Speechless and Furious

Warning: this could be a long one. I have posted a few times in the past couple of days about some issues Vince is having in keeping his blood sugar under control. This is the first time in 31 years that he has pumped himself full of insulin, on the hour, way more than ever "prescribed"' and the sugar remained high with no explanation. Well, it seems after a trip to the ER, and loads of tests all showing up negative, we figured out what was wrong. Thanks to a great ER doctor who took 10 mintues to look at my husband.

About two weeks ago Vince visited our family doctor for some wheezing problems. She went over all of his medical history, asked again how long he has been Type 1, and took down his medications. She proceeded to say, after examining him, that he must have developed asthma and prescribed two inhalers to him. One inhaler was a steroid, Flovent, to be taken two puffs, twice a day. The other was albuteral sulfate, Proventil, to be taken a few times a day at first, and then only as needed. So for the last two weeks, he followed the instructions he was given and the wheezing stopped and all seemed to be well. On Friday, about 72 hours ago, his sugar began to creep up to the 200-300's, and he couldn't get them lowered. This is very unlike him. He has always been able to control his highs when they happen, even when he is sick with a virus. So we did a site change about 3:30 Saturday morning. Saturday evening we decided to try another site change to a brand new location (his back) and got out a brand new vial of insulin. By Sunday morning, we knew something very bad was going on. He has never been this uncontrolled, ever. We called the Endocrinologist Sunday morning, and he said it sounds like an absorption issue. He said try a higher temp basal or try using the insulin pens for an injection in addition to the pump and see if that makes a difference. Throughout the day on Sunday, we continued to pump him full of insulin almost on the hour. He ate a sensible dinner. For this dinner, he would have normally taken 15 units of insulin. He instead took 35 units in hopes he could control the carbs he just ate. Two hours after dinner his sugar continued to rise, but at a faster rate. This is when we got out his insulin flex pen from the refrigerator and he gave himself a regular injection of another 10 units. We decided to wait one hour and if that injection did not work, then we would call the doctor again and ask if we should go to the ER. So at 8:30PM, we phoned the Endocrinologist and he agreed we had done everything possible and that there must be something seriously wrong like an infection of some sort. Keep in mind, aside from feeling crappy from the high sugars all weekend, Vince had no signs of any infections or other problems. So I gathered up a site and sensor change supply kit, (in case they made him remove his) and off we went to the hospital. We checked in just before 9:00PM. They got his vitals, checked his sugar and took down his list of medications. When Vince told him he was going to take some more insulin, they said okay and recorded it on his chart, but mumbled something to the affect of, "it's probably not doing anything but go ahead, since you probably know better than us" Keep in mind these were just the triage nurses. Vince and I both knew that even though the numbers weren't not going down, the insulin was stopping them from going to a severely high level. As we waited in the waiting room for the next 5 hours, they took all of the broken arms and flu patients and insisted we needed to just wait. We were getting livid at this. People would wait 1 hour and would get taken right back. We just sat there hour after hour thinking Vince must have an infection, kidney failure, or even worse: we both thought maybe it could be cancer! We didn't know each of us thought this same thing until later when we joked about how we were freaking out at the unknown of what was wrong. When you know all is well, you can only laugh right? A quick side story, while we were in the waiting room watching the people come and go, and walked in what appeared to be a Type 2 patient in a weak episode who lost her meter at home. She came in saying she was having stroke symptoms, and it turned out she was having a low episode and was being "silly" from it. Made us chuckle to see it and know she just had to get some OJ, which she did, and then walked out. Anyway, about 1:30 or 2:00 AM we were taken back and we explained what had been going on and said that the Endo told us to come in. They did blood work, urine check, chest x ray, EKG, and checked his entire body for any possible infections that we missed. They looked over his medication list and came across the Flovent inhaler. They asked when Vince had started using this, and we explained the wheezing from two weeks prior. They proceeded to tell us that people with Type 1 cannot be on steroids for an extended period of time, since, unlike Type 2's, they cannot fight against the raise in blood sugars. They explained that over the past two weeks, the steroids had built up in his system, and when that happens in a Type 1 Diabetic, it can cause the blood sugars to soar high with little chance of control, no matter how many units of insulin you pump into your body. We couldn't believe his family doctor would ever give this to him. I even asked her and the pharmacy about 3 times each, if this medication was okay to use with all of his other meds. This is something I always ask over and over because you never know...she assured us this was safe for him to take with the other medications and failed to mention he would end up in the hospital from it. So the ER doctor gave him a bunch of IV fluids and said that should help. We had no clue how but hey, if it helps, then go for it right? I asked if they were going to admit him, as they mentioned before they realized what was wrong, but they said no, since there is nothing they can do until the steroids are out of his system. They sent us home and said give it until Tuesday, tomorrow, and the steroids should be out of his system by then, and the sugars should go back to normal. Here it is Monday afternoon and they are already improving. 

I had asked the ER doctor what Vince should take since he is wheezing and needed the inhaler. He said the second inhaler that was given to him, Proventil, was much more safe for Type 1 Diabetics, and that he should only use that one. So...needless to say we will now be shopping for a new family doctor, and will not be seeing Mrs. Idiot who could have put Vince in kidney failure if it wasn't for us dosing him with insulin every hour for the last 72 hours. We were furious that she was so dumb to prescribe him this medication. Lesson learned, never completely trust what the doctor says.