You ever have one of those moments of instant realization that you just screwed up royally?  Not only did you just screw up big time, but you can’t unscrew it, and you know you just have to ride out the consequences.  Yup, I had a night like that last night.

I was at the karate school, and the last class of the evening was about to end, and my fight team was about to start their closed door training session.  It was around 9pm.  My blackberry was buzzing, and the alarm update reminded me that it was time to take my evening insulin injection.  Knowing how forgetful I can be, I had my diabetic supplies already sitting on top of my desk, ready to be put to use.

I was also in the middle of a conversation with one of my staff members, and getting offline at the same time.  I have done this routing thousands of times, so no reason at all to suspect what would happen next.

Let’s back up for just a second.  I take two kinds of insulin.  The first is  Levemir, which is my long term insulin.  It is supposed to be a once a day shot that gives you a 24 hour baseline of insulin, to mimic what a normal, healthy pancreas does.  I said mimic, because it is far from a perfect science.  Anyway, instead of taking it once a day, I divide it up into halves, and take it twice a day, about 12 hours apart for better control.

The other type of insulin I take is NovoLog, which is a short term insulin, designed to be taken with meals, according to the amount of carbohydrates I eat.  This is called a bolus, and can also be used to knock down a random high blood sugar reading.  I test my blood sugar about five or six times a day to be sure.

The company which manufactures the insulin makes it in a ‘disposable pen’ form, so the two different types of insulin come in the exact same shape and size.  To insure that the diabetic purchasers do not mix up their shots, they make the Levemir with a bright aqua colored label and end cap, and the NovoLog with a bright orange colored label and end cap.  Since I am only blind in one of my eyes, the other one should pick up which is which.

Now here’s the rub.  I typically take 20 units of my long term insulin twice a day.  When I take my short term insulin, either to cover a meal, or lower a high blood sugar, I usually take between 2 and 6 units.  Big difference in volume.  Do you see where I’m going here?

Taking too much of the fast acting could cause my blood sugar to drop dramatically.  In a mild case, I eat something sweet and wait to recover.  In an extreme case, a diabetic could drop so quickly and so far that they slip into a coma, or have a heart attack and die on the spot.

Here’s my big screw up.  You guessed it – when it was time to take my 20 units of the long term, slow acting Levemir, I inadvertently took 20 units of the short term, fast acting NovoLog.  To make matters worse, upon checking my blood sugar at that moment, I recognized, that it was at a reasonable level, and did not need any NovoLog at all.  Ugggghhhh!!!  Things were about to get real hairy real fast.  I also knew I needed some of the longer term insulin, so I played doctor on myself, and decided to take half; in my case 10 units.

I had done this once before, but that was about 30 years ago.  At that time, to make sure I didn’t slip away in the night, my parents and sister stayed up with me throughout the night, shoveling ice cream and canned pineapple down my throat at regular intervals.  Some things you don’t forget.  The difference is now I am a grown man in my forties, with a family of my own to look after.

Well, sticking around for fight team training was definitely out, because I didn’t want to drop on the mat, and I had to get to where the food was.  Walking my dog was definitely out, because that would lower my blood sugar further – normally a good thing, but the last thing I needed at the moment.  So get someone else to walk my dog, go home, get comfortable on the couch, see what sweet things there are in the house, and what’s on TV.

Although it may sound like fun, believe me, it is not.  Try to stay up as long as possible, when every ounce of your being wants to sleep, repeatedly shove the next high carbohydrate item down your throat, which you really don’t want, and you know as a diabetic you will pay for the next day for sure.

Without going into the gory details of the crappy movies I watched, and how much food I ate, I woke up on my living room chair at around 4-something a.m.  only to realize I had conked out.  Thankfully I was still alive and coherent.  I ate one more bowl of whatever cereal was in the cabinet, and went upstairs to bed.

My wife, Yvonne, told me the night before that she would get the kids to school in the morning, which is usually my job, so I knew I would be able to sleep a little later.  By some miracle, I woke up only about an hour and a half late, and instantly checked my blood sugar.  The second miracle of the morning was that my blood sugar was actually perfect, as if nothing had gone wrong the night before.  While the rest of the day should be interesting, to say the least, I was happy that it started out well.  It is still morning as I write this.

The moral of the story?  Three morals actually.  One:  Pay attention to what you are doing.  Two: READ THE LABELS ON YOUR MEDS BEFORE YOU TAKE THEM! And three:  When you screw up in life (which you will), don’t panic.  Settle in to the idea that you are going to have to change your plans for a little while, and calmly make the necessary adjustments.

Tags: diabetes

While I am typically known for other things, I am an insulin dependent (type 1) diabetic. I was first diagnosed at the age of ten back in 1977, although, looking back I realize that I had all the classic symptoms for years before I was ever diagnosed. I have long since taken for granted all of the things that go on inside of me in on a daily basis, and how I am constantly adjusting myself to them throughout each day. It’s just something I do automatically. However, it occurs to me that the average person really knows very little about the inner world of their diabetic friends and family members.

When I wake up in the morning the first thing I do is blink my eyes a few times to make sure I can still see. Most people probably don’t wake up this way, but I have had eighteen laser surgeries on my eyes combined to fight off diabetic retinopathy. On my left eye, I have had three vitrectomies, and retina re-attachments. Unfortunately, they did not take, and I have been left completely blind in that eye since I was in my late twenties. The reality that you may lose the vision in your eyes is probably not on the minds of most people, but every diabetic knows at some level, that this is a possibility.

Before I do anything further in the morning, I change the needle heads of my two different insulin pens, and the lancet in my blood sugar meter. Then I poke myself three times. Once to test my blood sugar, then to take my long term insulin, and finally to take my short term insulin to adjust to any high blood sugars, or to cover for whatever I will eat for breakfast. Sometimes it is ok, and other times it hurts like hell, because either I hit a nerve with the needle, or I hit the exact spot I used not too long ago. Although routines will vary slightly, your diabetic friends and family probably do something similar.

Throughout the day I must continually check my blood sugar. If you eat the wrong foods, you might get fat and feel guilty. If we diabetics eat the wrong foods, it may cause any number of nasty side effects, such as coma, blindness, amputation, heart disease, etcetera. The stakes are just a little higher.

Of course we can’t let the blood sugar get too low either, because then we ‘crash’ as I call it, or experience hypoglycemia. On a low level, you eat some candy, and you are pretty much wrecked for the next hour until you fully recover. Yes, the blood sugar may be back up in fifteen or twenty minutes, but after a good crash, you are just ‘out of it’ for a while. Of course there will be a rebound high within the next twenty four hours, so you will get a nice unexplained insanely high blood sugar for no apparent reason. No biggie; take another needle, and knock that blood sugar back down. Sure, you’ll have some serious mood swings on this blood sugar rollercoaster ride, but it is all a part of our day.

On the other hand, we also know that a serious enough blood sugar crash could just give us a heart attack and kill us on the spot. What? Are you serious? No, you are exaggerating, you might be thinking; but I’m not. What could cause this anyway? Well, some malfunction between the balances of the calculation of insulin to food; forgetting to eat (which does happen); sensitivity to exercise; and a number of other factors.

Remember, what your body does automatically, we must do externally, and it is never perfect. Trust me when I tell you it is on our minds all the time.

Every time we put anything in our mouth, we have to figure out if it is worth the bother of taking another needle over, and if so, how much insulin. Sometimes we just don’t bother, because we don’t feel like taking the needle. Or we eat and don’t take it, and just deal with the rotten mood and personal ineffectiveness that comes with high blood sugar.

Most diabetics can guesstimate the amount of carbs in just about anything. That is, of course, if we cooked it and know what is in it. Going out to a restaurant is like playing Russian roulette with the blood sugars. We don’t just look at the menu to see what’s good. We have to start doing math problems in our head to gauge how much insulin we think we need. Ready for another diabetic nightmare? You just finished ordering or even eating, and realize you forgot your insulin and tester at home, or in your other bag.

There have even been times when I was out of the country, and this has happened to me but worse. I once left my insulin, which was in a cooler pack, in a cab in Israel. If you know anything about Israel, you know that strange, unattended packages get blown up inside of a robot in case they are a bomb! In Mexico, on my honeymoon, I left it on a little cruise boat, and by the time I got back to my hotel, all the pharmacies were closed. I don’t know what magic my wife worked, but sometime that night, insulin appeared at the hotel. That was not the last time Yvonne would save my life, but we’ll save those stories for another day. Most recently, I left my insulin and tester on a restaurant table in England. One of the people I was with picked it up, and waited until I realized I had left it to tell me he had it. Of course we were already about twenty minutes away at that point, and he let me experience my temporary panic before telling me. I can only laugh.

To your diabetic loved ones, their insulin and glucose monitor are literally their lifelines. Without it, they will die. This simple fact has kept me, and I’m sure the people you know as well, from having any desire to stray too far from civilization as we know it. Not only that, but if I leave my insulin in my car or outside, and it gets too hot, it spoils, and I’m stuck. I must always be aware of where it is, and what the temperature is. We even have to remember not to leave it by the window because the sun can heat it up, and it will go bad. On the other hand, when left in the fridge, it hurts when you shoot it in cold, but it is a pain in the neck to warm it up; so you kind of try to keep it room temperature. Again, it is a delicate balance.

How then you must be asking, could a diabetic possibly leave it behind, if it is so important? Oh yes, there is another side effect of diabetes; memory loss. If you have a conversation with a diabetic, and their blood sugar is too high or too low at the time, there is a good chance they will not remember having that conversation with you. Just ask my wife or anyone else who lives with a diabetic. It must be very frustrating.

Finally before going to bed at night, we must make sure not to eat too much, because high blood sugar over time steals our health as well as our ability to heal. (In fact, we have to be more concerned about cuts and bruises than ‘normal’ people, because everything takes us about twice as long to heal as it does for a non-diabetic.) We also must not take too much insulin or overdo the exercise late at night because if our blood sugar crashes in the middle of the night, we may be too disoriented to deal with it ourselves, and our family members may not wake up with us. If it crashes really badly, we may not wake up at all.

It is not easy acknowledging all of the challenges that being diabetic presents. I am supposed to be a tough guy. Here’s what I think. Dealing with life’s challenges will either kill you or make you stronger, and I’m not dead yet. And I don’t have any such plans for a long time.

Tags: diabetes