Thursday, November 1, 2007

Gluca-GONE.

It's Move-In Day, Day 2. I am trying to rub the sleep from my eyes. Matt and I were snuggled up in bed all night, happy to finally be here, and now we are just waking up, discussing plans for the day. Unpack? At least a thing or two. Lunch? Double T Diner, down the street. Moving truck? Take it back sometime tonight.

We are joking about something or other, wondering when Nigel's work shift might end, when Matt's cell phone rings. It's his mom. My mother-in-law, Janet, is notorious for practically yelling into her cell phone, so I could hear most of the conversation she was having with Matt. She asked how the move went, the usual questions, then she said, "Well, actually what I was calling about was more of a question for Hannah." Then she started asking him something, and Matt said to her, "I'll just put you on speakerphone." So he did.

She then recounted to us what had happened to her the night before. She was out camping with her fiancé, Dan, who has diabetes. Now, I don't know many more details about his D situation. I don't know if it's type 1 or 2, but I do know he takes Novolog and Lantus, because I've seen pens of both in Janet's fridge. They had gone home to watch the Penn State game, then returned to their campsite in the RV. After being back at the campsite, Dan had an extremely low blood sugar and went into convulsions.

Janet said he was unable to swallow, and she didn't have any kind of liquidy-type sugar that she could just put under his tongue, so she was chewing up glucose tabs and rubbing that on the inside of his lips! Then, she ran out of glucose tabs and had to go get some chocolate from a neighboring RV. Dan's son was with them, and she gave him a cell phone to call 911, but since they were all out in the boonies, reception wasn't an easy thing to get. She told him to just keep walking until he got reception. I think it took half an hour to 40 minutes for the paramedics to arrive!

She said he at least wasn't convulsing and was more responsive by the time help arrived and gave him some glucagon.

Janet also mentions this isn't the first time this has happened.

I wanted to jump up and yell, "Oh my GOD, why doesn't this man own a glucagon kit of his own?!! Don't you know how important that is?" But I knew that wasn't the answer. She'd need to be convinced more gently, and maybe at a different time. We talked about how she or Dan could carry fast-acting glucose gel or liquid, or even a tube of CakeMate icing would work in a pinch. That's what they always told my Mom to carry for emergencies when I was little. I could have lectured Janet on how important it is to have and know how to use a glucagon kit, because what if the chocolate wasn't working or what if the paramedics would have arrived in an hour instead of half an hour?

But it was what she said next that made me remember not everyone is educated about their significant other's/spouse's/family member's diabetes. She essentially said, "Well, his doctor said Dan's A1c was pretty good at his last appointment, so why would he keep having these blood sugar problems?" I went on to explain that A1c, for the most part, is a number that averages you glucose levels over a period of time. They could all be normal, or they could be just the right mix of highs, lows, and normals to get the magic number.

If Dan's glucose reading was 235 before dinner, but then 25 while he was having convulsions less than two hours later, maybe he took too much insulin. Overcorrected, or didn't count his carbs right. Maybe his insulin ratios are just wrong.

"There are so many reasons why his blood sugars could be up, then down," I told Janet. I notice Matt is smiling at me, obviously proud of how well I could discuss these matters. Janet mentions what Dan's doctor said about the A1c again. It dawns on me. "Is Dan's doc an endocrinologist or a specialist, or is this just his general practitioner?"

I find it's Dan's primary care doctor. He doesn't see an endocrinologist, an internist, or a diabetes educator.

I tell Janet that maybe they need to talk about getting him to a specialist. He needs to see someone who is more skilled at analyzing ALL of Dan's numbers, so incidents like this can be better prevented.

It must have been scary for Janet. I'm sure if anybody has any pointers that I can pass on to my mother-in-law, she'd be appreciative. I haven't heard any more on the situation since we first moved in, but I've been hoping we can catch up about it soon.

The thing that I find the most odd is that even his regular doctor didn't know to prescribe a glucagon kit in case of emergency! I've had primary care doctors refuse to write me a script for test strips or insulin because they knew I was seeing an endocrinologist, but I'd think if I only had one doctor, they should know what's best for me in all situations!

That, in itself, is a kind of unsettling thought.

5 comments:

  1. I'm always kinda surprised when I hear about someones spouse not really knowing much about their partners diabetes. It's even more surprising when I talk to diabetics and they themselves know very little about their diabetes.

    I talk to a lot of diabetics. They basically fall into two groups. Diabetics that I have met online that frequent diabetes message boards and blogs or actually have a diabetes related blog themselves make up the first group. This group is sharp when it comes to diabetes. They have goals for their blood sugar and a plan to get there. They understand the different treatments that can be applied and overall have a great deal of information stored away about their disease.

    The second group is diabetics that I just run into in my daily life. There couldn't be a more stark contrast between this group and the afore mentioned one. I have been absolutely horrified after having a conversation with some people I've met. You have to wonder if their doctor is just not giving them the info they need or if they just don't want to seek out answers for themselves.

    At any rate I always worry about people like that after we talk. I was so sick when I wasn't controlling my diabetes properly and I feel bad that these folks may have to go through something similar. I always try and give some helpful advice but you can just tell sometimes that they aren't going to take it. Too hard to check blood sugar 5+ times a day. So what if I skip this injection? It won't kill me. I have all the time in the world, I will control my diabetes tomorrow, and if not next month.

    I would also like to say that the above is a gross generalization. I don't actually believe all people that blog about diabetes have a good grasp on what it takes to control it. Thats silly. I also don't believe that every diabetic that isn't out there blogging and taking part in JDRF e-mail campaigns is destined to have complications because they don't know what they are doing.

    What percentage of diabetics would you say take it as seriously as they should in your opinion?

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  2. Mike--Personally, I feel like I am somewhere in between your "online diabetics" and "real-life diabetics". I think I have a pretty good grasp on what I should be doing, and keeping a blog is helping me to actually do it. I am getting over a few years of rebellion, and now that I feel I've come into my own as a person, now I should come into my own as a diabetic.

    I think the percentage of people who take diabetes seriously is probably not as good as it should be. I'm hoping it's at least 50/50, but you know there have to be a lot of folks with diabetes out there who think they're doing a great job when they're really not. Because, Lord knows, sometimes I think I'm doing a TERRIBLE job, and then it's really only a rough patch that I get over a short time later.

    I don't feel that there's a good barometer out there for diabetes care, and maybe someone needs to think about that.

    My mom-in-law's fiance seems like a laid back, quiet guy, so to me he's probably the kind of dude who just doesn't want to worry other people with the details of his diabetes. I can understand that, but there are times when one must draw the line, especially when your own life could be at stake. There's a difference between a "no big deal" low blood sugar, where you have to drink some juice in the middle of an activity, to an episode that requires Glucagon without a kit in sight! Haha, I'm not saying Janet needs to be the diabetes police, but Dan's care sounds like it could be a lot better and much more informed.

    I'm beginning to think Dan has type 2, and that his primary care doctor thinks he can manage somebody who has "a touch of diabetes". I blame the small, rural area where Dan lives. If his doctor was in a bigger town nearby, like Williamsport, where I'm from, or State College, which isn't far, I think his diabetes care would have been a different story.

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  3. Wow. How scary. I've never had a low like that, so I can't really imagine convulsions. Maybe that is why I (gasp) don't have a glucagon kit. I know it's silly, being type 1 and having low blood sugars often. I really need to get one, for safety's sake. I know I blessed that after nearly 19 years with t1 diabetes, I've never needed one. I did have one when I was younger, but to be hoenst, I don't know where it went since I never used it. I carry sugar or glucose tablets or juice for low 99% of the time, but I'm bad with the glucagon kit.

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  4. "I don't feel that there's a good barometer out there for diabetes care, and maybe someone needs to think about that."

    You hit the nail on the head. I have been thinking about this lately. I think it boils down to the people on the net are more informed because they sought out answers instead of ignoring diabetes or just taking their doctors word that the treatment they are pursuing is the best.

    Thats the rub though. How do we get the vast amount of information we have actively sought in front of people who may not know they are doing anything wrong or have decided it's best not to think about such things?

    Heh, I know it sounds kinda lame but I have actually considered making a religious style pamphlet about the insulin pump and leaving it at my general practitioners office. If you don't go to an endo you probably don't even know about the pump or have many questions your general can't answer. It could answer basic questions and direct the reader to some on-line sites that have helped me sort things out.

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  5. Holly B9:23 PM

    when I used to ride the ambulance, there were people with low blood sugar and they didn't have those kits. i wish they did, cause it's a good idea. but i guess im preaching to the choir. thanks for sharing about yourself, its cool to learn some more about you.

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