Pancreatic poker face

By | 26 January, 2011
Hypo dogs and Neville the Newshound enjoy a round of diabetic poker

Hypo dogs and Neville the Newshound enjoy a round of diabetic poker

I often (well, only really when it gives me a theme for a post, but go with it) think that playing at being a pancreas is a bit like playing poker. You need confidence. You have to bluff your way through and show no weakness when it comes to gambling on that extra bolus to bring down the high. Show no fear at giving that extra unit.

My pancreatic poker face has slipped slightly lately. I’ve just started some new drugs for something or other and they don’t play nicely with the broken pancreas. The one advantage I have is that I’ve been here before and survived it so I have experience on my side. Sadly at the moment that doesn’t seem to be worth a lot.

Previous experience shows a few extra buckets of insulin are required to deal with the drugs. But last weekend, by the time I was up to 4 times my usual bolus ratio the stakes felt pretty high and I wasn’t sure I wanted to carry on playing my hand. At this point, all the extra insulin had managed to keep me at a kidney-frying, eye-blinding 18 for a whole day. The CGM had been alarming that much it was begging for respite.

So, by early evening I celebrated having halved my blood sugar to 9 and decided that was as low as I was willing to go for now. The drugs have a habit of creating huge insulin resistance and then falling asleep for a bit allowing service to return to normal for a while so I didn’t want to be caught running too low when that happened. If we were playing poker, this is the point where I would have banked my winnings and left the casino but there was no one to take over my hand so I had to carry on.

At 3am, the husband was awoken by a screaming CGM and a sweaty, rambling wife who when she finally submitted to a blood test was enjoying the hallucinogenic qualities of being a 1.3. After an hour the glucogel finally fixed the problem and the husband changed the sheets (what is it about diabetes and sheets?). Apparently he doesn’t like sleeping in a bed full of glucogel slime. He’s so fussy.

And so, I feel like I took as safe a gamble as I could and still got badly burnt. Which means my poker face has slipped and I’m a bit nervy about this high stakes game I’m in the middle of. I hesitate to double or quadruple my insulin even though I know that’s what’s needed. It’s tough getting straight back on that horse when you’ve just fallen off.

I think that’s where I’ll stop for now. A metaphoric mixture of falling off horses whilst playing poker in casinos with sticky sheets is enough to undermine anyone’s confidence!

Category: Living with diabetes Tags: , ,

About Alison

Diagnosed with Type One in 1983 at the age of four, Alison's been at this for a while now. She uses Humalog in a combined insulin pump and continuous glucose monitoring system and any blood glucose meter as long as it takes five seconds or less.

22 thoughts on “Pancreatic poker face

  1. Donald Thomson

    What drugs were the culprits? I had a similar experience over Christmas with some blood pressure tablets. Couldn’t bring my level below about 14 for 3 days, and it peaked at 24 despite my best efforts. And they were making me dangerously dizzy. My 5’2″ wife was unwilling to risk her back having to pick up her 6′, 15 stone hubby. Called the doctor, and decided a slightly elevated blood pressure reading was preferable until I could get in for an appointment. Am now stable with BG and BP. And what does 1.3 feel like? I’ve been down to 2.3 and that was trippy enough for my taste!

  2. Alison Post author

    What a nightmare Donald. I don’t remember much about what 1.3 feels like. My first memories of it are being soaked in sweat, very cold and having sticky lips from the glucogel. The rest is a blur. As for my drugs, I like to maintain an air of mystery around them, it makes me seem more exciting 🙂

  3. Tim

    Anyway, back to the topic in hand. I know what you mean with the poker game of insulin. I have a similar, but milder, experience when I’m having a complete carb fest. I’ve carb counted 3 zillion grams of carbs and my pump tells me I’ve got to put 4 gazillion units of insulin. Shoving in so much insulin in at one time always makes me feel a bit nervous – could it all go horribly wrong?

  4. Angie

    I was diagnosed with autoimmune hepatitis about six months ago (my immune system loves me…;)), which is treated with steroids, which really do not play well with the broken pancreas. It was really difficult to increase my insulin to the levels I needed at first – even though I *knew*, in my head, that the fact that my blood sugar was sitting at 18 despite bucket loads of insulin meant I needed even more, actually taking the plunge was so much harder than I though it would be. It doesn’t help that I’ve had two really nasty hypos in the last six months, one of which landed me in A&E after a seizure, just to add to the whole bunch of doubts plaguing me. It’s difficult when your heart and your head are arguing about something so important! And yet somehow we have to get on with it…

  5. Bellebe

    Yup – currently doing the poker thing following a cortisone injection in my shoulder.

    “Your BG levels may be a little elevated for a while” was the very precise information given by my GP as he stabbed me in the shoulder.

    “a little elevated” – turns out to be 15 or above between 3pm and 9am, but have no effect at all 9am to 3pm – odd.
    “a while” so far is nearly a week
    so I’ve doubled my afternoon and night time basal and my evening meal bolus and am just holding my cards (and a pack of glucotabs) till whenever the “while” ends and I have a massive tea time or night time slump

  6. Annette A

    Odd – the last time I had a cortisone injection (also in my shoulder), I was told to watch my levels. So I did. And they did nothing. nada. But then again, neither did the cortisone injection have the intended effect.

  7. lizz

    I’ve decided to go for the mobiliser machine instead of cortisone. It’s £2,600 but it’s worth every penny.

  8. katherine cromwell

    When I was pregnant with twins I had to have a steroid injection to enhance their lung capacity (I felt 40 weeks but was only 32) I was having as was norm in those days 3 short acting and 1 long acting injection per day but my total long acting went from 40 units up to 120 units just because of the steroids. My diab consultant at the time said I had to believe in her I did and my readings were still above 6-7mml but thankfully I had healthy babies at 37 weeks weighing 7Ib 3 and 6Ib 1.
    With the pump I would have found it more comfortable, because with fear of hypo I could have stopped any extra insulin.

    I think we all suffer with the poker face sometimes in our lives the pump is easing it though. Good luck Alison x

  9. Rohan

    I have actually just managed a week of braving it out a little – and held my poker face right until the last day! Have had a weeks Outward Bounds course with work, so have been running around the Lake District, burning up glucose like nobody’s business. Luckily there were LARGE amounts of food available, and I have had better BG’s for that week than I have had for months!

    Except for Friday, when we spent the day sitting around for presentations and the 4.5 hour bus journey home – forgot I would need about twice the amount of insulin for that, and had a pre-evening meal high of 20.1!

    One lesson I learnt that the top bosses at my presentation didn’t want to know is this: Exercise REALLY helps my BG control! Once my arms have recovered from the press-ups challenge, I’m going to be getting lots more of that. Shame the countryside in the Midlands is so uninspiring :/

  10. Annette A

    You just dont know where to look, @neobrainless. Try Sutton Park, Cannock Chase, Drayton Water, Ryton Pools, anywhere out south of Coventry until you get to Banbury – lots of lovely villages with pubs in separated by country roads along which you can cycle, walk, run, whatever floats your boat. Try Burton Dassett Hills, or indeed most of the Warwickshire countryside. It’s all there, you just have to go out and find it.

  11. Rohan

    But it’s all so flat and boring! Plus, south of Coventry means I’ve already cycled 8 miles… I will confess part of it is laziness, but a large part is me having been spoiled – growing up in North Devon (stunning), living in Oslo (stunning) and living in Cardiff (not bad, and easy access to stunning areas)…

    If I’m here for the next few months I will make it to Cannock chase at least (though I’ve been saying that for 6 months since my mountain bike caught up with me).

  12. Hairy Gnome

    I have to admit that even someone like me, a grumpy old T2 who’s accustomed to slurping up insulin by the cartridge full has moments of terror! I’ve recently been struggling to get my BG down to sensible levels and have started taking a ‘booster’ shot of Lantus in the morning, as well as my normal evening dose. This means I’m now taking 225 units of Lantus a day, plus 90 units of Novo-Rapid before each meal, or 60 before a snack. I constantly have this nagging feeling that one of these days my insulin resistance is going to suddenly evaporate, and I’m going to discorporate faster than you can dial 999!

    I know you T1s are forever teetering on a knife edge, and you have my greatest respect, but sometimes I feel as though I’m standing on the edge of a cliff and that something as simple as missing one of my drugs could tip me over into perdition. I’m sure you’ll correct me if I’m wrong, but I reckon my daily dose would last the average T1 for a week; scary stuff!

  13. Annette A

    A week? That would last me nearly a fortnight! When you are on those sorts of levels, it must be pretty worrying – what if I miss one/duplicate one/suddenly have a change in resistance levels – scary stuff indeed.

  14. Cecile

    @teloz: 15.375 days (if you&me only snack twice a day)…no wonder you have such problems with lard accrual – your insulin receptors might turn a blind eye to that amount, but to fat it says “Come in!” Pity you don’t have the guts for Metformin 😉 (I looked around for you for injectable Metformin; the closest I got, was cherry&fish-flavoured Riomet {oral solution})

  15. Tim

    Four days worth for me! Bloody hell Terry – I knew you liked your insulin, but I didn’t know you liked it *that* much.

  16. Alison Post author

    Terry, I may talk about virtual bucket loads of insulin, but your doses are geniunely bucket-sized. You must need help carrying all that insulin home from the pharmacist 😉

  17. lizz

    Wow! Your day’s insulin supply would last me over 2 weeks. My average insulin bolus before a meal is about 2 units!

  18. Rohan

    I’m gonna have to say it too, WOW, that is a lot… That’s about a week for me, I think. I reckon I would be pretty scared at injecting that kinda quantity too, I freak out a little if I have a big sugary dinner and have to go for 20U pre-meal…

    I’m gettign better al lthe time though, facing it down. Thinking of it like a poker game has helpeda surprising amount, as now, every time I think to myself ‘ooh, that’s a lot, do I really want that much?’, I say ‘YES. I want to wake up within limits, not hyper’. My morning bloods have behaved every morning I have been ‘brave’, so I get a reward and everything. I just have to make sure I don;t give my self a sugary treat as a bonus reward… 😛


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