The State of the Pancreas

I saw my endocrinologist last week. That wouldn’t be such big news, except for the fact that I hadn’t been to his office is almost 3 years. Between life changes, insurance switchings and everything that comes with it, I was always seeing my PCP because it worked well for me. But with the recent turn of events, my pancreas being so cranky and all, I decided it was time to go back to Dr. B and I’m so freaking glad I did.

I’ve always liked Dr. B. He’s personable, he cares about his patients’ mental well being above everything else, and he never gives me the talk about how things are so horrible, I better watch out. He may get frustrated—oh, so frustrated… but he never shows it. After all, it’s not his job to make me better… he’s just there to guide  and advise, but the biggest tasks are mine. So after almost 3 years, he was glad I went back, but not so glad that my diabetes is giving me a hard time.

The most important questions I had when I saw Dr. B were:

  • “Did my pancreas check out?”
    To which he replied that no, my pancreas is probably just overwhelmed and being stubborn.
  • “When do I start with rapid acting insulin?”
    To which he replied that it’s better to let the Lantus do its work and see if my pancreas responds.

So that’s what I’ve been doing, giving Lantus a chance. I’m up to 20 units a day, and my numbers—at least my fasting numbers—are getting better every day. I’m guessing I’ll find the “magic” number of units this week. However, my post-meal numbers are never under 200, and I hope they start behaving soon… (I’m low-carbing, dang it!). Based on my log, in two weeks Dr. B will decide if I need rapid acting insulin or add another medication to my metformin since Victoza didn’t quite agree with my stomach.

Whatever Dr. B says, this thing is no joke… it’s no joke when your blood sugar is 466 and you realize all hell got loose, and you want a quick fix. There is not a quick fix, not in the general sense (I don’t bolus). And it requires work, and tears, and a few swear words… and it never, ever ends.

I don’t know what I think I know

In the 15 years I have lived with type 2 diabetes, I have not had many meltdowns. I have suffered from diabetes burnout, denial, periods of anger, periods of negligence, and overwhelming moments courtesy of the endocrine rebellion I have been subjected to by my body. But I have not cried or thrown pity parties that often. Not the kind of pity parties where I bawl like a baby because I just don’t know what to do and no one understands me. Well, I had a fantastic meltdown last night when I was supposed to start my Lantus treatment. Why? Because I am afraid of hypoglycemia in the middle of the night and not knowing what to do.

Sure, I have dealt with a few lows here and there; my worst one being a 52 mg/dL that came with some disorientation and face numbness. Other than that, my lows are very rare and not that bad—most of them have been “false” lows when my body is trying to trick me. But a real bad low where I don’t know where I am or what to do? Nope, I don’t remember that, and I am terrified.

Now, we are talking about basal insulin, the one that has a long lasting action and a starting dose of 10 units. Insulin veterans must be laughing at me. But hey… I have never used the stuff before, and my body may get crazy, you never know. I have gotten mixed stories; people telling me they were OK, people telling me that they went really low, etc. I guess we are all different, but I think my fear comes mainly from the fact that I am supposed to do bed time Lantus, I am alone at night because my fiancé works 3rd shift, and I don’t think I can rely on my cats to help me that much.

After expressing my fear to a few people, one of them actually told me something that surprised me. She said I should learn everything I can about hypoglycemia and go from there. Now, wait a minute… I thought I already knew everything I can about hypoglycemia. Are you telling me I have to do the Hypoglycemia 101 course all over again? And if that is the case, does it also mean I have to relearn everything I think I know about diabetes? I guess I will have to go all Socrates… ipse se nihil scire id unum scia… I know that I know nothing. 

But I will be brave tonight, and I will take my Lantus. I am prepared with an alarm clock to test in the middle of the night, a bottle of glucose tabs, and juice boxes. What I need now is to keep on being the same brave human being I have always been and grab this insulin fear by the horns. I am sure my pancreas will thank me.