The D50W Experience

In a way, it’s sort of funny how the medication used to bring up a low if you ever have to go there is labeled D50W… sort of makes me think of the metal lubricant WD40 in a way – though it has no connection whatsoever other than the letters are the same and in different spots and one number is off.

BUT, that’s not what this post is about. It’s about actually having to go to the ER to get it.

Most of the time, a stomach virus is simply an inconvenience to most people. It sucks, no doubt about it. But when you’re a diabetic, it can be dangerous. Some people react with high glucose levels due to the sickness and can easily go into DKA (diabetic ketoacidosis) because you’re dehydrated from the sickness. That’s usually how I am in that I stay high for the most part because of dehydration, but I’ve never gone into DKA. I’ve also not had a situation where it had the opposite affect on me and made me low for an extended period of time… until this past weekend.

Saturday morning, I woke up feeling very queasy and knew I had caught my son’s stomach bug that he had the day before. Knowing that I usually run high, I didn’t turn my pump down at all, but also being pregnant, I didn’t want to assume that I would run high and turn up the basal unless my BG showed the need for it. And it was a good thing that I didn’t.

I was able to eat breakfast as long as I ate slowly enough. But, two hours later, I started trending down. I started eating glucose tablets and drinking juice as I could tolerate. Before long though, my stomach was full and not digesting anything, and my sugar was plummeting even more. I kept trying to eat glucose tabs. Eventually, upon smelling yet another drink, I lost everything. I could see that I had thrown up every bit of anything with sugar – glucose tabs, juice, my breakfast… all of it. So, as much as I didn’t want to, we had to get to the ER. I knew I wasn’t going to be able to hold down anything and I needed help.

It took 30 minutes to even get treatment, even though they took me back immediately. I had heard the doctor give the orders for half of the syringe of D50, but the head nurse was busy trying to find the billing code for it and apparently got side tracked. I guess because I was awake and not passed out they didn’t see it as quite the emergency that I felt it was. I knew before getting there, my BG was 52. By the time another nurse came in to start an IV of fluids, my BG as down to 45. I asked her about it, and finally the head nurse came in with the D50.

It wasn’t long and I began to come up again. However, it didn’t hold very long and they had to come back an hour later and give the rest. All this time I had been trying to find a good temp basal to set my pump at but that wouldn’t have me skyrocket and get sick from having no insulin at all. The last thing I wanted was to go into DKA straight from a low because I was dehydrated and now I was going to be cutting off all insulin… and from what I could tell, the staff in the ER had no idea of what to do with an insulin pump.

The ER visit

I was finally stabilized and set home around 3-ish, and I did okay the rest of the day. I will say it was one of the scariest things I’ve had happen in a long time. I hate when I am no longer in control of what happens with my diabetes for whatever reason and it makes me anxious, plus I was scared because it wasn’t just me that I was worried about but also this little person growing inside of me.

While I’m angry over how long it took to receive treatment and how some things happened while I was there (they were more worried about paperwork than treating me at all to begin with), I’m thankful that it wasn’t worse than what it was. My ultimate fear is losing consciousness and no one knowing what to do and how to treat me because they’re unfamiliar with how I manage my diabetes. That, along with being labeled as an uncontrolled or careless diabetic for letting it happen in the first place. I work my tail off to achieve the control that I do, but all it takes is one person giving into the stigma that only uncontrolled diabetics end up in bad situations (the ER, with complications, etc), which projects through their attitude toward me, to make me not want to trust them or feel like I have failed.

I know that I didn’t fail and that it wasn’t in my control, but it’s the emotional aspect that gets me every single time. I don’t know that I’ll ever be able to ask for help without that overwhelming sense of having failed and crying my eyes out every time.

Halfway

19weeksI’m now 19 weeks and 2 days pregnant. By books and online places, this means I’m in my 20th week, which means I’m at the halfway point of the pregnancy. Boy has time flown! Looking back, it went by so slow, but that was because I was anxiously awaiting the feeling of my baby kicking and rolling around in there… to have proof every day that I am actually pregnant, not just every 3 weeks when the doctor did the doppler wand thingy to find the heartbeat at my appointments.

I’ve done well so far as far as my blood sugars. The lows were tiring and aggravating at first, but I wasn’t as worried about them because both my endo and my OB said they wouldn’t hurt the baby as bad as a high. And, up until a few days ago, I had balanced out pretty well and only had a low once a day and the high (above 140) would hit only after breakfast.

That is until sometime around Thursday or Friday of last week. Random highs here and there. I knew the time was coming, just wasn’t sure when that would be. So, I did what I knew to do. Treat and go on. But with pregnancy thrown into the mix, it makes for a new learning curve. Learning whether or not your prebolus time needs to stay the same. Learning whether or not this food still works with you or if it makes your bg do funky things now. Learning whether or not you should skip eating the food in the morning but that it’s okay to eat it in the afternoon because of the wicked (<—term stolen from Kerri) Dawn phenomenon + insulin resistance that hits in the morning I guess from not only waking YOU up, but the little one as well. Learning that just because you’re starting to see higher numbers does NOT mean you need to cut back on food or that you can skip a meal.

I knew all of this was coming. I knew it wouldn’t be long before it set in. What I didn’t know and didn’t count on was the emotional impact. After working so hard at getting good control before the pregnancy, I didn’t realize that the mentality that I had before would actually hurt me now. And what I mean by that is that every time I see a number pop up on my meter that’s out of range now, I’m instantly irritated with myself and I start thinking “Oh crap, what’d I do wrong now?” and I get upset and mad at myself. I used to do this before, but I could in just a few minutes shrug it off if I couldn’t pinpoint it (i.e., didn’t prebolus far enough ahead, miscalculated that SWAG bolus a little, you know) and wouldn’t worry about it. Now, I go through a whole drill over and over and over in my head because I feel like it’s something I can’t just say “Oh well, I screwed up…” and go on. I feel like I have to figure out what I did… when in the end, it may not be what I did at all, but just the fact of being pregnant itself. Even while I’m trying to figure out what’s wrong, and I’m rubbing my little belly, my d-brain isn’t making the connection with my hand that “HELLO!!!??!! Are you forgetting something!!???”

This morning, it all got to me. The higher numbers. The increased need of insulin for bolus’ and basals. I still have that frame of mind that “Uh oh. I’m having to increase. What did I do wrong?” and I go all into diagnostic mode. And when I couldn’t figure it out, I wanted to skip breakfast because my CGM was rising and I didn’t to add to it by eating – I just wanted to correct and go on until lunch like I used to. But I can’t. I can’t do that stuff anymore. I can’t treat my diabetes as I used to. Things have changed and I have to balance the pregnancy needs WITH diabetes needs. I honestly wanted to break down, but I can’t. Break downs for me usually result in a “I need a break” mentality and I follow through with that and take a break for a couple of days. I can’t do that not only because I’ve got 19-20 more weeks to go, but because I DO have this little one inside of me, and if I give up on myself now, I give up on him or her. I simply cannot do that.

I thank God for people like Cherise, Kerri, and ..well, I don’t know her name, but she tweets as @DeerPassion, who have been through this pregnancy wild-“hat” bg mess and have been my support net so far in this journey more than anything because they have been there, they know and understand the whole diabetes + pregnancy mess. If I could go and hug each one of them, especially this morning, I would. Thank you guys (or, uuhh, gals).