Tuesday, May 25, 2010

Lessons Learned and I'm Grateful For Them

Last week something happened that shook me to my core; a diabetic experience that left me feeling so vulnerable and, for a while, like everything I thought I knew about this damn disease meant nothing.  It was the glycemic equivalent to that dream we’ve all had - the one where you are running as fast as you can to escape some dark force but the harder you run - the slower you move, like you are running the wrong way on a moving walkway.  I learned a couple of invaluable things during this experience that I will remember to apply to future experiences.  
* * * * * 
It was a soup and sandwich night - a supper that has two distinct perks: easy preparation and easy on Jenna’s blood sugar.  Nothing crazy-high in fat or carbs.  It was a straight forward bolus.  The night should have been a cake-walk, as blood sugars go.
A bedtime blood sugar check reveals a lovely 7.1 mmol/l.  Nice.  
Two hours later, at 10:00pm we perform one more routine check just to make sure things are still tickity-boo.  WHAM!  We get sucker-punched with a whopping 17.  I stare in disbelief at the meter while my heart pounds in my chest.  
I quickly come to grips with the reality that this night has taken a sudden, unpleasant turn, dial up a hefty correction, press Go on Jenna’s pump and set my alarm for two hours later.  
Okay.  So it’ll be okay.  I’ll check her in two hours and she’ll be on a slow descent back to a respectable number - maybe even single digits!  Back to bed I go and try to sleep for two hours while I put my faith in Dr. Frederick Banting and Charles Best and that bolus.
Midnight.  Another check. SMACK!  Another cheep shot from out of nowhere slaps me across the face with an 18!  I decide it’s time to check for ketones.  Yup.  She’s got ‘em.  Only trace but they’re there!  Time for some drastic measures.  I decide a site change is in order.  Her site must be tired given that it is almost four days old.  I feel guilty for trying to squeeze another day out of it beyond the recommended three.  But up until 10:00 pm she was getting great performance from that site.  Nevertheless, a change must be done.  I go for the site-change-in-her-sleep maneuver.  I’ve done it before with success.  I just have to be slick, organized and quiet.
I perform the site change and Jenna only stirs a bit. We load up another cartridge and perform a rewind/prime sequence on the pump, reconnect her and secure the pump in its pack around Jenna’s waist.  I then administer the correction for this last high reading with a little extra to help fight those nasty ketones.  I decide to leave the old site in place until morning when I can apply adhesive remover to assist in its removal.
Good.  That ought to do it.  A bad site!  That’s what it must have been.  All should be good now.  She’s got a nice fresh site in place, a solid correction is in play and I can breath a little easier.  I figure I should give the bolus a little extra time to work on that stubborn, ketone-laced high before I check her again. Back to bed and an alarm is set for two and a half hours later.  Time to log some zzzz’s.
2:30 am.  I stumble out of bed and make my way to the hall to clumsily load a test strip into the meter, grab the little flashlight and shuffle to Jenna’s bedside whispering - please let it be a good number - please let it be a good number -  but optimistic that things will be on the right path.  It has to be!  I don’t have many more tricks up my sleeve!  
At this point I’m fighting panic.  I’m confused, angry, afraid and desperate to find the cause of this insanity.  I fight the urge to fall apart.  I check for ketones and, of course, they are increased.  What. The. Hell.  
J and I discuss what our next move should be.  We trouble shoot the problem.  The insulin.  Maybe the insulin has gone bad.  We need to break open a fresh vile to rule it out.  So as we discuss and open the fridge to retrieve a new bottle of insulin, Jenna wanders out of her room.  She sees the goings on and calmly inquires “Site change?”
J tries to allay her fears saying “No sweetheart.  We’re just going to change the insulin.”
At that moment something inside me steps in and takes over.  “Actually, let’s do another site change.  It couldn’t hurt.”  
I’m not sure what made me think that putting Jenna through two site changes in less than three hours was necessary.   I thought it would be a tough sell to both J and Jenna.    But J only briefly looks at me like I’m crazy then promptly gets on board with the plan.  Surprisingly, Jenna is game as well. 
We do a second site change, change out the cartridge with fresh insulin and give yet another correction.  Again I decide to leave the second cannula in place until morning.  We settle Jenna back to bed with a total of three cannulas in-situ - two duds and an active one - and return to bed as well.
5:00 am.  A glorious 12 stares back at me from the meter.  It’s still out of her range but it’s obviously on its way down from that ghastly 24.  Again I become emotional only this time it’s tears of sheer relief...and a splash of pure exhaustion.  
Later that morning, after breakfast and another blood sugar check confirms that things are indeed back to normal, I decide to remove the two cannulas that tell the tale of a long, anxiety-riddled night of hyperglycemic hell.  
This was the four day old site:

And this was the two hour old site:

A bent cannula that had not even penetrated her skin.  It left a bruised mark but did not puncture at all.  She was getting absolutely no basal insulin for more than two and a half hours, not to mention missing a correction bolus!  
I was horrified when I saw this.  It had never happened in our twenty months of pumping insulin.  But I was also incredibly thankful for my inner voice - my intuition that told me to perform another change on Jenna.  I shudder to think of what could have happened had I not listened to my gut and done a second change.  
So the two main lessons I have gleaned from this experience are that cannulas can malfunction and that I should always, ALWAYS listen to my inner voice.  The value of my mother’s intuition has already made itself known to me countless times in my seven years of parenthood.  But I still marvel at it’s incredible, unexplainable power.  And I am always thankful for whatever sense prompts me to heed it.
Note: I am not suggesting that anyone should handle a similar situation the way I have described here.  There are protocols that should be followed in situations like these.  If you have questions about how to deal with a similar situation, please contact your CDE or healthcare provider.  


Lorraine of "This is Caleb..." said...

Yowza! Not even penetrated her skin! Eghad!!!

Whew - I'm sure you're more than glad to have all that behind you. I hope you've had some sleep since then and nights have been more cooperative. :)

Sherry said...

Thanks Lorraine! Yes, things have been better lately. I still get up at least once every night, but blood sugars have been more cooperative. Thanks for being there for me that day, btw. It was so nice to have someone say they understand. ((HUGS))

Stacy said...

We had our first inset failure on the day of my daughter's pump party with our very first pump change. One was a bent cannula and one was parental stupidity. Racked with guilt over that one, I can assure you...

It's so scary and the panic is so intense. I've been there and it sucks. I'm sorry you had to experience it, too!