Monday, February 18, 2013

The Cortisone Bitchswich, Flipped.

Cortisone shots might be small, but they are indeed mighty members of the steroid family that can cause the liver to dump glucose in your blood for weeks, and weeks. With that being said - cortisone shots reduce inflamation and if you have diabetes and inflamation issues and have exhausted every other method out there - Cortisone and diabetes is doable.  But it takes work - A lot of work!

It's been 11 days since I received a cortisone shot for my trigger

finger - And while my finger feels about 86% better, it's still tight
and feels slightly achy and swollen.

But with that being said, It's SO MUCH better than before!

And I'm keeping my fingers proverbially crossed that the cortisone will bring a permanent end to all the locking, clicking and sticking on my left ring finger digit.

Choosing a cortisone shot was something I'd fought for a long time.  

I'd spent an inordinate amount of time being in constant pain when ever I fully flexed my left hand digits.  And beecause of the constant pain I'd spent an incredible amount of time icing my hand, getting it messaged and going for acupuncture treatments. 

I slept in a hand brace and al that helped, but with all the typing I do, they were only temporary fixes.   Did I mention that I'm left handed? 

Because after almost 4 months of doing all of the above mentioned & my

palm and finger being in a constant state of aching and tenderness,
perpetually, popping, and locking - And interfering with all aspects of my life.
I stopped cycling because of my hand and was afraid to start a spin class or lift weights
for fear of increasing the swelling in my hand tendons.

Typing had become downright painful and required ice afterwards, hence the reason my blog posts haven't been as daily as I would like them to be.

My knife skills were altered and left me me unable to slice and dice and forced me to order more takeout than anyone should have to endure.
Not to mention being unable to write more than a few sentences long hand at any given time was cumbersome to say the least. 

Enough with the procrastination and the excuses, I knew I needed to get a shot.

I'd done the cortisone dance before:

I knew what to expect. First of all, cortisone shots hurt like a motherClucker - especially in the hand/palm area.

Secondly, cortisone shots make blood sugars reach sky high proportions

for extended periods of time and they require lots of testing and
basal rate fine tuning - and I was fine with that.
So I went to the hand specialist again he gave me the shot - And he
told me that my blood sugars would be elevated for about 4 days.

And I looked at him in the eye and said: More like two weeks - Last time

I had a cortisone shot my numbers were elevated for weeks - And I was
taking 4.25 units of insulin per hour.

And he seemed shocked by that info - but like I said, I'd done the
cortisone dance before - I knew what to expect and I know my own body
and how it reacts to cortisone - And I was right.

I received the shot on the afternoon of 2/7 and here's what my insulin

totals looked like for the next 10 days - And FYI: My normal intake of insulin in a 24 hr period is somewhere between 30 & 40 units of short acting insulin.

2/7: 56.60 (3 units per hr) Increased temp basal rate of 250%

2/8: 108.70 (4.35 units per hr) Increased temp basal rate of 250%
+ new increased basal rate setting
2/9: 109.90 (4.35 units per hr) Increased temp basal rate of 250%
2/10 107.40 (4.35 units per hr) Increased temp basal rate of 250%
2/11: 79.00 (4.25 units pr hr) Increased temp basal rate of 220%
2/12 86.50 (4 units pr hr) Increased temp basal rate of 200%
2/13: 81.80 (3.05 units per hr) Increased temp basal rate of 180%
2/14: 74.90 (2.10 units per hr) Increased temp basal rate of 160%
2/15: 59.70 (2.10 units per hr) Increased temp basal rate of 160%
2/16: 58.90 (2. units per hr) Increased temp basal rate of 150%
2/17: 46.60 ( 1.69 units pr hr) Increased temp basal rate of 130%

PLEASE REMEMBER: These numbers represent how MY body reacts to

cortisone - And these are the daily amounts of insulin MY body
EVERYONE insulin requirements post cortisone are different.

I was up most of the first night after the shot because diabetes technology has changed since I'd gotten my old pump, big time.

My two new loaner pumps temporary basal rates only went up to 250% & 200%.
And that just wasn't cutting it for me. My old minimed 512 had no limit on the temp basal rates. I set my alarm for every 3 hours when I went to bed and did two correction boluses between midnight and 6:30am the morning of the 8th.

And yes, I was ready to kill someone. I was tired and grumpy and not being able to get below 240 was not a good thing. I was spilling trace amounts of ketones.... But I figured it out.

Finally, (thanks to the DOC & customer service) I figured out that I could input different basal rate settings and by the afternoon of 2/8 I had fooled around with 2 additional basal settings and found that basal rate #3 worked like a charm. 

With that new setting I was able to increase my temp basal rate to 250% and was able to achieve blood sugar nirvana in the form of 4.35 units of insulin per hour.

And my  bloods sugar numbers with the increased temporary rate are good,
very good. And my blood sugars have been on target more often than not for the most part - And that makes me happy.

I reminded myself that increased daily insulin requirements with cortisone, much like shit, happens.

And would have absolutely  happened if I didn't have a busted pancreas.
I wouldn't allow myself to get freaked out about the daily insulin
totals - Because those daily totals were working. - And that's what was important.

Slowly but surely the daily insulin requirements are decreasing and my

temporary basal rate is fluctuating between 110% and 130%.

Hopefully by Thursday, I will be back to my normal daily totals.

Am I glad I took the cortisone route? Yes, I am.

Am I glad that I used an insulin pump ( in this case a loaner) to combat the affects of cortisone? - DAMN STRAIGHT.

Honestly, I don't know how I would have handled the cortisone shot if I was on multiple
daily injections.

Was I frustrated that both loaner pumps ( all newer model insulin pumps for that matter,) limit their temporary basal rate percentage settings? YEP.

I understand why they do it, I understand legal departments & lawsuits and I understand that they're fear of someone hurting themselves by increasing their temp basal rates too much. 

But with that being said, I've talked to many people with diabetes about this

issue and many feel the same way I do - max temporary basal rates are too conservative - And not just for pwds dealing with cortisone shots.
Some pwds require massive amounts of insulin per hr when they get their periods or if they're fighting off illness like the flu or bronchitis - And while a more conservative maximum temporary basal rate looks good on paper - It  doesn't always work in real life.

But at least having different basal rate options/settings  allow us to figure it out.... Eventually.

Still, when I'm battling extremely prolonged high blood sugars due to cortisone or illness, I don't like the fact that I have to put a lot of time into the basal rate setting options to

find out which diabetes mathematical equation  will get me past the my magic cortisone
battling 'temporary basal rate' setting of 4.25 units per hour.

I also feel like I've put on a few pounds since the cortisone injection - Subconsciously.. or not I'm hungrier since the cortisone shot. 

But now that I can start cycling again, I know that those pounds are temporary.

And I'm incredibly grateful for the loaners pumps because without them I wouldn't have gotten the cortisone shot - And I would still be in pain.

Am I afraid that cortisone might only be a temporary fix?

I'd be lying if I said that wasn't a fear, because it is - Especially after my finger and wrist felt tight and slightly sore this weekend.

But I iced my hand and tried to stay calm - After all, I hadn't been

able to fully flex my hand without my finger sticking or locking for
months, so of course it would feel tight and sore after 10 days of
finally being able to do so - And I am lucky.

So right now I'm going to concentrate on the NOW instead of the WHAT IFs.

Has anyone else out there ever ridden the cortisone crazy train

express - If so, how'd it go?

Are any of you considering a cortisone shot but haven't yet - What's stopping you from
actually getting one?

Diabetes Stigmata???
No - Just my hand after a cortisone shot!


Scott E said...

I've been reading for awhile on your Diabetesaliciousness Facebook page about how cortisone increases blood sugars, but have you ever gotten an explanation as to WHY? I'm wondering if it increases insulin resistance or if, maybe, it has an effect like glucagon in getting the body to dump sugar into the bloodstream. Either way, it's peculiar that a single shot in an extremity can have such a profound effect on the whole body for such a long time.

k2 said...

Scott E
Cortisone is a powerful steroid and steroids cause the liver to release way to much glucose, thus increase blood sugar levels. And as you read in my post and as you'll see in these other posts - I am not the only one who has experienced this.
Kelly K

Cara said...

Oh poor Kelly! I hate it that you are still up on the insulin intake. Crazy. :(

Unknown said...

Ugh...just stinking Ugh for you. Our sons recent 2 month illness triggered his asthma and our doctor fought to keep him off steroids for this very reason. I am so glad now that I see this. I'm glad things are getting under control and that you are so invested in your D care...THAT is exactly what I want to teach my son. I hope he gets it.

Are you still fighting with your insurance over the new pump?

Scott K. Johnson said...

Never had to deal with one, myself. It's very intimidating to me. Crazy how that little shot in your hand can wreak so much havoc!

StephenS said...

Oh my gosh... This is very useful for anyone considering such a procedure. Thanks a ton for going into so much detail. It's very necessary for anyone to consider all of this when considering the same thing. My only advice would be to keep from overdoing it now. You may feel better , but that doesn't mean you're healed. The cortisone will make you feel better ... But that's all. If you let everything heal in the meantime, you will be a lot better. If you work your hand too much, it won't come back.

I wish you all the best. Let yourself heal. Thanks

FatCatAnna said...

Hey Kelly - I went thru' the same ordeal when I was your age - no fun at all (and I was only on MDI at the time). I know for myself - cortisone shots rarely did the job for my TF (beware of where you point girl ) - of course - you go thru' the cortisone shot BEFORE the surgery - but I can say that after (counting the scars in my palm here - feel like Count Dracula - ha ha ha) - 4 surgeries - and I - touch wood - have been cured now for over 20 years.