Wil Dubois

Happy Saturday! Welcome to Ask D'Mine, our weekly advice column hosted by veteran type 1 and diabetes author Wil Dubois in New Mexico.

This week, Wil tackles a second question from the Diabetes Community about seizures. Make sure you saw his response to a basic seizure question last week, and then take a look at today's about the aftermath of this harrowing experience.

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Brandon, type 2 from California, writes: I’m just recovering from a seizure, which I had on Monday at the doctor’s office. My blood sugar levels were 463 and when I went into the office (the dcotor) gave me 3 series of shots to bring my blood sugar level down. The last shot she gave me sent me into a seizure. What should I do as a next step? I am feeling real leery about going back to that office for fear that the wrong medications might be prescribed.

Wil@Ask D’Mine answers: First off, I’m sorry this happened to you. It must have been terrifying. But at least you were in a doctor’s office where you had quick help on hand. I appreciate you writing, and I’m happy to give you my opinion of what I think you should do next. But first, I want to analyze what happened based on what you’ve told me, and try to put all of us in your doc’s shoes so we can better understand how that could happen.

First things first. A blood sugar of 463 is crazy dangerous. You understand that, right? Reverse engineering that reading to an A1C, it comes out to a whopping 17.8 percent. Your poor doc could hear your kidneys screaming through her stethoscope. As you sat in her waiting room, the sugar levels in your blood were so high your tissues were dissolving. Every second, cells were dying, killed by your toxic blood.

Both microvascular and macrovascular systems were at risk. In addition there was another theoretical risk. While type 2s are normally considered coma proof, at that kind of blood sugar level there was a genuine risk that your beta cells might faint, stop producing insulin, and leave you open for type 1-style diabetic ketoacidosis (DKA), which is a serious life-threatening emergency.

So your doc had to act. And she did: She gave you the first shot. Apparently, that didn’t do the job so she gave you a second one, which also failed to bring you down to a safe level. So then what happened? Did she give you the medical equivalent of a rage bolus? Did she do a poor job of tracking insulin on board? After all, each shot—assuming it was fast-acting insulin—lasts four hours, and they do stack up. Did she get impatient?

Or more frighteningly, did she simply not know what she was doing?

There’s no way for me to know. But there’s a reason that medicine is called an “art” rather than a science. It’s too complex, too personalized, and biology is too damned messy for medicine to ever be a proper science. Spit the atom? No problem. Regulate blood sugar? Ha!

So I really can’t venture an opinion about the quality of care at that office. There’s just too much I don’t know. I’ll come back to that in a moment, but first, I want to reassure you on one point: They did not prescribe the wrong medication. There’s only one drug for what was ailing you, and that was fast-acting insulin. Sure, once you are out of crisis, once someone has time to look at your diet and activity, then there will be other options. Lots of options. But in the moment, they were just trying to keep you safe.

But still, while you were given the right drug, you were given too much of it. Does that justify jumping ship? Maybe so. Maybe not. Like I said, this is an art. Even the best artist botches a painting now and again. Here are some things for you to consider to help you decide if you should go back, or find someone new to help you:

  • How long have you been seeing this doc? Is she brand new to you, or has she been following your health for years? Given your stratospherically high sugar levels, I’m guessing that it’s likely been a considerable period of time since you saw any physician; but still, even if you are a once-every-decade patient, does she know your history better than anyone else? If you’ve been with her for a long time, it might make sense to give her another chance. If it was the first time you met her, you have little to lose by shopping around. Unless…
  • Aside from this one horrible experience, how well do you like this doctor? Did she listen to you? Did she communicate clearly with you? Finding a doc you really like can be hard. Regardless of how long you’ve been with her, if you “clicked,” I’d give her a second chance.
  • Next, what sort of doctor’s office was it? Is the doctor a general practitioner, or a diabetes specialist? Even though most type 2s are treated by primary care docs, you might want to consider an endocrinologist, the type of gland specialist who, among other things, specializes in treating diabetes. You can also be assured that endos really “get” how insulin works, not that it will grant you 100% protection from the butter-side-down nature of the universe. Remember what I said about this being an art.

But one last thing: You can’t let this bad experience keep you from getting medical help. Whether you go back or move on, you must get help. The insulin they gave you brought you down. Too far down, I get that. But I guarantee you that if your blood sugar is back up in the mid-400s again, leaving it untreated will bring you far greater misery in the future.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.