Where's the Memo When Insulin Needs Change?

Diabetes is simply a fact of my life.  I’ve had insulin dependent diabetes since I was almost fourteen years old.  This isn’t the kind you get when you carry a few extra pounds and need to mind diet and exercise.  This is where the body does not make insulin at all.  The diabetic, without insulin, starves to death in a sea of food.  But, of course, there is no need for that today, with insulin.

I am so accustomed to life with diabetes that it is sometimes hard for me to imagine not having it.  Counting carbs and taking insulin for it is just life.  I forget everybody doesn’t do it.  Even insulin reactions don’t faze me much.  That is, until I have a few days like the last few.

My insulin needs, in recent months, have gotten extreme.  I needed way more insulin than was normal for a person of my height and weight.  I didn’t understand it, but neither did I question it.  I had to take what I needed to survive.  My doses were adjusted on the basis of need.  When I took less insulin for the carbs than one unit for every five grams of carbohydrate, my sugars went high.  Last time I adjusted my doses, I was running blood sugars of 250 after meals regularly.  (Normal is between 70 and 120, though two hours after a meal, with insulin still working to bring it back down, 150 would be perfectly acceptable.)

J got sick about a week ago, and Thursday, I followed suit.  I ate nothing on Thursday because I wasn’t hungry.  Friday, I followed the BRAT diet.  All day long, my blood sugar went low a couple of hours later, which I attributed to the lack of protein and minimal fat in that diet to keep the carbs in my system as long as the insulin was active.  Saturday, I had a horrible, horrible low.

Lows, or insulin reactions, typically cause shakiness, confusion, irritability, sometimes even cold sweats.  Reactions like these, I can handle.  It is the other kind that I really can’t.  Diabetics can be arrested for DUI for an insulin reaction.  While I’ve never been drunk, I think I know something of how it feels. 

I can go unconscious while low, or have periods that I was awake but have no memory of afterwards.  But the reaction that I hate more than any other is the kind where I lose muscle control.  I cannot walk.  Simple tasks like bringing my hand to my mouth (or my bloody finger to the test strip) are almost impossible.  I will my body to cooperate, but the result is jerky, sloppy motions that miss the mark.  Instead of walking, I crawl, and the crawling usually involves wildly flailing limbs.  I feel really horrible, and when it happens, it seems to last until my sugar is well into the normal range.  It seems to happen, too, with lows that don’t want to respond to the sugar that I am given to offset them. 

Such was the low I had Saturday afternoon.  G and I battled this reaction for a couple of hours.  He brought me juice that I spilled all over myself.  He squirted a glucose gel in my cheek before that, which I instinctively spit out.  (Every time I’ve been given this stuff, always when I was too incapacitated to eat or drink, I’ve spit it out.  I don’t know why.)  I had just showered before, but now I had glucose all over my face and in my hair.  My clean clothes were soaked in orange juice.  G dealt with the mess on the carpet. 

After a reaction like that, I don’t want another, not for a long time.  I called the on-call endocrinologist, who “just happened” (thank you, Lord) to be my regular diabetes doctor.  She suggested cutting my basal rates (that is, the amount I get automatically throughout the day via my insulin pump) by twenty-five percent.  This I did.  There they remain.

Sunday evening, after a normal meal, it happened again.  This time, I was fully conscience and I think coherent the entire time, but I did experience the awful loss of muscle control.  G brought me my kit and various sources of glucose, and my muscle problem was not so extreme that I couldn’t manage those tasks of checking my sugar and eating/drinking the necessary carb sources.  I still couldn’t walk, and we both went to bed much later than normal, after we knew my blood sugars were finally back where they should be. 

Today, I called my doctor.  She recommended that I cut my insulin to carb ratio from 1 unit for every five grams of carb to one unit for every ten.  Remembering my last experience of 250-300 blood sugars with a much lower insulin to carb ratio, I expected to have to adjust it in between the two.  While I’ve not had lows since then, my sugars two hours after eating are lower than they should be.  I may have to adjust to more carbs per unit of insulin before this is through!

I really wish my body could make gradual changes in insulin needs, rather than dramatic ones.  And I wish I could get some sort of warning when it was about to happen.

I usually don’t even think about what having diabetes means to me.  At times like this, I wish I’d never heard the word, but once again, I am grateful G was there to deal with them both times.  What if it had happened when he wasn’t at home?  J has certainly had my diabetes explained to him, but he’s never had the responsibility of dealing with it alone.  I pray he never does.  While G dealt with the Saturday reaction, he sent the kids to the back yard.  He usually prefers to have them out of the room, at least.

I am grateful for God’s provision for me when I need someone else there to help me.  In twenty-two insulin dependent years, I’ve never been alone or even alone with my children when I was unable to care for myself.  That is God’s provision.  I’m grateful for it, even though, for the moment, I wish I’d never heard the word “diabetes.”