DKA: It Wasn't My Fault!

I can officially count THREE times when I lost control of my diabetes and it wasn't anything that I did to cause it. One story is boring. The second is wall-to-wall stupid. The third is a bit amusing. 

First Story

This one's short. I was 24 and wound up in DKA because. That's it. My answer is officially, "Because." When my physician asked me what happened, I told him that I honestly had no explanation whatsoever. We collectively shrugged our shoulders and hoped it would never happen again.

Second Story

Well, it did. I was 38. By that time, I was using "The Poor Man's Insulin Pump." That means I was taking a dose of insulin for each meal. I should have been checking my glucose before each meal, but I wasn't mentally there yet. To my credit, I was at least taking enough of an averaged dose to cover the food I ingested.

I was going to be out and about in the world to get a new pair of glasses, so I packed up some alcohol swabs and my insulin, and then rode on a couple of buses for two hours. When I reached my destination - an establishment that promised glasses in an hour - I had my eye exam, then walked the half-mile to the mall.

It was only after I'd eaten some lunch that I remembered to take my insulin. Hey, it happens. And I've heard people ask with shocked incredulousness, "How do you forget to take your insulin?!?" Their assumption is that something I do regularly would be impossible to forget. I counter with a question of my own: "Haven't you ever rushed out of the house and forgotten to brush your teeth?" When they try to point out that the insulin scenario is more dangerous, I offer the counterpoint that they're both daily rituals that can be overlooked when we're preoccupied.

Were you paying attention when I listed the supplies I brought with me? Alcohol swabs and my insulin. NO SYRINGES! 

Well, no problem, right? I would just go pick up my glasses and hop on the next bus heading home... except that I'd treated myself to the damned orange chicken at Panda Express for lunch.

I'll go into detail about how I take my insulin doses one of these days, but back then, because I wasn't actively calculating my dose per meal, I would be taking just enough to cover a meal that might be a little... sweeter than usual. And orange chicken definitely qualified as "sweeter." Additionally, there was no 24-hour insulin covering me on those off-hours back then.

By the time I reached the optometrist, I could feel my glucose levels rising. I was going to be in trouble if I didn't take some insulin soon. But I still had hours to ride two different buses to get home, so I got my new glasses and skedaddled.

With about 20 minutes before the bus arrived, I walked across the street to a sports bar for a drink. No, not a drink-drink. Just a drink. I was starting to experience the early signs of polydipsia, excessive thirst, so I ordered the largest Diet Coke they had to go. When it was served, I took a HUGE gulp of it and thought, Ummm... that... That didn't taste right. I asked the bartender if he'd given me a Diet Coke, and he replied, "No, that was regular Coke."

Yet another moment of inattentiveness helped that day go from bad to worse. If he'd given me the drink as I'd ordered it the first time, maybe I would have avoided the hospital. Maybe. Alas, as I boarded the first bus, I knew that was impossible.

Reaching my final stop, I still had half a mile to walk to get back to where I was living. While not the most strenuous activity, being active without any insulin to correct my metabolism was only helping all of the building poison do more damage to me. By the time I walked through the front door, I could barely stand. My housemates took one look at me and asked if I was okay. All I could mutter was, "Hospital." Why I didn't say, "Ambulance," is a mystery. One of them drove me to the hospital, where I finally vomited for all of the nice doctors and nurses, thereby proving to them that I was officially in DKA.

That's when I learned a new thing. It had been 14 years since I was last in DKA, so I didn't know that an insulin IV drip now meant being put in the ICU. Why? Because insulin in the veins as opposed to subcutaneous, (just beneath the skin), works at least 100% more potently. THIS IS NOT AN ENDORSEMENT TO TRY THIS AT HOME!!! IT'S EXTREMELY DANGEROUS!!! There's a reason why they administer this treatment in an ICU, where you can be continuously monitored by nurses. If for whatever reason you rapidly swing from high to low blood sugar, they have the knowledge and tools to counteract it... especially if you wind up losing consciousness. I really can't be any clearer. DON'T ADMINISTER INSULIN INTRAVENOUSLY AT HOME!!! 

When I could finally think straight, I explained how I wound up in DKA and we could both see how this case was a kind of comedy of errors.

And speaking of comedy...

Third Story

When I was 16, I started developing post-auricular inclusion cysts. Think of them as mountainous mutant pimples that never come to a head, and keep growing until they get so soft that they explode. Well, kind of. It's not like I'd be walking around school when they'd go off like volcanos. They'd usually burst if I rolled over onto them while sleeping. I'd wake with a small, bloody mess to clean up, and then life would go on.

Except when one of them decided to become extremely infected. Very red. Very tender. And since I haven't mentioned it previously, diabetes and infections are like a mix of steak-flavoring and Jell-O!

Okay, let's pause a moment and learn a thing or two, shall we? The body is chock full of autonomic functions. These are things that don't require conscious thought. Breathing. Blinking. Digesting. You get the idea. When we experience stress, we naturally go into fight or flight mode, even if it's a situation that requires neither fight nor flight. Case in point: pain. Let's imagine you suddenly burn yourself. Reflexes - another autonomic function - have you pull away from the heat source immediately, while naturally produced steroids are pumped into your bloodstream. Those steroids are packed to bursting with everything you need to fight or flee. This includes lots of sugar to energize you.

I'm only using pain as an example. Any form of stress can release those steroids. And in the case of my cyst, the stressor was infection. My body needed energy to fight the infection, so it fed me naturally occurring chemicals that I can't process without insulin! Yeesh! You'd think my body would've learned by that point!

The infection was bad enough that I lost complete control of my diabetes without putting any effort into it. I took my insulin, followed my diet, and still wound up hospitalized.

From the time I was brought to the ER to day seven of my hospitalization, I told everyone that needed to know about the giant, painful cyst behind my right ear. No one - and I mean NO ONE - was paying attention to that complaint. They simply chalked up my visit to the usual Rob antics, like not taking insulin and eating garbage.

In the background of this visit, my endocrinologist went on vacation, leaving a different doctor in charge... and then he also went on vacation, leaving a resident in charge of my care. Residency is an important part of a doctor's training, where they learn to fine-tune their considerable education. Alas, the resident I was left with wasn't the sharpest tool on the tree. (Yeah, I mixed metaphors. What are you gonna do about it?)

Seven days of being monitored and my glucose levels continued to fluctuate between 200 and 300. This was not how I usually responded to treatment. By day seven, they were usually ready to send me home. And because they couldn't wrangle my sugars, I earned a visit from the arrogant turd of a doctor left to care for me. He walked into my room, stood intimidatingly at the end of my bed, and demanded to know how I was cheating on my diet. There was no alternative in his mind. I had to be sneaking in some kind of candy or other junk food to maintain a consistently high blood sugar.

I was actually insulted. I mean, yes, I absolutely cheated on my diet egregiously, but never when I was in the hospital. And this doctor being so monumentally cocksure was offensive.

So, of course, I confessed. "The only extra thing I've had is soft pretzels with mustard." Plenty of extra carbs to raise the blood sugar there, right?

Dr. Know-It-All had a pen and notepad out in the blink of an eye. Now he wanted details. Who was bringing me... soft pretzels with mustard, was it? Yeah! When were they bringing it to me? How were they getting past the nurses station with extra food for me? He would have those answers immediately or I'd be confined to my room!

That's when I held up the book I was reading: Soft Pretzels with Mustard by comedian David Brenner.

He stared incredulously at me, getting red with rage. He was so mad that he couldn't find the words to tell me off. He simply stomped his way out of the room.

A few minutes later, a smiling nurse came in. She obviously found my cheekiness amusing. Thinking on it now, it's entirely possible that that intern's arrogance was something the nurses had to deal with daily, so him getting burned by some 16-year-old punk was exactly what she thought he deserved. This time, instead of instantly being accused, she ASKED if I was cheating.

For the umpteenth time, I explained about the incredibly large and painful cyst behind my ear. And for the first time during that hospital visit, someone looked at it. The cyst was warm, red, and so soft that it might well have popped that very night. But a surgeon was called up. He numbed the site, drained the cyst, and prescribed antibiotics. And wouldn't you know it? My blood sugars came under control two days later!

The cysts became an adventure all on their own, resulting in four different surgical procedures. But those aren't diabetes related, so you don't get to hear about them unless you ask nicely. 😛

Another blog post completed. I'm gonna try again. I know it seems impossible to confuse pictures so easily, but mine is a strange existence that defies explanation. And now... the beautiful, scantily clad young woman!

Oh, come on! That's just cruel!