Coping With A Type I Diabetes Diagnosis & Insulin Injections


One diabetic’s journey. Going from Type II diabetes to Type I. Explains symptoms, treatment, medications & use of insulin injections to control blood glucose.

Preface

As a writer and reporter for the past 15+ years, I have covered quite a number of stories and subjects. However, one subject that I have always managed to avoid thus far is a fairly personal one. Me.

I am probably not your typical blogger, in the respect that I loathe revealing personal details about myself in print. I don’t even particularly like seeing my own name on a byline, which seems to run counter to the attitude of most reporters these days. I would much rather work behind-the-scenes as a ghost writer than I would having my name in print each and every day. I’m not really certain whether this is a positive character trait or a personality defect, but that’s just the type of reporter that I am. As long as what I write is informative and useful to others, I don’t really care who gets the credit.

That being said, this personal journey through diabetes is being recorded in the hopes that it will help to educate others about the disease and to hopefully avoid any mistakes I have made, and will make, along the way. This has definitely proven to be an overwhelming experience in my own life, and I am sure that it must feel the same way to others. This blog is currently ongoing as I continue treatment for Type I diabetes.

Background

I was diagnosed with Type II diabetes approximately five years ago, when I was 35 years old. During several previous exams, my Doctor had warned me that I was exhibiting “pre-diabetes” symptoms and blood sugar levels. I was told to modify my diet and increase the amount of exercise I was getting. Honestly, I was not very worried about it back then though. My main health concern at the time was my high cholesterol level, which had peaked at nearly 400 prior to beginning treatment by medication. I went on the prescription medication Lipitor, which eventually lowered my HDL levels to something reasonable, around 200.

Besides the high-cholesterol, I have never had any major illnesses or surgeries. Other than having my appendix removed when I was age 12, I had never been hospitalized to that point, or even been to the Emergency Room for treatment of any kind. The high cholesterol was mostly the result of bad diet, lack of exercise and a high-stress lifestyle that included working a rather grueling schedule that took up an average of 80 hours a week. That and a rather turbulent personal life at the time definitely took it’s toll on my body. Sitting in front of a computer for 12 hours at a stretch definitely is not a recipe for good health. I also went through a brief period where I smoked cigars on a regular basis, which I gave up after being lectured by my personal physician. Having grown-up the only child of two chain-smokers (who both died of cancer), I definitely should have known better. Still, I have to say that I was rather shocked when my Doctor eventually told me that I definitely had Type II diabetes.

Living With Type II Diabetes

For the first five years or so, I was treated with oral medications. At first, they seemed to help, and I eventually got to the point where my blood glucose had stabilized at nearly normal levels. Eventually, I started developing brief periods when my blood glucose levels would suddenly rise for weeks at a time. This sometimes prompted an increase in medication levels, or switching to a different oral medication entirely. After approximately four years though, it became increasingly apparent that oral medications were becoming less and less effective. There was a last-ditch effort at using a relatively new drug called Jaumet that showed promise at first, but seemed to become more or less ineffective after a matter of several months. I had been told when I started it that if it had not worked, the next step was insulin. It was combined with a second drug and pushed to its maximum dosage, but my blood glucose levels only rose higher and higher.

On my previous Doctor’s visit, my blood glucose levels had actually improved, but only slightly. My Doctor said that there had been an improvement, but that it was still too high after my A1C test. The dosage was bumped up. My blood glucose levels had been hovering anywhere from normal to the low 200’s at that time. Not good, but nothing that I would consider an emergency. About a year earlier, I sought help at the local Emergency Room when my blood glucose unexpectedly shot up to over 500. Since I had not seen it ever rise anywhere over 300 or so at the time, I was fairly alarmed. The ER visit turned out to be a waste of time though. I was simply sent home without any treatment and told to contact my regular Doctor after the weekend. I ended up being billed over $1,500 for the visit.

Shortly after my last appointment, something started going wrong though. One morning, I was shocked when my blood glucose monitor displayed 499. That was the second highest reading I had ever seen, and I had actually improved my diet, started getting more exercise and had lost around 10 lbs at that time. I thought that it might have just been a fluke. However, day after day, my blood glucose levels stayed high. The lowest blood glucose level I remember seeing that week was around 366. I decided to give it a chance to get back to normal, and ate an increasingly strict diet. It didn’t happen though. After more than a month, my average blood glucose level was somewhere in the high 300’s. I had lost almost another 10lbs by now, since I didn’t really feel like eating all that often. I did feel like drinking though. A LOT. I drank more water in a day than I used to in a week. I had to have some kind of drink nearly every 15 minutes and was making two trips an hour to the bathroom. This was the worst my diabetes had ever been. I finally felt that I had no choice but to schedule an early trip to the Doctor that week. Fortunately, I was able to get in rather quickly. In retrospect, it was probably foolish to wait as long as I did to see my Doctor. I was fairly certain that the trip would most likely result in my being put on insulin treatment though, which I had been working quite hard to avoid.

The Doctor’s Visit

I arrive at my Doctor’s office that day with my blood glucose monitor, to show my Doctor what has been going on. I’ve lost about 10 lbs since my last appointment, which should also be a fairly good indicator that something is going wrong, seeing as I was last here less than six weeks ago. The last time I had seen my Doctor, her last advice to me was to ramp up the amount of exercise I was getting, which I had definitely done. It didn’t help though.

Having to go on insulin was something I had been dreading for years. I often took her warnings on having to go on insulin as more of a threat than actual medical advice, seeing as how she knew that I was terrified of needles. Unfortunately, I know that is where things are leading though, and am not surprised when she tells me that the pills I have been taking are no longer going to be enough.

I am basically given a course in “Insulin 101” for the remainder of my visit. I get instructions on how to properly draw insulin from a vial with a syringe, measure the dosage, make sure that no air bubbles are present and inject myself with the needle somewhere below the skin. I’m told to stick to places where there are fatty deposits on me, like my stomach and legs. I guess that in this case, having some fat actually pays-off. I get to inject myself for the first time, using a practice dosage of sterile water. The result was both stressful and painful. I was promised that the diabetes syringe I would receive with my prescription would be much smaller though. It turns out that syringes for injecting insulin are specially designed for diabetics. They are shorter and thinner than most needles. Sounds good to me. I know that the bigger the needle, the worse it hurts.

Before departing, I’m told that the insulin dosage I will be getting of Levemir is rather small, and will not probably help my blood glucose levels all that much. I get the impression that this is more of a trial-run than an effective dosage to control my blood sugar levels. I’m told to come back to visit in a week. That’s a rather short time-frame, which is actually kind of comforting, seeing how bad things have been lately. I’m hoping that the results will be more than just superficial though. I feel rather horrible at the moment, so am definitely looking for some type of relief. Unlike usual, I am constantly thirsty and have to urinate something like every 30 minutes. My muscles hurt and I have absolutely no energy at all as of late. I’m definitely hoping that this insulin therapy works. If not, I hate to think of what the consequences may be.

Day One

I returned home from the pharmacy tonight with a bag that will definitely have life-changing implications for me. Starting tonight, I will have to begin giving myself insulin injections. This is the day I have been fearing since I was first diagnosed with type 2 diabetes over five years ago. I had always held out hope that things would never get to this point, but it seems like I have always known in the back of my mind that this day would eventually come.

My first impression upon opening the bag from my pharmacy and looking at what laid ahead of me was… Did I get the wrong prescription? Unfortunately, it seems that what I received from the pharmacy bares absolutely no resemblance to what my Doctor had educated me on the day before.

Instead of a single syringe and a vial of insulin, I instead get a box with what looks like five felt-tip pens and another box full of what look like rubber nipples from a tiny baby bottle. It turns out that the latter are actually very small, disposable needles. The other contains vials of insulin and act as a plunger as well. This is one of the rare times in my life where I actually look for instructions prior to putting something together.

Despite my first impression, this is definitely what I was prescribed. Each of the vials are actually called Levemir Flexipens. Yep, that’s what I am supposed to be taking. Fortunately, a rather large, fold-out set of illustrated instructions on how to use the Flexipens was included. Honestly, without the instructions, I would have been completely lost. This was nothing like I had been shown at my Doctor’s office the day before. Fortunately, they proved quite a bit easier to use than the method I had been shown, which included filling up an empty syringe from a vial and measuring the dosage by reading the tiny lines on the side of the plunger.

As it turned out, measuring the proper dosage of insulin to take was pretty easy. I basically had to turn a “dial” on the top of the Flexipen to a number that corresponded to the dosage I was supposed to be taking. The numbers were much easier to read than the tiny lines on a plunger, which should make things significantly easier.

Attaching the needle to the end of the Flexipen seemed rather complicated at first. It seems as if the design was not so much created for ease-of-use as it was for being stupid-proof. It may take longer to put everything together, but it is impossible to screw-up.

When I finally got to the point where I actually got to see the needle, I was a bit relieved. It was quite a bit smaller than the one I had been shown at the Doctor’s office. It’s still a needle though, and the thought of sticking myself with something sharp still runs completely contradictory to my natural instincts. It’s about as natural as hitting oneself in the head with a hammer. I can’t imagine that many people look forward to this. My life-long fear of needles makes the entire idea almost unimaginable, to be honest. This is a very surreal and somber experience.

After convincing myself that I had read all of the instructions correctly, and that I wasn’t going to accidentally kill myself somehow, I finally arrived at “that moment”. There definitely was no turning back now. I picked a spot to inject on my stomach and slowly injected the needle. It hurt. It didn’t hurt as much as I thought it would, but it still hurt. The instructions told me to hold the needle in for six seconds after I had finished injecting the dosage. Those were a long six seconds. I probably caused myself more pain than necessary by yanking out the needle as fast as I possibly could. I will have to remember that for next time.

I’m assuming that everything went as it should have. I’m still alive, so I couldn’t have messed things up too badly. Still, having never taken insulin before, I am pretty on-edge for the first few minutes. The point of injection still stings a little, but nowhere near as bad as my finger feels after pricking it to take a sample for my blood glucose monitor. In fact, on the whole, I’d have to say that getting stuck with a lancet to draw blood is far more painful than injecting myself with insulin. Now, I’m thinking, why can’t they make sticking myself with a lancet as painless as an insulin injection? I will have to look into that later.

After an hour, I am pretty convinced that I’m not going to die from an accidental overdose or an errant air bubble. In fact, I can’t say as I really feel much different at all. I know that Levemir is supposed to be a long-acting insulin, rather than fast-acting one. So, I guess that my reaction is probably normal. My circulation today is not all that great and my feet are swollen. The injection didn’t change anything, at least not yet. I guess that the first real test will be when I check my blood glucose level in the morning. It has been an exhausting day, so I will let it do its work while I get some much needed sleep.

Day Two

Not much seems to have changed since the night before. My blood glucose levels still hover in the 400’s after I awake. About the only noticeable difference is that I am now suffering from nausea. Although I start out the day needing to drink water every 15 minutes, the need seems to dissipate as the day goes on. As the morning moves into afternoon, it seems that my inability to eat has “paid off”. My blood glucose levels are now down to 276. That may not sound like an improvement, but it’s the lowest reading I have had all week.

Unfortunately, along with the lower blood glucose level has come another possible side-effect. My heart has been beating like crazy all day long, and it’s getting worse. I never attempted to take my own pulse, but I can tell that it is well above 100. My breathing is also labored as well. I’m not sure if this has anything to do with the insulin injections, my diabetes or maybe just the fact that I drank a couple of cups of green tea that morning, but it is physically very uncomfortable.

The thumping in my chest and difficulty breathing are stressing me out. Since I already have an anxiety disorder, this is definitely not a good thing. I decide to take a couple of Ativan in order to calm my nerves a bit. It works, and within an hour the symptoms seem to have abated.

Unfortunately, I am also extremely drowsy as a result of taking the Ativan, and fall asleep well before I am scheduled to take my injection of Levemir before bedtime. I am doing insulin injections at Midnight each night, along with my pills for the evening. As it turned out, I did not wake up until 7 a.m. the next morning to take the injection and pills. Hopefully, this will not mess-up what little progress I have made thus far. Not being a “morning person”, I go back to bed shortly after taking my insulin injection and pills. I will check my blood glucose level after I wake up again.

Day Three

Not much of a change today, other than the fact that I have become increasingly conscious of how much my high blood glucose levels have affected my overall health. My circulation is obviously quite poor at the moment, with numbness in my feet being a regular event. Also, I have had an increasingly difficult time catching my breath after even modest amounts of exercise. Just walking to my mailbox is becoming increasingly difficult. Heart palpitations seem to follow even the simplest of chores around the house. I remain hopeful that the Levemir will eventually bring my blood glucose levels back to normal though. Today’s levels did not go down, but they did not rise, either. I am getting a bit more used to the procedure of injecting insulin, though I still find it a very awkward and clumsy experience.

Fortunately, the nausea I experienced yesterday seems to have subsided. I seem to have short periods when I become very thirsty, but it isn’t lasting all day long, as it had been. That also means less trips to the bathroom, thank goodness. I’m completely exhausted by the end of the day, despite not having done much at all. I definitely need some recovery time. My body has absorbed a lot of punishment over the past few weeks, and I really need some downtime. Hopefully, I will be able to get some over the weekend.

Day Four

Day four brings much of the same. I am surprised at how far my blood sugar levels are swinging, despite sticking to a diet that is extremely low on the glycemic index and practically devoid of sugar and simple carohydrates. For the most part, I have been eating fruits (most fresh, some canned), steamed vegetables (brocolli, cauliflower, carrots), a turkey sandwhich on stone-ground whole-wheat bread, chicken noodle soup and sugarless, non-caffeinated drinks throughout the day. Sill, my blood sugar bounces from the mid-200’s to the high 400’s.

This is the first day that I have started reading the book The Easy-To-Use Glycemic Food Index. I am hoping that it will help to spot some of the foods I may be easting that are contributing to my high blood glucose levels. The first revelations that I run across is on oatmeal. Apparently, most forms of oatmeal are high on the glycemic index. This includes one of my favorites, which are traditional, whole grain rolled-oats. These are apparently excellent in combating high cholesterol, but are bad when it comes to raising blood glucose levels. Similarly, the only remaining cold cereal that I still eat is also on the list… Cheerios. This makes sense, since it is mostly made of oats as well. I will either have to avoid these foods, or use them in much greater moderation in the future. Sad, because I always considered these delicious, as well as healthy, snacks.

Day Five

My return trip to the Doctor is tomorrow, so I am growing increasingly anxious, looking for some sign of progress. Again, little has changed though. I am sticking much to the same diet, other than having added some milk. Probably not good, but the new Glycemic Index book I just finished reading seems to be much kinder to dairy products than I had originally anticipated. I figure that I might as well give it a try.

After several days of bed rest, I finally feel well enough to walk around for a bit and manage to make it through taking a shower. I had been getting winded too easily to walk down the stairs to take a shower much of this past week. I seem to be feeling slightly better today, at least. I haven’t checked my blood glucose since this morning, when it was in the mid 300’s. We’ll have to see if things have actually improved since then.

Day Six

The morning starts out normally enough. My sleep was intermittent last night, and I will most likely take a nap sometime later today. I managed to take my insulin and pills (Metaformin 1000mg twice a day) exactly on-time last night, which I hope will help. One small concern I do have is that I accidentally forgot to place the Levemir Flexipen I used last night back into the refrigerator. I was asleep for a couple of hours before I woke-up again and realized my mistake. I will have to ask my Doctor later today just how important it is to keep the insulin refrigerated once it has been opened. Seeing as the flexipen is more or less re-sealed after every use, I’m hoping that it will not be too important an issue. The unused Levemir Flexipens I have are unrefrigerated, as that is how I received them from the pharmacy. Only once opened did the instructions say to refrigerate them.

I was able to schedule my Doctor’s appointment for fairly late this afternoon, at approximately 4:30 p.m. Since they close at 5 p.m., I imagine that I will be the last patient of the day, or close to it. This will hopefully give me a chance to get some more rest prior to going in. Although I have a bit more energy than I have had during the rest of the week, my blood glucose levels are still out of control, and I am definitely nowhere near feeling “better”. My condition fluctuates throughout the day. I woke up with a blood glucose monitor reading in the low 400’s earlier. Later on in the day, I hope to install some software on my computer that will allow me to more accurately track my blood glucose levels. I purchased the software and data cable for my OneTouch Ultra blood glucose monitor some time ago, but have not yet had a chance to install it. I will try to do some screen captures to post to the site later on.

Day Six – The Doctor’s Visit

I am actually writing this the day after it happened, since I was a bit to stressed out to write about it last night. The Doctor’s appointment did not go well. It seems that my blood pressure was unusually low, my heart beat was rapid (somewhere between 100 and 120 bpm) my blood glucose was still high and I was having difficulty catching my breath. The Doctor strongly suggested that I go to the local emergency room for tests. I decided (rightly or wrongly) to skip the ER and come back the next morning, when there would be more time to run tests. In the meantime, she had told me that she suspected that I may have pneumonia and that I was severely dehydrated, probably due to my blood glucose being so high. I stayed up the entire night drinking liquids to rehydrate myself and get my blood pressure back under control. It was a long, long evening.

While I was home, I decided to be productive and do some further reading on the subject of diabetes and dehydration. As it turns out, out of control diabetes readings can cause dehydration to reach a level that is dangerous enough to be fatal. High blood glucose levels force you to urinate so frequently that it is very difficult to keep up with the fluid loss. I had thought that I had been drinking enough liquids to compensate for this. Obviously, I was wrong. This could have been a fatal error in judgement, had I not seen my Doctor that day and gotten a handle on what was going on.

In the event of dehydration, the consensus seems to be that the best treatment is the use of IV fluids. Apparently, the body is able to absorb these fluids via the bloodstream much more efficiently than simply ingesting liquids orally. As I did not have an IV drip at home, I was forced to improvise. I was able to Google information on how to create a type of oral saline solution that would be absorbed by the body better than plain water would be. The information also said to add sugar to the solution as well, but with my blood glucose levels as high as they were, I didn’t want to push my luck. I was also hoping to lower my blood sugar levels through rehydration as well, since the more water was in my bloodstream, the less the concentration of glucose. In effect, “watering down” your blood should make your blood glucose levels drop.

The effort seemed to work, to a limited extent. I was able to bring my blood pressure back to normal within 4-6 hours. My blood glucose levels had dropped, but not by much. My rapid heartbeat was still a problem though. I planned on calling my Doctor that morning to set-up a follow-up appointment. The rest of the evening, I continued drinking fluids and eating what was probably the strictest diet I have had in years. It was mostly vegetables like spinach, celery and cauliflower. Along with them I added low-salt chicken noodle soup, chicken broth, peanuts, peanut butter and a banana. I’ve since learned that the latter is probably not a great choice while on a diabetes diet. From now on, I will make sure to keep my banana intake to one a day, at most.

Day Seven

Before I had a chance to call my Doctor, she actually called me at home to see how I was doing. She scheduled me to have a chest x-ray done at a lab that morning and an appointment at 9:30 a.m. I felt very fortunate to be able to get back in so soon, since I know that she has a very busy schedule. The chest x-ray went fine. The rest of the morning was spent “fixing me up” at the Doctor’s office. First, the results of the chest X-Ray showed no pneumonia. Blood and urine tests showed no signs of infection. My blood pressure was stabilized, but my Doctor did not want me to leave until my pulse rate had come down. I ended up being put on an IV drip for the next hour or so. While I absolutely hate being stuck with large needles, this was something I definitely needed to rehydrate.

After an hour, the IV drip had completed. My pulse had stabilized and slowed down considerably. An EKG reading showed that my heart was doing o.k. Some lab work was still pending, but it looks as if the crisis has ended and I can get ready to go home.

One final thing… Insulin. Obviously, the once-a-day insulin injections of Levemir I was taking were not controlling my blood glucose levels well enough. My Doctor told me to take the same dosage (16 units) twice each day from now on. That should be easy to remember, at least. I hope that this will be enough to bring my blood glucose levels under control. I’m scheduled for another appointment next week. Let’s hope that the Levemir does its job this time. In the meantime, I have decided to do more research on what foods should be added to, or eliminated from, my diet.

Between talking to my Doctor, reading books and getting advice from some reputable medical websites, I’ve come to the conclusion that both oatmeal and Cheerios need to be cut from my diet. I had been under the mistaken impression that their high fiber content would make it a good choice for a diabetes diet. Unfortunately, that is not the case. It rates very high on the glycemic index. One food that I have almost completely eliminated from my diet is milk, which it turns out isn’t anywhere near as bad as I thought. My Doctor actually recommended my adding it to my diet. Works for me. Without Cheerios, I’m not sure what I will use milk for though. I will try to see if there are any breakfast cereals that are healthy for diabetics. So far, most of them seem to be extremely high in sugar and/or very high on the glycemic index. I’ll keep looking though.

Day Eight

It’s a Wednesday, and I finally seem to be having a non-eventful day, for once. Unfortunately, one event that I WAS hoping for hasn’t materialized. Despite having doubled my prescription of insulin, my blood glucose levels have still not stabilized. In fact, they don’t seem to have gone down at all. Today’s high was a whopping 402. The low was 269. Not good.

I know that Levemir is supposed to be long-acting insulin, but I should have seen at least some results the first 24 hours, especially considering the highly restrictive diet I am on right now. If things do not improve at all by tomorrow, I am going to contact my Doctor again. I do not have another appointment scheduled until next Tuesday, which seems like a long, long time away at the moment.

At least my pulse and blood pressure have stabilized. For the past year or so my blood pressure has been slightly elevated, but not to the point where I have needed to take medication for it. Things seem to be back to normal in that regard. My pulse was down to 75 last night. I am about as calm as I can be, considering the circumstances. I have been able to get a little bit of writing done over the past couple of days, but I am still nowhere near feeling well enough to work a normal schedule, let alone MY normal schedule. Let’s hope that things get better tomorrow.

Day Nine

Things have gotten better… Slightly. I no longer seem to be getting blood glucose readings in the 400’s anymore. My average for the past couple of days has been in the low 300’s. It’s obviously still way too high, but at least it’s getting better.

I planned on talking to my Doctor today about my continued high blood glucose readings, but she is not in the office today. Looks like I will have to wait until at least next Monday to talk to her. My appointment is scheduled for next Tuesday. It will be a long weekend, for sure. Unfortunately, my health seems to have an odd habit of taking a turn for the worse during the weekends. Go figure. The practice is open on Saturdays, at least. So, if it gets any worse, I can at least see someone there. Sundays are unavailable though. That’s just the way things are in a small town.

My blood pressure seems stabilized, although my pulse is a bit higher than it was. It seems to be running around 90 bps. That may very well be due to dehydration, since I tested it shortly after waking up. Funny thing about sleep… my body definitely needs it, but I’m not able to drink any water while I am asleep, so it is easy to become seriously dehydrated if I sleep for very long. I used much of yesterday to catch up on my sleep, so I’m sure that my liquid intake was insufficient. That may also account for the serious headache that I woke up with this morning.

My appetite is unusually low today. Perhaps it is because of my headache. I will take some Ibuprofin to see if it helps, but I expect that rehydration will probably do more good. Thus, my most important goal today is to drink more water. I wish that the Levemir was doing more to help. There’s not much I can do at this point though than watch my diet, try to get in what exercise I am capable of doing, and drink a plenty of liquids.

I did quite a bit around the house today. Probably, too much. I ended-up becoming very short of breath and experienced some minor chest pains as the afternoon wore on. Blood glucose levels are about the same during the evening. I went to bed early. Even a little bit of work is exhausting at this point. Still drinking plenty of fluids. My heart rate is not down though. As long as I stay laying down, I am comfortable. I am not sure how long I can keep going on like this though.

Continue to Part II >>