OMG – Insulin Injection Mistakes…. and what to do and not do!!!

We get up in the morning and it’s another beautiful day.  We don’t expect anything to go wrong  but we all have our busy schedules, we are all in rush to get to work or school,  and the pressures of life are always surrounding us when all of a sudden  out of nowhere   on one of these beautiful days SHIT will HAPPEN.  SHIT HAPPENING is an almost inevitable part  life.  To me it’s happened a number of times   and if you haven’t guessed what I’m talking about it’s an INSULIN INJECTION mistake.  The mistake can come in many  forms but it’s as scary as hell for anyone who  has ever gone into insulin shock or has experienced extreme hypoglycemia.    I think every TYPE-1  diabetic and the parents of  children with TYPE-1 diabetes will find this post interesting and possibly relate to some of the things I describe.    Nothing in this post however are supposed to replace or change the  medical help or instructions that you have gotten   from your doctor or will get in the future.    Many diabetics  have started  using CGM (Continuous  Glucose Monitoring) devices instead of glucometers which I mention a lot in this post.  Things are continuously changing  but I sincerely hope there are diabetics out there who will find this post helpful to them.

OMG (Oh My God) I just overdosed on INSULIN.  To me as a type-I diabetic probably the biggest fear I have is overdosing on insulin. I’ve gone into diabetic shock twice in my life when I was much much younger – once on the tennis court  and once after I managed to park my car while driving to work.  I’ve learned my lessons the hard way – that low blood sugar should never be ignored.   I literally have freaked out on more occasions than I’d like to even think about because of the fear of an episode of hypoglycemia.   I’ve yelled at myself (something like WTF did I do), my heart has skipped  beats   and depending on  what exactly I did or didn’t do I’ve given myself self inflicted panic attacks.  In short I fully understand any diabetic who fears hypoglycemia.    Today I know how to handle most of these hypoglycemic  situations but I also know that severe low blood sugar can kill me or  put me  in a coma.  So if I do  freak out I  freak out quickly and  get over it.  There’s no time to waste and there should be  nobody better prepared than yourself to  treat your  low blood sugar episodes as well as to prevent it from happening if you know that at attack is imminent.   Here are some (first hand) examples of things that could happen….

1. Accidently taking  2 rapid acting insulin injections like LISPRO.  This has happened  to me  on a few occasions and it’s scary.  Sometimes I take my rapid insulin injection before my meals and other times I take it  after eating.  Taking the injection both  before the meal and then again after is a hypoglycemic event in the making.    Mistakes like this  don’t happen often to me but when you take many injections throughout the day to keep your blood sugar levels in check and then add life’s usual stress to the equation- things can go wrong.  Depending on how extra insulin I’ve taken this could be a pretty serious situation if I don’t treat it quickly.   Unfortunately when SHIT HAPPENS you can’t take it back  — you have to deal with it!!
2. Taking a  high  dosage of  rapid acting insulin that I didn’t need to take.   This has happened to me occasionally and the reasons for taking large injections are usually not a mistake.  Since I balance my blood sugar with different dosages of rapid acting insulin throughout the day the amount of insulin I take usually depends on what sort of meal I’ve eaten and what my blood sugar is to begin with.   When I  see my  blood sugar levels  are very high and seemingly out of control the way to get it back under control is with a rapid  insulin injection.  Taking a large dosage of rapid acting insulin seems the right thing to do – correct?  Well usually… but sometimes for whatever reason SHIT HAPPENS or maybe MURPHY IS WORKING OVERTIME and  you or I can  get a false high reading on our trusty glucometer .  This doesn’t happen very often and shouldn’t happen   but  if  SHIT is meant to happen it will happen!  Glucometers are not fool proof and sometimes need calibration and even  taking a bIood test from  fingers which aren’t clean can cause faulty readings.    Generally I check twice when I see a very high blood glucose reading on my glucometer – especially  if this glucose  reading  is the reason I  am going to take another   injection (which  I normally wouldn’t take!!).  Unfortunately (for me) there have been tmes   I’ve shot first   and checked  later.   Ever wonder why  you always see your mistakes after you’ve made them — well it’s probably because if you saw them before you made them then you wouldn’t make them and they wouldn’t be mistakes!!   I am pretty convinced that  it always pays to   WASTE  another blood glucose testing strip before you shoot yourself with more insulin. I usually make sure my hands are clean the second time!  Seeing high blood sugar numbers on my glucometer have  always been upsetting to  me  which has sometimes contributed to me  making quick and sometimes bad decisions.    Whenever taking an added  or extra dose of insulin make sure you really need it!!.
3.  This mistake  happened to me a few months ago  (and I actually hadn’t made this mistake before… guess I missed one)  – This time I took the wrong type of insulin and mistakenly injected my rapid acting lispro  insulin instead of taking my long acting LANTUS insulin.   Since my long acting LANTUS injection is at a much higher dosage than my  rapid  acting lispro injection this was an OMG mistake.  I had to act fast to get my blood sugar up to avoid getting a very dangerous case of hypoglycemia.   Despite a lot of initial fear I suffered no ill effects or hypoglycemia.

Summing the above up –  we are all human, we all make mistakes  and SHIT  does  HAPPEN  and MURPHY DOES EXIST and comes out of nowhere when you least expect him.   If you are a type-1 diabetic you need   to know how to deal with situations like this and be always be prepared.

What Now – you think you just made an OMG (insulin injection) mistake!!

I’ve said it before — try not to freak out – I know what you’re going through.   First off  once you calm down  take a minute to think about what you really did.  In times of fear/stress etc… your mind can play tricks on you.  Did you really take those 2 injections, did you really take the wrong insulin, how much addition insulin did you inject  etc..     From my experiences there’s been many times I’ve thought I might had made a bad mistake when I hadn’t.  Do not add insult to injury by making an even worse mistake!!   Bringing up your blood sugar levels by going on an eating spree when you didn’t actually take the wrong injection   is only going to cause you lots of unnecessary blood sugar problems — so take a minute to think what you actually did!   If you don’t   remember if you took an injection or not do NOT run to  take that missed  injection without thinking or trying to check what you did.   My cardinal rule which usually works for me  is when in real doubt —  I do not take another injection until I  am 100% sure that I didn’t  take the one I thought I skipped or missed.   Keep testing your blood sugar until you’re sure what happened.     If  you feel the need then talk to your doctor and definitely tell some family member or close friend what is going on!.      I personally WHEN IN DOUBT  prefer to control any  high blood sugar levels which might be caused by a missed or forgotten injection  with small dosages  of rapid acting insulin  than run the risk of accidently taking a double dose of  rapid acting  insulin.

The Unthinkable Oh My God (OMG) insulin injection mistake happens to you!!

You now know for sure that you just took that extra injection or a big overdose of insulin.   There is very little time to waste from here on.  Rapid acting insulins such as lispro starts working after a short amount of time   so  getting your blood sugar level up quickly  before the insulin reaches it’s maximum peak is essential in preventing a bad case of hypoglycemia or going into insulin shock.  First thing I do now is to test my blood sugar and know where I stand. This is one of those times where high blood sugar levels are a welcome guest to me.    In one of my previous posts I talked about insulin curves and how important it is to know how  your insulin  works. Rapid acting insulin usually has a peak between 30 minutes to 3 hours.  There are many different brands of insulin on the market and each has it’s own specific action curve – and the curve of quick acting REGULAR insulin is  different than  rapid acting insulin LISPRO.  If  for example your insulin reaches it’s peak after 30 minutes and then tapers off after 3  hours then getting your blood sugar up  quickly is essential but once the insulin starts tapering off (and your blood sugar levels are not low)  then you know you’ve probably dodged the bullet of hypoglycemia.   Don’t forget  however that  dodging the hypoglycemia bullet doesn’t always mean you are out of the woods.  High blood sugar (because of consuming excessive amounts of glucose/carbohydrates to prevent hypoglycemia)  is a real threat which must be recognized.  Bringing low bood sugar up too high and then taking injections to lower it can become a real ROLLER COASTER ride for diabetics.

HOW DO I GET MY BLOOD SUGAR UP  and still AVOID a ROLLER COASTER  RIDE AND CYCLE OF LOW & HIGH BLOOD SUGAR LEVELS?

If I didn’t  mention it   I’ll say it here  (and again and again)  that a diabetic needs to BE PREPARED -ALWAY!!.  Being prepared and ready  for an imminent hypoglycemic emergency   means having 2 things with you at all times.  The first is a working functional GLUCOMETER with many glucose test strips available.  The last thing you want in an emergency is to find you’re out of strips or your glucometer battery has ran out.  Murphy is always lurking around every corner – don’t help him!! Always have a spare battery and a spare bottle of blood testing strips for your glucometer – it could save your life or save you a trip to the ER (emergency room of your nearest hospital).   The next thing in your survival kit are glucose tablets. Keep LOTS OF THEM at hands reach just in case of an emergency!!  I never move without them – at work, in the gym or beside my bed when I go to sleep.   The glucose  tablets are also available in liquid form  if you prefer.  I think it’s probably worth keeping both of them on hand!

Unfortunately I don’t know of any magic pills or remedies   that in one BANG  will get your blood sugar back to normal after overdosing on a large amount of insulin.  Below is the  method that I  use to treat  my hypoglycemia when any medical emergency arises.

1 First I try to make sure I know what happened.   There’s a big difference between treating yourself for a major overdose of rapid acting insulin  or having a hypoglycemic reaction due to  perhaps a  missed  meal or  excessive physical activity or exertion.  Hypoglycemia that is not caused by a major insulin overdose – which is probably the usual case that unfortunately plagues diabetics most of the time  should be  treated quickly by consuming glucose tablets (or other glucose sources) immediately to bring up the blood sugar.   After I consume the glucose tablets I usually check my blood sugar again after   15 or 20 minutes  to see that my sugar level is back around the normal range and I don’t need any additional glucose.  If my blood sugar level is back to normal  (and this was not brought on by a major overdose of insulin) then this bout of hypoglycemia  is usually over and I can go back to my usual routine.  Knowing the reason for any hypoglycemic reaction  is always a big plus in treating it   but the body is a very complex piece of machinery  (as I keep learning everyday…)  and sometimes the cause of both low and high blood sugar can be pretty evasive.

2.  If I have discovered I’ve taken  an overdose of insulin  there’s not much time to waste.   Even if my blood sugar is normal or high at the time this is not the time for complacency.   As all type-1 diabetics know – rapid acting  insulins work very fast  but luckily (if you overdose)  their peak duration time  is  shorter and the peak blood lowering action will be out of your system in around 3 hours .   In this sort of emergency  I  try to increase  my blood sugar  immediately to a  pretty  high level (before the peak effects of the rapid insulin)  again   with the help of glucose tablets.  This is hopefully  before I start feeling the effects of  the rapid acting insulin and getting a hypoglycemic reaction.  Trying to prevent any hypoglycemic reaction is the main objective right now.     Once the rapid insulin starts it blood sugar lowering magic it becomes a continuous routine   of glucose testing and consuming   glucose tablets or glucose syrup  to keep my blood sugar levels  from reaching any low danger point.     I usually keep checking about every  15 or 20 minutes which is the time it takes for the glucose tablets to work.  In overdose emergencies like I am talking about   I’m not that  worried about seeing some high glucose readings since the main objective  is to dodge the bullet of extreme hypoglycemia or insulin shock.  If  my blood sugar remains around or above  the  level  (or in the high range)  from  when I tested it last then there’s usually no reason to keep consuming more glucose.  I do however keep testing for the entire duration that the rapid insulin is  working at it’s peak.    If   during the peak  period   I see my blood sugar levels   decreasing   or going below “my safe zone”   I   resume consuming   glucose tablets to raise my blood sugar.

I titled the  above paragraphs as the ROLLER COASTER RIDE and  HOW TO AVOID IT  but never really got into details. I’m pretty sure that just about every insulin dependent diabetic knows what a roller coaster blood sugar trip is – when he or she has had a case of hypoglycemia only to eventually see his blood sugar skyrocket and then to get it down he or she must take  additional injections which sometimes lead to additional cases of low blood sugar and in short – a vicious cycle which sometimes takes days to get your blood sugar back under control.    I’ve had this happen to me and it’s never fun.   One of the major reasons  for my ROLLER COASTER rides have been the uncontrolled way I’ve  used to raise my blood sugar levels which means I’ve either gone on a  feast of  eating cakes, cookies, ice-cream, sweet drinks etc… or otherwise a feast combined with glucose tablets as a sort of  topping to the desert!!   One  of the reasons for my frantic eating was of course the FEAR FACTOR of the hypoglycemia   but you always pay a price for  gluttony when you’re a diabetic and it’s seldom worth it!!.       The irony with these one man feasts that I gave myself  is that most of the foods I was consuming despite being full of  calories and sweet as sugar   didn’t raise my blood sugar nearly as fast as glucose tablets do.   Don’t forget that even sugar is part glucose and part fructose – and fructose raises the blood sugar slower than glucose.  These sort of feasts can really turn into a  diabetics LAST SUPPER….

Now For Some Simple Math about glucose (tablets and syrup)

I’ve talked about glucose tablets a lot throughout this post.  The best, simplest  and maybe the only way a diabetic can bring his blood sugar up in a CALCULATED way without running a really big risk of  a ROLLER COASTER RIDE  is by using glucose tablets in my humble opinion.  Below is an example…

If you weight  100 pounds (45 kilogram) every gram of glucose will raise your blood glucose 5 units (mg/dl), if you weigh 150 pounds (68 kilogram) it will raise your blood glucose 4 units (mg/dl)  and if you weigh 200 pounds (91 kilogram) it would raise your blood glucose level by 3 units(mg/dl).   In short the less you weigh the more the glucose tablets raise your blood sugar.  The math is simple.  Lets say you’re  a  man weighing about 91 kilo (200 pounds)   and your blood sugar is now in the hypoglycemia range of 50.   Let’s say you want to get your blood sugar up to the 90-100 range as fast as possible.  What do you do?   First thought might be to grab a chocolate bar, piece of cake and wash it all down with some cola — but that is the wrong answer….   Here goes:

A 91 kilo man would increase his blood glucose levels by 3 points for each gram of  glucose.  If you are this man and you want to bring your blood glucose up from 50 to around 90 to 100  you need to raise your blood sugar between 40 to 50 units(mg/dl).  The math here is 40/3 to 50/3 grams of glucose to get you there which comes to somewhere between 13 to 17 grams of glucose.  The glucose tablets that I take are 4 grams per tablet but there are loads of different brands out there coming in different sizes.  The man in question would  have to take around 3 to 4 glucose tablets (of  4 grams glucose/tablet) in order to get his blood sugar up in the range specified.  Even without a calculator most people can do this math in their head.    Now try to  do the same calculation but instead of the glucose tablets you  take a piece of cake, some ice-cream, a chocolate bar and maybe some cola  or possibly coffee and milk  to wash it all down….   It’s pretty easy to see that if you’re a diabetic  having glucose tablets with you at all times is a MUST.

Looking forward to user comments on this post.

 

 

 

 

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