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.

4 thoughts on “The D50W Experience”

  1. I am sorry you had to have that bad experience in an ER. I don’t know how big the ER was but for me being a field paramedic for 20 plus years, we gave D50 to diabetic patients whose numbers were at a level we could treat for. Every EMS system is different as far as standard of care. I would sure do some follow up in to that ER. I cannot imagine them never having to deal with a diabetic pt on a pump. Not to scare you but time was wasted, probably as you know. I really understand your fear, especially being with a child. Sorry for rambling, but that was not called for the way they treated you. I would do some follow up and try to find out what are there procedures for a pt with a pump. I am glad you and the baby were fine. Take care.

  2. So glad you made it through safely. As you know, a couple years ago I had a nightmare time in a hospital ER. They all seem to have no clue of an insulin pump.

  3. My worst nightmare. So glad you are ok!!! This has never happened to me but I’m only almost 5 years into T1. I just learned about D50. Is it the same as glucagon? I will ask my endo about it. I take Lantus for basal by injection. Not sure how it works work with a virus since it’s already in your body. Another question for my dr. I was in the ER for high blood sugar in 2013 and they refused to give me insulin to bring it down. It took more than 12 hours and all I did was drink water and sleep on and off, longest night ever. What a disease. I get emotional too, especially because T1 took from me the healthy life I knew, was diagnosed after age 40. God bless you and your little one. Thank you for sharing your story, and so glad you are ok!!

    1. Hey! Thank you for your comment.
      Sorry you had a bad ER experience too. To answer your question, no, D50 is not the same as glucagon. Glucagon stimulates your liver to dump stored glucose into your bloodstream and is injected into a muscle. D50 is actually watered down dextrose that is given directly into the bloodstream through IV. It’s more of a sure thing because with Glucagon, if the liver has depleted it’s stash trying to keep your BG up anyway, the glucagon won’t work. Still, you need to keep it on-hand just in case.

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