(Click on diagram to see full view)
I wrote a widely read post last year about the time, about 3 years ago, that I accidentally gave 20 units of humalog instead of lantus.
Well, I made that fatal mistake, again. This time, I had the previous experience under my belt. I also had a lot of juice in the fridge. I was also lucky that my parents and youngest brother were visiting. So they and my husband took care of our twin toddlers and I immediately began chugging juice.
First I quickly downed 32 ounces of orange juice. That amounted to about 100 carbs. My blood sugar was 146. Thank goodness it wasn’t lower. Then I had 8 ounces of grape juice which was 40 carbs. Within the next hour I was continually downing 8 oz. glasses of grape juice. My blood sugar peaked at 196 but, quickly dropped from there. I was extremely nauseated and after an hour began having diarrhea from all the sugar. I was trying to just make it about two hours into the “clear”. Just 20 minutes shy of two hours I began throwing up grape juice. All the juice was a bit much. My blood sugar hit it’s lowest during the two hour ordeal at 93. I still had insulin working and I couldn’t drink anymore darn juice.
My dad made the above diagram. I emailed him the data and he put it together in an interesting and easy way to read. As you can see I drank the perfect amount of juice to stay above 90 at all times and avoid going dangerously low. I also needed the head start that it indicates that I got. I drank a large portion of the juice within the first 30 minutes of giving the insulin shot. This is because when fast acting insulin peaks and there is a lot of it, you better be prepared. My goal was to keep drinking juice and bring my blood sugar as high as possible so that when the insulin peaked, I’d have some cushion. It worked but it was definitely not fun.
When I tested 93 I decided to be extra safe and call 911 and asked them to send me an ambulance. I explained that I accidentally gave 20 units of fast acting insulin instead of 20 units of lantus and the 911 operator said very abruptly, “Oh, I see your problem.” “We’ll be there right away, just hang in there.” Last time I did this I didn’t believe I could drink enough juice so I automatically got myself to the ER where they administered a lot of intravenous glucose as I continued to plummet below 70. When the paramedics arrived they had me test and we found I was 98. Finally moving up! I looked calm but I had been so nervous and they found my blood pressure was 160/100, my pulse “faint, barely there” but, It looked like I did it. The final count of about 72 ounces of juice worked (67 ounces is 2 liters). They stayed a few minutes asking me questions. I got the strong sense that they don’t normally visit fully alert diabetics every day. They didn’t know what A1c meant. They wanted me to eat some solid food to settle my stomach. I tried to explain I had hit my limit with drinking juice and just wanted to be safe rather than sorry and didn’t mean to bother them.
The four responders looked at me as if a little confused, a little amused, and a little impressed. One said, “you seem to really have things under control”, which I appreciated hearing after making such a simple and dangerous mistake. I explained why it happened: I normally use a 100 unit syringe for my lantus and a 30 unit syringe for my humalog. Well, I ran out of my 30 unit syringes so I was temporarily using my 100 unit syringes for both my lantus and my humalog. The problem is that I am so used to automatically drawing up 20 units of lantus once a day in that 100 unit syringe. So when I was giving insulin for dinner that night, I automatically drew 20 units of humalog and injected it. Then I suddenly had a flashback of what I had just done and I thought…”oh great, here I go again”. I’m wondering if I should have some easy to eat candy available in the case this ever happens again. It shouldn’t happen again, now that I am well aware of how important it is that I be strict to keep stock of both types of syringes. You know those Queen Anne cordials? A few days ago I had one and thought to myself, I could have tons of these-they’re that good! Well, they’ve got TONS of sugar. Maybe I should stock up on a few boxes of those? Maybe that would work better considering 2 liters of fluid is most uncomfortable and not as efficient on blood sugars once you start throwing it back up.
Don’t worry, I’ve at least stocked up on the 30 unit syringes for use only with humalog. I feel safer already. I had let my sugar run to 180 after this incident because I was so scared to give insulin and let’s face it, old habits die hard.
Last year’s Christmastime drama included me accidentally dislocating my then 6 month old’s shoulder and spending Christmas night in the ER holding her still for X-rays. This year’s drama will give me an interesting story to tell others about how my husband and I and my parents all scrambled together to do the math needed to keep me alive and decide what plan of action to carry out. We contemplated taking me to the ER but, if you read the story about the first time I did this, you’ll see I really didn’t want to go there.
This really is a reminder to me and my loved ones showing just how fragile life with diabetes is. You can be human and make a tiny mistake and it can cost you everything.
In any case, possibly learn from my mistake, or laugh at it, but definitely don’t do the same :)
PS: I make the point to tell this awful story because it may serve as useful info. For example, if I were younger or had given any more than 20 units I really would have needed to quickly just get myself to the hospital (while eating/drinking sugar). Also, had I not been willing to miserably overload myself with juice I would have had to quickly decide to go to the hospital in that case, as well. Someone weighing less would also have a greater problem with this much insulin overdose, too. Anyway the key is not hesitating. I’d hate for people to think this can easily be handled at home. (I barely got away with this). Do note however, I didn’t think I could drink one liter of juice. I’m a small person and yet, strictly deciding I had to allowed me to drink over 2 liters. Just thought it was interesting :)