The husband above.
I panicked. Just around midnight. Minutes after I took my once nightly injection of my long-acting insulin.
Had I taken my once nightly shot, twice?
Like others with type 1 diabetes who don’t use an insulin pump, I take what’s called MDI. Multiple Daily Injections. I take an injection of rapid-acting insulin before meals and snacks to lower the rise of my blood sugar produced from carbohydrates.
I also take an injection of long-acting insulin once a day for the background metabolic functions that require insulin.
For years I took this once daily injection at 9 AM. But when I switched my long-acting insulin, from Lantus to Toujeo recently, taking Toujeo at night seemed to work better for me. Now I take it every evening at 9 PM. Yet, this habit isn’t really fully formed yet.
It was easier to take my once-a-day insulin in the morning. I’d take it at the same time I took my rapid-acting insulin to cover breakfast. But there is nothing to remind me to take my 9 PM injection.
So I’ve written it onto my computer calendar. It’s there in the box every day. Well, every night. Of course this does require me to be behind my computer at 9 PM to see the calendar alert. Sadly, I usually am, but that’s another story.
Last night, though, from 8 to 10 PM I was watching a movie on my iPad sitting on the couch. Chances are my calendar alert came up on my iPad but, watching the movie and intermittently Facebooking a friend, I likely didn’t see it.
Yes, the horrible dopamine of social media and multi-tasking had kidnapped my diabetes-tasking-mind. But I was trying to do a good deed. My “friend” had asked, “How do I adjust my long-acting insulin for flying to Germany?”
Of course this should have reminded me to take my own insulin injection. And, maybe I had. That was the problem, now at midnight. I couldn’t remember if I had. Please, no sneers, life with diabetes is tough enough.
Reviving myself from my near slumber, I ambled into the kitchen where I keep my long-acting insulin pen. I stared at the pen begging it to answer my unspoken question, “Did I stick you in my body just a few hours ago?”
When I’m not certain I can usually answer that question by remembering where on my body I injected. If that doesn’t work, I try to remember where in my apartment – in the kitchen, in the bathroom, on the couch? I was coming up blank.
When I was using Lantus, I relied on a Timesulin cap to keep track for me whether or not I had taken my shot. Timesulin is a pen cap with a counter in it. I always knew how long it had been since my last shot. Simple, yet fantastically effective.
But Timesulin doesn’t make a cap for Toujeo. And while I was using my Timesulin cap on an old Lantus pen, “shadowing” my Toujeo injections, the cap’s battery had run out just three days ago. I was in the process of getting a replacement.
Standing right at the fork of do I or don’t I, I dialed up my dose and injected. If this was my second long-acting shot of the night, I would have double my dose of insulin in my body for the next 24 plus hours.
This month I’ll have lived with type 1 diabetes forty-four years. Yet, for anyone who has it, we know every day is a new day.
Years in don’t prevent making a mistake. Or being at risk every day and every night for taking too much insulin. Leaving you wondering, as I was now, if I was about to overdose in a few hours and not wake up. Trust me, that’s a terrifying feeling.
Immediately after I took the shot, I googled, “Who has double dosed their basal insulin?” “What do you do if you take two long-acting shots by mistake?” I read the stream of comments and then followed the strategy many well-wishers suggested. Set your alarm and wake up every two hours to check your blood sugar.
I read for another hour til 1 AM and set my alarm for 3 AM. Laying there, I wondered how long it would take my husband, who was in Holland on business, to discover tomorrow that I hadn’t woken up, but had died.
Next thing I knew I heard music. It was my alarm. Instinctively I scanned my body for signs of low blood sugar: Was I convulsing? Was my heart beating frantically? Was I sweating? Were my thoughts muddled? No, no, no, no, a very good sign.
I walked to my bureau where I had laid out my glucose meter ready for the check. Before going to sleep my blood sugar was 135 mg/dl (7.5 mmol/l). Voila, a lovely 120 mg/dl (6.6 mmol/l)! I had not taken two shots. This small overnight drop in my blood sugar is my normal.
In the morning my blood sugar was 105 mg/dl (5.8 mmol/l). Fantastic, no worries. But I do worry.
It can happen again. It can happen anytime. And I wonder if the chances will grow greater that I forget if I took a shot or not as I get older.
Type 1 diabetes is not just arduous to take care of. It is a scary disease. Frightening for the almost inevitable miscalculations that will occur in a lifetime of every days.
I, like many people, have mixed up my rapid-acting and long-acting insulin. Once, exactly a year ago. Drinking a quarter cup of maple syrup prevented a near death experience then.
Insulin is a dangerous drug yet we must rely on it to live.
But please don’t forget, those of us who live with type 1 diabetes, and to a lesser degree those with type 2 diabetes who take insulin, are making daily decisions for their health – that can just as easily snatch their lives away any day, or any night.
5 thoughts on “How taking care of my diabetes could have killed me: double-dosing”
When I experimented with using Lantus along with my pump, I set a phone alarm for every evening at 9:00 and every morning at 7:30. The morning dose was not difficult to remember, but I would have never remembered the evening dose without the dinging from the phone. I am not sure that I could ever again get used to having to remember to take bolus insulin.
Yes, it’s tough to remember sometimes to take your shot and tougher to remember if you did. By the way, you mentioned on Facebook you have extra Dexcom G4 transmitters. Is one of them looking for a new home? Mine died and I haven’t worn the CGM since.
I’m very absent-minded, so here’s what works for me. I keep one of those pill boxes labeled for each day in the drawer near where I inject my Levemir. When I remove the cap from the pen needle, I put the cap in the proper day’s spot. If I need a little R, I put the needle cap in the same slot. Then I can easily see what I’ve injected that day, well, not how much (which I write down), but whether.
Oops, I meant to write “basal” insulin not bolus. Will contact you directly about the other question.
I fully understand what you are saying, it is easy to forget ! When I first started on the Insulin Pump, we had family staying with us and they were getting ready to leave and we were getting ready for church, I completely forgot to bolus, when I checked my BG a couple of hours later it was 500–ugh!!! I immediately called my Endo and did what he told me to do. I thought and thought what I had done wrong and finally realized in the midst of all that was going on that I had not done a bolus for my meal. Since I was new to the pump I had forgotten that you could check on the pump to see if I had did the bolus or not–boy–what a learning experience. I have reminders set on my pump now to beep to remind me to bolus for my meals–been on the pump almost 2 yrs. and still use it–and very grateful for it.