Today is the 105th anniversary of the discovery of insulin.
About five weeks ago, I started on a concentrated version of insulin that’s essentially “double strength,” so that I could take fewer units of that miracle hormone and therefore put less daily stress on the cannula insert area. I had a great care team lead for once who has really tried to work with my “no trends” numbers, so I was feeling excited.
A week and a half before the switch, I found out he’d gotten a job elsewhere and left without a trace, and now my big switch was to be handled by people I had never met, one of whom had never presided over that specific medication change. It was, to say the least, disheartening. Worse, they had to push my appointment back.
Since I had already ordered the new insulin, my insurance wouldn’t let me order the old kind–and I was going to run out, now, a day before the switch, and I wasn’t allowed to switch by myself. Thankfully, you can order insulin over the counter and it was only $45 for a vial (most of which will go to waste, now), but what if I didn’t have it? Rationing or skipping insulin kills.
When I got to the hospital for the appointment, I had to explain to one of the nurses in charge of my health, a woman in her 60s, the basic functions of how my insulin pump worked. While I love teaching hospitals and I am an educator by profession, it did not inspire confidence. But the switch was made, and the dosages cut accordingly. Everything was done clearly, and correctly.
And at 2am, with my beautiful new supercharged insulin, I almost died anyway. It worked too well.
A non-diabetic in Canada should have a blood glucose level of 4-7 mmol/l, depending on time of day and what you’ve eaten. For diabetics, the ideal is 4-8 with up to 10 after meals (that is *ideal.* Reality is regularly extremely different). Anything lower than 4–even 3.9–is cause for concern. Anything lower than 3 is a bright red warning sign. It can lead to seizures or unconsciousness. You can not wake up. The lowest I’ve ever been is 1.7, but that was mercifully brief. (Most meters don’t even read that low.) When your blood sugar is below 3, it’s literally like you can feel your life force draining away, while professional soccer players kick the shit out of your muscles. Even when you come back up, the effects can last for a day.
I was between 2.1-2.3 for more than two hours. I could not bring myself up, no matter what I ate or drank. I have been diabetic for almost 30 years and I have never gone to the hospital. I did not want to wake anyone up. Ten more minutes and I would have had to.
In the weeks since, I’ve managed to get things much more balanced. I feel the switch was, on balance, a great choice. I’m no longer burning through expensive supplies at a furious pace.
It’s a constant reminder that insulin is a 105-year-old treatment, not a cure, and that too much can quickly become even worse than too little. (Remember: there are at least 42 factors that influence blood sugar, so it’s not as simple as carbs to insulin.) The whole thing has me thinking about the precariousness of care, and the notion that we can be one postponed appointment or one miscalculated dose away from disaster.
It makes me want to fight more for access for everyone, and to feel grateful for what I do have.
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