around for bad numbers made me mad.  The endocrinologist I saw was dragging her feet so I talked to my Coumadin nurse (a nurse practitioner) who had no problem starting me on Lantus.  My numbers almost immediately got better.  I had to be my own advocate.  The fired endocrinologist wasn’t doing anything productive.

I also learned that having diabetes is so different than taking care of patients with diabetes as a nurse.  There is no connection.  Those sliding scale doses of insulin are useless unless they are very specific for the specific patient’s numbers. If I didn’t tell the doctors and nurses  I have my ratios figured out, I would have gotten some ridiculously low dose when in the hospital.  I had to speak up.  I also know what foods make my blood sugars weird- they’re different for each person.  I know to have proteins and/or fat with carbs to level things out. Some emergency room folks here don’t have a clue about that when treating lows, and put me in danger.  There was a lot to learn, and in the process I learned to look at each diabetic person I took care of as what they were- an individual.

Now, just to get things back to normal after chemo…that was a game changer.  I’m cured of APL, but my sugars have been wonky for a decade now. (edit)