Before Emergency Strikes
Making an emergency plan a priority now.
By Deanna Glick
Editor's Note: While this columnist is no longer writing for dLife.com and we have ceased to update the information contained herein, there is much to be read here that is still applicable to the lives of people with diabetes. If you wish to act on anything you learn here, be sure to consult your doctor first. Please enjoy the column!
September 2008 — It had been a particularly difficult day with my daughter: whining, crying, battles at every turn. Than, just when I finally got her to sleep and plopped on the couch in front of the TV, my pump alarm started beeping. It didn't take long for the company rep and I to figure out I needed a replacement. It was a Thursday night. It would arrive sometime Saturday. Time for Plan B.
I broke out my copy of Pumping Insulin and a file of instruction on NPH dosing, although I didn't have a prescription for that type of insulin. Still, I attempted to calculate a formula based on my current basal rates. I had "Mommy Brain." I needed guidance. Plus, I need the prescription. So I called the medical facility at which my endocrinologist practices to reach the doctor on call.
It took the receptionist four separate attempts to page the doctor. While on the phone with the doctor, who I'll call Dr. E, I provided her with my basal rate information so that she could determine appropriate insulin injection dosing. She advised me as to how much NPH to take every 12 hours, but recommended that I use Novolog on a "sliding scale" during bedtime hours and awaking to test after four hours. I asked how much Novolog I should initially take before going to bed. She said that it depended on my "sliding scale." After verifying that by "sliding scale" she was referring to my correction factor I told her that I take one unit of Novolog to reduce my blood sugar 70 points. She then wanted me to test my blood sugar. I did and it was 250. She asked me how much insulin I would take to correct that reading. I told her 2 units. I asked how much insulin beyond that I should take to cover my first four hours of sleep. She again asked about my "sliding scale." (Sliding scale is a term often used to describe insulin dosage via injection based on current blood sugar or planned food intake.)
This conversation repeated two more times, after which I became frustrated. Dr. E became angry and suggested I go to the emergency room unless I "spoke to her differently." She said she was going to "give me a minute and call back" and then hung up. I did not answer the phone when she called and opted to come up with the answers on my own without being scolded.
I admit that I may not have been altogether pleasant myself. But I don't think I was unreasonable or out of line given the circumstances. It was 11 p.m. I had a blood sugar of 250. My pump had failed. I had waited a long time on the phone for the doctor to respond to multiple pages. She was not pleasant at the outset nor did she apologize. I attempted to answer her questions and was not receiving answers. And when it comes right down to it, she was the one being paid to help me.
Still, I questioned myself. So I consulted friends, including one in the medical field and several people with diabetes for their opinion. Reactions varied, but were all empathic. Some wondered why I didn't just play chase with my Novolog until the new pump arrived. (I thought more than 24 hours of that and dealing with a 2-year-old might truly drive me over the edge.) But nearly everyone suggested I get an emergency plan in place to avoid such a hassle next time.
It occurs to me now that I've put more plans into emergencies having to do with my daughter and my dog than my own diabetes. I have a neatly typed list of contact names and information along with a magnet boasting the toll free number for Poison Control on my fridge. I also have a list of items that would be potentially hazardous to my pug if he ingested them. Heck, I've put more time than I really care to calculate into packing items for potential emergencies in the diaper bag – Tylenol, change of clothes, multiple diapers, bags to hold the fallout from a diaper blowout, teething gel. I admit, extra pump supplies and glucose tabs don't always make it into this overstuffed and overused tote.
It also occurs to me that the only person who hasn't brought up the idea of a pump emergency plan is my endocrinologist, whom I informed of the unfortunate on-call doctor incident in an effort to spur better training for such situations. Instead, my doctor defended the doctor on call as doing "her best" and has "suggested" I obtain "coverage" by a "local" endocrinologist or CDE since his practice runs out of an "academic" center and "doesn't always meet the acute needs of patients." He never mentioned that he and I should have worked out an emergency plan that would have subverted my need to make that nighttime call.
It's clear to me now that such a plan is mandatory. And I plan on doing just that with a doctor and practice that can meet my needs, whether they are acute or not.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
Well maybe not so much a furor as a controversy. The question, bluntly put, is whether or not a single HbA1c reading should be sufficient and adequate to diagnose diabetes — and whether the conditions under which the test was conducted should have any bearing on the diagnostic or non-diagnostic value of the test. The lede from