Monday, December 13, 2010

Sick Day- Not for the Queasy

Yesterday just past 11 AM I got the abdominal agonies. Ow, ow, ow, ow, ow, ow. I attempted to go about my business through the day, though not very successfully.

About a quarter after 9 PM, I threw up (through my mouth AND NOSE!) about a cup and a half of grayish stuff sort of tinted green. I then felt lots better, which was so wonderful I started sing-songing about it. My mother looked at the vomit and concluded it was mostly bile.

Here is how I managed, diabetes wise. My blood sugar was dropping when the pain set in, which was no good. When it got below 90, I ate a mint (5g carbs). My blood sugar started rising. It rose at a rate of about 50 mg/dl/hour until it was over 300. At that point I took 2 1/2 units of insulin. That prevented much further rise but brought no decrease in blood sugar. After an hour and a half, I took another unit and a half of insulin.
A little later, I finally managed to pee and peed on a urine ketone strip, which showed moderate-to-large ketones. Uh oh!
A bit after that, I took 4 units of insulin and drank some pediatric electrolyte stuff. Not much, 'cause it REALLY HURT to drink.
I tested my urine ketones again about two hours later and they were moderate-maybe-small. I was leaving the bathroom when I got a feeling that I was going to throw up, and ran to my room, where I always have a bucket for just this situation, and then I threw up again and again and again.
After rinsing out my mouth, I drank some more pediatric electrolyte, took some more Novolog, took a unit less of Lantus than I had the previous evening, took a bath, and went to bed.

This morning, my urine ketones were moderate-to-small, but I was hopeful that that was showing a huge time lag. I tested blood ketones (my mother went to Walgreens and got a Nova Max meter with two sample strips for $20) and they came in at 0.3, which is normal. I haven't called the doctor yet.
I'm really sore and in some pain but not in agony, and extremely grateful for how well I feel.

My gall bladder was removed on April 22, 2009, but it helped with my abdominal agonies only temporarily, and not that much. On March 16, 2010, I had an endoscopic sphincterotomy (with removal of stones from the pancreas and common bile duct), which helped a lot- but again, it seems to have been only temporary.

I suspect that I have an underlying fat malabsorption issue that contributes to the development of gallstones, and/or that the gallstones over the years have done enough damage to my internal organs and specifically my liver and pancreas, to have impaired my fat absorption.
My father has felt sick from eating fat all his life, and eats a low fat diet. Like me, he has cholesterol levels below the normal range. I have wondered if maybe he and I have a genetic condition affection cholesterol.

Although gallstones are a fairly common ailment, a number of things about how I've had them is not common. First of all, I developed this pain as a preteen- not common- and had my gall bladder removed at age 20- average age for gall bladder removal is over 65. Then I had gall stone pancreatitis- not common- almost a year AFTER having the gall bladder removed- not common. I also had worse gall bladder disease than most- I had multiple adhesions, a shrunken gall bladder, and one that displayed a wall echo shadow complex on ultrasound. And I have none of the big risk factors- no family history, no pregnancy, not fat, young, etc.

Off topic- my endo left a message on Sunday. There was a miscommunication with the lab and they haven't tested my vitamin D levels. My doctor was hoping they would, which is why he hadn't called. He says he's sorry. My A1c came in at 6.2%, hooray! My urine and metabolic profile were normal.


Reyna said...

Bummer on the sick day Jonah and what a medical history you have had to date. You definitely do not fit the profile for all the gall bladder issues you have had. Sorry you continue to endure pain.

WOOT on the A1C and I am psyched that your metabolic profile was wnl.

Anonymous said...

hi, new to the site, thanks.