Jan 22, 2008

Setting Priorities: Diabetes Doesn't Always Come First

Jan Chait

In the middle of an interview with a surgeon, my continuous glucose monitor vibrated. I reached into my pock… (OK, it was my bra, but it was the only "pocket" I had) and took it out to tell it: "Yes, I know my blood glucose is higher than you like, but you'll have to wait for me to fix it."

A couple of minutes later, my insulin pump went "deedle, deedle, deedle," so I took it out—of a holder clipped to my waistband this time—and pressed the appropriate buttons.

Well, there went my professional demeanor.

At that point, I felt obligated to explain to the doc what was going on. These new-fangled medical devices are great if you manage to do your part to keep them happy.

What started the whole thing was a failure on my part to put insulin in my pump when it first alerted me. Nope, I pressed a button and promptly forgot about the insulin level being low.

Later, I was sitting in the waiting room at the orthodontist's office, waiting for my grandson to get his bands and wires on, when I kept hearing somebody's ring tone and wondered why nobody was answering the phone. Turns out it was my pump, telling me—again—that it was low on insulin.

Nothing to be done about it then, so I figured I'd run by my house and fill 'er up between Grandson's appointment and my interview.

But Grandson seems to have started a tradition: Get out of orthodontist's office and go for a milkshake. Which ate into my time to go home...and raised my blood glucose. (Because strawberry-banana frozen yogurt shakes are good, is why.) But I would be going home and filling up my pump, right? Wrong. I ran out of time, and would have even if I hadn't stopped by the pharmacy to pick up a prescription.

So there I was, in the surgeon's office, when the dominoes began to fall. Since I hadn't taken insulin for the frozen yogurt shake, my blood glucose inched over the "warn me if I get higher than this number" line. And insulin pumps are, of course, inclined to keep pestering you until you feed them more insulin.

To add to my previous discrepancies, I didn't have the requisite emergency syringe and insulin I'm supposed to be carrying with me. (Or at least a syringe to suck up some of the insulin in the neck of the reservoir.) After all, I was in town and not that far from home. If only I'd had the time to drive to my house.

If you haven't figured out by now that I'm not perfect, what planet have you been living on? To recap:

• I ignored an alarm that my pump was getting low on insulin. In my defense, I'd like to point out that I still had sufficient insulin in my pump to supply my basal needs for a few hours, as long as I didn't eat anything.
• I then proceeded to have a milkshake. Frozen yogurt shake. Whatever.
• I didn't have emergency supplies with me. That's something that I'll need to remedy and not assume that, since I'm in town, I'll have time to go home and take care of things.

But why did I consume a milkshake when I knew I didn't have enough insulin in my pump to keep my blood glucose down? It was a matter of priorities: a choice between being a "diabetic" and being a grandmother. I've learned that, when a teenager takes the earbuds out and asks to spend some time with you, that choice takes priority—especially if it is at least minimally harmful in the long run.

On the one hand, my blood glucose was going to go over my goal, but I knew I could correct the high before a lot of time had passed. My belief is that diabetes complications stem from consistently high blood glucose, not from brief excursions.

On the other hand, when a teenager asks you to spend some time with him, it's a mirac...er, a chance to connect. It shows that child that he—or she—is important enough to deserve that most precious of commodities: your time and your undivided attention.

Our lives are full of decisions—decisions about our diabetes care, our careers, our leisure time, our families, and the interactions among the different aspects of what makes us a whole person.

Admittedly, I may not have made the right decision about adding insulin to my pump, but I think I made the right decision about having that milkshake.

I remember that my grandmother had diabetes, and that she took care of it the best she could, given the circumstances of the day.

However, that's secondary. What I remember most is our conversations and that she was always ready to listen to me. That's the kind of grandmother I hope my grandchildren remember, too.

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Living With Diabetes

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