The Diabetic Arts

Diabetes is a two-handed disease, it turns out, and in a household that generally has four hands but temporarily is reduced to three, that means some changes have been in order this young year.

Lynn had shoulder surgery on Dec. 30 and now has her arm strapped into a sling. She also has diabetes, as does Na Ki’o. Ki’o is my fourth diabetic cat, so I was versed in cat care; Lynn is my first diabetic woman, but she came self-managed, so I haven’t had to do much except argue with her when her blood sugar goes low enough that medical intervention is required. (The emergency room once advised me to call the cops if I couldn’t get her there on my own — fortunately I managed to wrestle her into the car without that step.)

Diabetes occurs when the pancreas fails in its duties processing glucose, a sugar needed for cell energy for muscles, tissue and especially the brain. Once the pancreas stops working, sugar levels increase in the bloodstream, causing all kinds of health problems. Left untreated, it leads to death. Lynn’s father died of diabetic complications.

Insulin is the substance the pancreas produces to process the glucose. So if your own body isn’t producing enough, or any, insulin, you have to provide it from an external source. All those sources involve needles.

Lots of needles in lots of places. First a diabetic needs to measure how much sugar is his or her system at a given time, and then he or she needs to supply enough insulin to bring it to an acceptable range. Too much insulin, though, makes a diabetic go “low,” which isn’t just like being a little sad — it can be a life-threatening situation.

We had one cat, Khonsu, who when she would go low would start bumping into walls and acting completely stoned. When Na Ki’o’s goes low, we can’t even tell. Sometimes he gets a bit manic, which is the opposite of what you might expect and the opposite of how Khonsu signaled her lows, but generally we don’t know. So while many people with diabetic animals just give the same amount of insulin in shots twice a day, we take readings of Ki’o’s blood to provide an informed amount of insulin, just like human diabetics do.

When Lynn goes low, she gets argumentative and stubborn. Well, more stubborn. It’s very hard to reason with someone who can’t be rational, so it’s always a concern when she goes low. She has never really bought into the argument espoused by me and a nurse friend: it’s better to be a little high than too low. All of the adverse health effects of being high are much slower than having too much insulin in your system, which can cause a diabetic coma in a matter of hours.

Lynn’s highs and lows have smoothed out a lot since she “went on the pump,” as the diabetics of this world phrase it.

The pump is essentially an artificial pancreas, but unlike, say, an artificial heart, all the components are on the outside of the body. Except the needles, which provide the necessary interfaces. And while I have gone with Lynn to numerous endocrinology appointments, seen the components and been aware that she was fussing with them, I did not really understand them. Until now.

So every morning, as I have since we got him, I poke Na Ki’o’s ear with one sharp object, take a blood sugar reading and then prepare another sharp object, a syringe this time, with his dose of insulin. Lynn did this in the evening, using the other ear and the other side of his body, so now I am doing this — and it’s amazing how awkward it is, fumbling around with his right ear and side each evening.

But not nearly as awkward as trying to install Lynn’s various bionic parts without knowing what I am doing.

Here is a true story: always on the cutting edge of technology, Lynn rushed out and bought an early digital camera. Somewhere, lost to the pixels of history, we have the first video I ever took with it. I wasn’t meaning to take a video; I, the Luddite, was trying to take her picture and in my ignorance pressed the wrong button.

My video is of Lynn holding her hand out, demanding her camera back because she couldn’t deal with the level of incompetence I was displaying. And this right here should prime you for the dynamic of Lynn, the pump and me.

Lynn would much rather be putting her assorted pieces together herself than relying on me. About one week into her one-handed life, she has figured out how to manage her infusion set without me. I feel so loved and needed.

But she isn’t going to be able to put her sensor in without me, which means more of these fun bonding projects where she stands there, holding her hand out, demanding her camera back while I snarl, “Can you use your words to tell me what I’m supposed to do?”

After our first finally successful but rather stressful infusion session, she hit upon a good idea and showed me a training video for the sensor.

I have to say, I have no idea who designed this system, other than it’s a company called Medtronic, but I don’t think they could have made it more complicated if they had set out with that goal in mind.

The goal, of course, is to replicate the human pancreas, and if it were easy we’d all be doing that, but honestly! The piece to inject the infusion set is really about 14 pieces, and you have to take off a plastic cap, unwind a spooling piece covering an adhesive pad, pull a plastic part off the needle itself, unroll a length of tubing, pull back an entire plastic contraption . . . I should stop complaining about trying to poke Ki’o’s right ear. At least he (generally) doesn’t protest while I’m doing it.

Lynn’s artificial pancreas consists of multiple components on a multitude of schedules. There’s the sensor, which continuously reads her blood sugar. But it’s not completely reliable, and still needs to be calibrated by sticks of her finger (a duty she also took away from me within a few days of surgery), just like we poke Ki’o’s ear.

The sensor, which is adhered to her upper arm and lasts for about a week, talks to the infusion set, an iPod-sized box that contains a lot of electronics along with a vial of insulin that lasts about two days. The box gets clipped to her clothing, while the insulin is pumped into a length of tubing that goes to a needle adhered to her stomach, injecting insulin as it’s needed.

She likes this system a lot better than the old cat style of testing and syringing, and I did too, up until I had to become an integral part of it. With two or three finger sticks per day, an infusion set change every couple days, and a sensor swap-out once a week, plus twice-daily cat care, that’s a lot of needles.

As noted, Lynn is back to managing a lot of her diabetic responsibilities herself, which is probably good for the divorce rate around here, but I’m pretty sure today is Sensor Day, so we have that fun to look forward to.

At least two-person physical therapy is going well, so far, and perhaps if we keep pace with that we can soon once again be a four-handed diabetic household. It makes things run more smoothly that way.