Sunday, 29 March 2015

The unpredictable side of Gastroparesis and Diabetes Management

“I heard you”, Mr T said.

“What did you hear?” I asked.

“I heard you being sick again. Why were you sick?”

This morning I’d woken up feeling nauseous. I got out of bed, leaving Mr T asleep, and pottered around the house, tidying and chatting away to the degus. I took an anti-sickness tablet and made myself some ginger tea – someone had suggested drinking it when nausea sets in. Not long after the kettle had boiled I was in the bathroom bringing up last night’s dinner. I had eaten 12 hours ago yet there it was, clearly it had been sitting in my stomach overnight, not heading anywhere. I instantly felt better after emptying my stomach, brushed my teeth and went back to my ginger tea. It was a relief to have the undigested food out of me and the nausea settled quickly, but it wasn't healthy, I knew that, I worried about the damage that was being done after years of vomiting on and off. 

I checked the screen on my insulin pump and looked back over the CGM (continuous glucose monitoring) trace for the past 12 hours. I could see that my pump had suspended my insulin around 45 minutes after I had bolused for my evening meal – the pump does this when the CGM picks up that I’m heading for a hypo. This must have been because the insulin started working before the food had digested. Throughout the night I could see that my glucose levels were unusually flat, with no post meal rise at all. This wasn’t surprising now that I know my food didn’t really leave my stomach (or the majority of it anyway).

This, compared with other days, has been a relatively easy day. For the past few weeks since I’ve had the CGM and been able to see exactly what my glucose is doing, I’ve become increasingly frustrated and scared when seeing my glucose levels. I have lows not long after eating and highs much later, this is due to stomach emptying as described above. I have tried to adjust to this by taking my insulin after I have eaten and spreading the delivery out over an hour or so. Sometimes this is effective, sometimes it isn’t. My stomach will, at times, empty like it should, meaning that I then have a high followed by a low, due to taking insulin later.

It’s almost impossible to take insulin to cover food as I never know when or if my stomach will empty. How can I predict that? I can’t. It’s opening up a whole new world to me and along with that come more and more questions. How will I manage this when I don’t have CGM in 3 weeks time? What will my a1c be like? Will I be able to have an a1c that will be safe enough for me to have children? Will this cause my retinopathy to progress? Will this cause me to have further complications related to uncontrolled glucose levels?

Taking it each day as it comes seems to be the only option with something this unpredictable. I’ve started medication as prescribed and I’m self-managing as best I can from information I have found on the internet. I had always thought that I quite liked spontaneity, not planning ahead and seeing what the future brings. One thing I have learnt over the last three weeks is that when it comes to my health, this is the opposite of what I want. It’s frightening, it’s depressing and it’s still something that comes as a huge regret.  

Take care of your diabetes as much as you can, and hopefully it will take care of you.

Ninjabetic x 
© Ninjabetic

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