We called 911 and he took an ambulance ride into the hospital. En route, they gave intravenous fluids and tested his blood sugar levels. "We don't know how high they are, because the meter only goes up to 500." Yikes!
At the emergency room, it was more IV fluids, followed by IV insulin, which they increased very slowly. His main complaint at this point was thirst, since he was allowed only ice chips because of the nausea. With insulin, he started feeling better as they increased the dose.
After a couple of days in intensive care, a couple of days in an ordinary hospital room, and meeting with a diabetes educator and a nutritionist, he was released.
There were many good things about the care he received and some not-so-good ones. The good:
- The ambulance crew did all the right things, and his high blood sugar was known long before he even reached the hospital.
- Everyone at Good Samaritan Hospital in Corvallis was cheerful, competent, helpful, and reassuring.
- The hospital recommended and provided the latest and most appropriate insulin and supplies for Karl. More on that later.
- The doctors told us, "This is Type 1 diabetes, and that means his pancreas is a goner. You may have a brief 'honeymoon period' where it recovers, but it's burn out soon enough and there's nothing you can do." This is nonsense with no basis in actual research; quite the contrary. It's an outdated assumption that's still widely believed by doctors in spite of having been proven false.
- The nutritionist told us, "Karl needs lots of carbohydrates to survive, so aim for 75-90 grams of carbs with every meal." In fact, the body needs no carbohydrates whatever to survive. The body needs fats and proteins (essential fatty acids and essential amino acids) to survive, but there's no such thing as an "essential carbohydrate"! Again, this is based on outdated assumptions that were proven false years ago.
Injected insulin doesn't have a feedback loop, so if you give yourself too much or too little, oh well. Even small mistakes in carb counting or insulin dosage can lead to big swings in blood sugar, unless you have some pancreatic function left, in which case the swings are much, much smaller. So keeping the pancreas going is very important.
In spite of what the doctor said, there are promising, known-safe methods of prolonging the honeymoon period, including the use of nicotinamide (also called niacinamide, one of the forms of the B vitamin niacin), using enough injected insulin that the pancreas isn't constantly exhausted, and keeping blood sugars under control, since high blood sugars actively harm the insulin-producing cells.
Keeping blood-sugar levels under control. So, in addition to vitamin supplements, the goal is to use insulin to keep blood sugar under tight control, keeping it below the danger zone of 140 mg/dl and above. (This is the goal set by the American Association of Clinical Endocrinologists, as opposed to the old-fashioned stance of the American Diabetes Association.)
Tight blood-sugar control is hampered by the fact that you have to match the amount of insulin you take to the amount of carbohydrates you eat, plus the fact that insulin's effect varies from shot to shot, and the carbohydrate values of the foods you eat are not reported with much precision. Nutrition labels can be off by 20% in either direction, for example.
To take an example from Karl's menu, a kids' chicken strips basket at Shari's restaurant is supposed to have 82 grams of carbs, but this can vary by 20%, or 16 grams either way. The safe range of blood-sugar levels is 70-140. A gram of carbs will raise Karl's blood sugar by 5 points, so if he's at 100 at the start of the meal, if the meal has 16 grams more than advertised, he'll end up at 180, and if it's 16.4 grams less, he'll fall to a disastrously low 20!
What does this mean in practice? It means that eating a meal with 82 grams of carbs is like playing Russian Roulette (and the advice we got from our nutritionist was wrong). But if we dropped the carbs to just 30 (say, with just chicken strips and no fries), a 20% variation is only 6 grams, and if he starts with a blood-sugar level of 100, the variation is only 30 points each way, from a low of 70 to a high of 130. This is within the target range.
So the only way of actually achieving blood-sugar targets is by cutting carbs from the diet. You eat fewer carbs. With every carb you cut, the margin of error goes down and control goes up. Simple, huh? Sometimes I think that the problem with doctors is that they aren't engineers.
Except that some doctors are engineers. I've been reading a wonderful book on blood-sugar control, Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars, which is by Richard Bernstein, an engineer who became the first diabetic to take blood-sugar measurements multiple times per day, using the then-new blood-sugar meters, which were considered to be laboratory equipment, not home-use devices. The insight he gained from this, and his engineering background in control theory and general problem-solving, allowed him to come up with a treatment plan that really works, reversing his diabetic complications. He entered medical school at the age of 45 so he could become a doctor and share his results directly with patients. His book is very practical and thorough, with both step-by-step procedures and a clear description of the underlying theory. A must-read for anyone with diabetes, or who helps care for someone who has.
A slimmer volume on much the same topic is Blood Sugar 101: What They Don't Tell You About Diabetes. I recommend that you buy both.