Do you remember when it all began?

I was really caught short the other day. Spending most of my personal time around diabetics who know the score, I was faced with my neighbor’s mother who had just been put on insulin and was scared witless to give herself a shot. She asked if I would lead her through it so she didn’t make a mistake. She was using an insulin pen, which I do not use, so I had to read the instruction sheet right along with her. In doing so, I realized just how confusing and daunting this can be.

First there was the screwing in of the pen needle. Do you do that while it’s still in its protective plastic case or liberate it first? I still don’t know. Then there was the actual slipping off of the needle cover to expose the slinty steel thread. Then the priming: tap the exposed insulin cartrige a few times – how many is a few times and what exactly are we looking for? Carol was looking for something while I figured this was just about sending any air to the top of the cartridge. But how would she know that? And I saw she took pains to tap the cartridge in a particular way as if tapping otherwise wouldn’t be right. Then you’re instructed to dial a dose of two units to release any air in the cartridge. With this motion one should see a drop of insulin escape from the needle. Well, I did, but Carol didn’t because at that point she told me her vision’s not very good and she wasn’t wearing her reading glasses which would probably help. Oy, I thought, we’re dealing with units of insulin and your vision’s not very good? And being as nervous as you are about this, you’re not wearing glasses? Is this denial?

OK, air test performed and I ask Carol how many units her doctor said she needed to inject. She looked at me confused and said, “Doesn’t it say on the instruction sheet?” Yikes, power outtage of the mind, total disconnect, no apparent understanding that you dose for your needs based on food, exercise, blood sugar count. But I can’t blame Carol. She doesn’t know what she hasn’t been told, or what hasn’t been clearly communicated. Whereupon I see what a major breakdown we have in our medical system. You need to manage this disease, yet probably millions of people with diabetes are walking around with no information, misinformation and totally unprepared to take it on. Hmmm…doesn’t bode well for rising medical costs or the millions who’ll find themselves in hospital beds in years to come, as one diabetes educator expressed to me. So, we held off the injection till Monday when she could ask the doctor how much insulin she was to take.

Monday night I ran down to her apartment to guide her through her first injection. She answered the door in a T-shirt and no pants. I was about to say, “Do you want to put on some pants?” when I realized she was thigh-exposed for her first shot. How foolish of me not to infer this, but then I shoot through stockings, jeans, and usually just tuck up my shirt and go right through my abdomen. Anyway, within 5 minutes I had guided her through her first injection, her shaking hands steadied and she put that pen in that naked thigh like a trooper, hit the button, and because she told me she heard the click, extracted it quickly only for me to see that the dose button had only dialed down from her dose of 8 units to 6. So I instructed she put the needle in her thigh again, click the button fully, wait 5 seconds and then extract. She was loathe to do it, not because it meant sticking herself again, but she’d been clearly told not to use a needle twice. Wow, since I use my syringes a week or two before changing, I saw again the long journey from novice to old-hand. In again we went and out. This time the full dose dispensed. Mazeltov! Success, and she was smiling. Her high pitched shaky voice calmed to a quiet gleeful whisper and a new insulin-dependent diabetic was born.

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