Saturday, April 09, 2011

My other life...

Today I taught art all day long. Literally. 9:30 am - 8:00 pm.

It was great.

A complete total getaway.

Did not think about diabetes once.

Did not worry about a thing.

I'm exhausted tonight, but it's such a peaceful exhaustion.

My one day a week to completely escape!

Life is good.

No decision on his work...everything has been put on hold by upper management. And the weekend is giving him a break from the stress.

Thanks for the comments...welcome Angus!

Thursday, April 07, 2011

Back to work way too soon!

And the signs are starting to show up. This is a guy who NEVER cries.....and he has been on the brink of tears twice this week because of things going on at work. He works from home, but it's just as stressful. He missed a call while getting back xrays last week and they moved 3 of his key employees into other units. Then yesterday, he got a phone call to join an emergency meeting and he had one hour to give the name of an employee they could cut. It's a huge corporation and he has excellent income and benefits and can do all this from home. But his stress is beyond anything I have ever seen with him.

So, we decided that he has 3 options after a lengthy talk yesterday afternoon.....into the evening.

1. He can go back out on a 6 month short term leave with full pay and see what happens at the end of that time.

2. He can try for the company's long term disability. I'm certain that he qualifies. It would be 66% of his salary for 5 years and then he would have to retire. While on disability, he cannot work anywhere else.

3. they are offering a retirement package right now. He qualifies. He would get a buyout around $100K and then $1600 a month for the rest of his life. Certainly not much income. We could buy a small retirement home with the cash and help my sis take care of my mom. I'm all for this option. I have a retirement income and between the 2 of us, we would be ok. And there would be no restrictions on his working somewhere else.

We were both leaning towards # 3 and talking about whether to help my mom, a 100 mile move, or move 1000 miles and help his parents who are younger. I thought we could do both. Move close to my mom until she passes, then move again. HA! That went over like a lead balloon.

The other problem is that my mom lives in our HMO area. His parents - no idea what insurce we'd be with there. And because he would lose his health insurance if he retires and have to go on mine, I decided I get to pick! LOL! (Just kidding!)

I was up all night long because this is how his company does. Makes an announcement and gives you 24 hours (or less) to make your decision. They have not offered a retirement package in 2 years and have had about 8 reductions in staff. If he doesn't go with the package now, he may not get the option. And there is no guarantee that his name won't be put into the pot with the next reduction,

And we are certainly ill equipped to make this kind of a decision in 24 hours!

So, we agreed to sleep on it. He slept, I searched the internet for homes for sale!

Got up this morning and he is in the worst, most foul mood ever. I realize this is beyond stressful for him. Not only is he in the process of making a decision about himself, he's got to give up the name of an employee that he really is close with. It's just heart wrenching. Bottom line, he is simply not well enough to go through this amount of stress He should not be back at work. He will neer heal. And he is not well enough for us to move. But if he retires, we cannot stay in this house - it would be way to expensive to maintain. We might even end up in foreclosure or bankruptcy. I have no idea. But I feel my own ulcer brewing!!!

What I do know is that no matter what happens today.....we wil get through this. No matter what decision he makes, I will be here beside him, trying my best to support him.

I have decided to take the day off and just play. Called some artist pals and they are coming to the rescue and my sister is going to skype in, so we're going to have a party! Carrot cake in the oven making the house smell wonderful!!! At least I've learned how to take a "bad" moment and turn it around!


Wednesday, April 06, 2011

Needles, syringes, humulin R-U 100, U-500, the little differences that impact life!

By the end of this article, I hope you see how the hospital staff could have ended my husband's life because of simple mistakes, and a lack of education. When it comes to diabetes and hospital staff, I don't think there has been near enough education. And with the rapidly increasing number of diabetics out's going to reach a crisis before too long.

Good article:

Click here

Humulin R U-500 concentrated is a form of Human insulin which is 500 units/ml and is 5 times more concentrated than Humulin R U-100 aka Humulin Regular or Regular Humulin. This is my starting base as this is what hubby takes.

BUT.....R U-500 is also called Regular Humulin (see the "R"?)

There is also Humulin R U-100 which is called Regular Humulin. Ahhh....see the confusion starting already???

U-500 (which is what I've decided to call the concentrated type) takes effect w/i 30 minutes (fast acting)
but it is also long-acting as it will last up to up to 24 hours duration

Note: If you take it at 7:00 am (breakfast) and 5 pm (dinner) there is a build-up, a half-life to the amount you take.

It is used in both type 1 and type 2 diabetes

It is useful for the treatment of insulin-resistant patients

It is used in diabetics who need a lot of insulin.

usually given 2 or 3 times daily before meals. Should be followed by a meal within 30 minutes of administration

may be administered in the abdominal wall, thigh, or upper arm. Abdominal wall ensures a faster absorption than other sites. Personal expeience is that it causes bruises in the stomach. Imporatnt to hit a different spot each time.

Use a U-100 insulin syringe = divide the units of U-500 by 5

So 50 units of U-500 is number 10 (units) on a U-100 insulin syringe.

If you use a tuberculin syringe (volume in mL, use a chart provided
Example. 50 units of Humulin R U-500 dose (units) would be 0.1 on a tuberculin syringe
75units would be 0.15
100 units would be 0.2

U-500 Insulin
Most insulin products are supplied from the manufacturer in a 100 unit/mL concentration. The insulin is then administered using an insulin syringe specially designed for use with this concentration of insulin. When a patient needs a dose of 40 units, a caregiver draws the insulin to the designated 40-unit marking on the insulin syringe. However, there is a more concentrated form of insulin that comes as a 500 unit/mL concentration.

The use of U-500 insulin has been increasing due to factors including an escalating obesity epidemic, increasing insulin resistance, growing use of insulin pumps, and rising usage of high doses for tight glucose control. However, there are no insulin syringes designed to measure doses of U-500 insulin (in the US) ; therefore, healthcare practitioners are forced to prescribe, dispense, and administer U-500 insulin using insulin syringes designed for 100 units/mL insulin or other syringes marked in mL. For example, a patient using U-500 insulin with a U-100 syringe might state his dose as “40 units” because he is reading 40 units on the U-100 syringe he used to administer the insulin. However, he is actually administering 200 units of insulin because of the higher concentration. This increases the risk that a fivefold dosing error will occur when the patient communicates his dose to a healthcare practitioner.

The prescribed dose of Humulin R U-500 should always be expressed in actual units of
Humulin R U-500 along with corresponding markings on the syringe the patient is using (i.e., a U-100 insulin syringe or tuberculin syringe

My husband's pre-surgery dose of 32 units of RU 500 would be 160 units of RU 100. (32 x 5 = 160)

Hospital gave hubby 16 units of novulog. They converted 32 straight across and cut it in half because he was NPO. Thus, he received 10% of what he should have received. No wonder his glucose shot to 400 the next morning! This is a common/typical mistake made by hospital staff.

Good information

To switch from regular to concentrated:

The total daily dose of U-100 insulin is added up, and then diided by 5 to indicate the U-500 insulin requirement. Then reduce the U-500 requirement by 10 – 20% and divide the remainder throughout the day. 60% pre breakfast, 40% pre dinner.

So, to switch from concentrated to regular:

Add the total amount of U-500 given per day, then increase by 10 – 20% ,then multiply by 5. This will give you the total amount of U-100 insulin needed.

I can't begin to do the math going backwards!!!

People have asked why hubby is not on metforim. You can't take it if you have renal impairment. My understanding is that if the kidneys are functioning less than 50%, then you are considered to have renal impairment.

The vial of U-500 insulin looks almost identical to a vial of U-100 insulin. The word "concentrated" is in small type and you actually have to hunt to find it.

U-500 is usually not available in hospital pharmacies, so patient must take their own with them to the hospital. Upon admission to a hospital, ask to have their endocrinology staff brought on board immediately. Patient’s chart should clearly indidcate that the patient isusing U-500 insulin.

In hubby's situation, I said he was taking Humulin R-U 500 concentrated. The Pharm D STUDENT who admitted him wrote down Humulin Regular which everyone then interpreted to be Humulin R -U 100.

In some situations, patients need to be fasting and hence intra-venous insulin is required. Insulin resistance is increased in acute ill-nesses and thus insulin requirements can be greater. It is crucial that the ward nursing staff/pharmacist clearly identify, label, store, dispense and inject the U-500 insulin separately from U-100 insulin. These patients may need a steep sliding scale at higher blood glucose levels.

another article

hospital errors


there are 2 kinds of insulin syringes. We have literally been to hospitals that do not stock insulin syringes! ICU at this last hospital did not have insulin syringes available. They did manage to get some from another floor. ICU without insulin syringes?????

1/2ML – u100

1 ML – u100

1 ml of insulin fluid has 100 standard “units” of insulin.

1cc (1ml) syringe holds a maximum of 100 units,numbered in 10 unit increments. The smallest line is 2 units. The smallest measure is 1 unit

1/2cc (0.5 ml) or ½ ml syringe holds a maximum of 50 units, numbered in 10 unit increments, the smallest measureis 1 unit.

U-100 insulin syringes have shorter needles, finer gauge needles for less pain. You want these!!!

Standard hypodermic syrines measure in cc and have larger gauge needles which will cause more pain.

good article on this

14 units on the ½ ML syringe is actually (14x5) 70 units of U-500 because you convert the dose of U-500 to U-100 volume equivalents in order to use the U-100 insulin syringe.

Ah! See where the staff's confusion comes in? They don't want to convert anything!!!

A standard tuberculin syringe measures volume in milliliters. But they do not come in 30 ga needles. Tuberculin gauges are 26 or 27 – bigger than insulin needles. (the larger the number, the smaller the size when it comes to gauges).

The Rx should be written as:

Insulin dose is 70 units, using U-500 insulin. This is equal to 14 units (.14ml) when measured in a U-100 insulin syringe.

Because U-500 is pretty rare, hospital staff is not trained in it's use. Therefore, spouses have to be the ones who are educated in the event that the diaetic can't communicate (how sad is that?) Spouses HAVE to be vigilant and check each does that is administered because each change of staff brings on a "new" nurse that has not bee educated. Doctors and nurses all want to switch from U-500 to U-100, but because the reverse formula is so difficult (adding back in the 10% reduction, giving consideration to changes in weight, etc) and because the patient will now need 5 times the "volume" of insulin (going from 25 units of U-500 to 125 units of U-100), and the timing of injections because U-500 is both fast acting and long acting) really does create a nightmare for the patient. Unless hospital staff are willing to test every 2 hours and adjust H and N types of insulin for the patients needs, it's just not going to work. And considering that my husband would go up to 6 hours without anyone checking would have been disastrous!!!

Needless to say, just the original PharmD student misunderstanding what I clearly said to him was a big enough disaster going into the first operation.

Insulin usage/doseage in hospitals is simply something that spouses are going to have to remain aggressive about. I don't see any medical staff understanding or wanting to understand U-500 and I have a feeling from what I've read online that most don't understand the regular, normal stuff

Here's hoping my research helps someone else. Feel free to print it out and hand it to the surgeon and the hospital pharmacy. They might as well love you as much as they loved me! :o)


Sunday, April 03, 2011

comments on comments.......

Comments from "Too tired"

But first, why repost comments?

Because it's just not so easy to go backwards in these blogs and see what others wrote - and I think it's important to give validity to their comments. :o)

Lilly wrote:

As you and I have said before, if we could get all the doctors that our hubbies see in one room together, it would be so much easier. I wonder if they could come to any type of agreements then? I really wish this could be done, because we as spouses end up trying to take it all on with the disagreements about meds, etc., and (you are right!) it is totally exhausting. The depression and feeling useless is something that my husband faces every day as well. He was basically forced into medical/disability retirement at the age of 40, so he has had a lot of time on his hands feeling useless, as almost all of his friends are still working. Most of the time, I don't have the energy to deal with it either, as I feel like I am picking up the pieces on everything else. Hang in there. I KNOW none of this is easy! Lilly

After hubby's most recent hospitalization, and all the follow up visits, I have come to the conclusion that nephrologists think they are gods. And possibly with some justification. After all, if the kidneys stop functioning there isn't much left. Nephrologists stopped his medicines (4 of them) without talking to us about it. Hmmm.....making life altering choices without discussing them with the patient or the patient's family? must think of themselves as gods. That's the only explanation I can come up.

So if we put all the specialist into a single room - the nephrologist would take over the meeting, try to control everyone else, make all the decisions and determine what's next. And that is exactly what happened at the hospital.

I personally would prefer to defer to the cardiologist. From what I have seen, they are more concerned about the whole person. Yes, their speciality is he heart....but they also seem to know more of what the entire body needs.

Hubby's nephrologist wants him off his atenolol.....which the cardiologist said to never stop, no matter what. That was written in his hospital chart, yet the hospital nephrologist stopped it.

Think there's a "power play" going on there? LOL!!!

I'm sorry DW. I hate specialist. I hate them with a passion. I voice this from personal experience of dealing with them for my own health issues. They will NOT look at the whole person and don't care what any other specialist says or does. At most they give seven minutes of their time and with hand on door-knob ask if there is anything else. I think someone can "wish yourself to death". Having the will to live is half the battle. Hopefully he can cheer up. It sounds like he (and YOU) had a truely terrible day. My prayers go out to you both. S

Hubby is still depressed. But I have been gone most of the weekend either teaching or presenting. Haven't had to deal too much with his mood.But it's no better tonight. Sigh.

Tom’s wife

f you could wish yourself to death, my 104-year-old grandmother would have died 10 years ago when my grandfather died. Instead she lies curled in a ball at a nursing home being forced to drink ensure and moved around by aides all the time. the horrible part of your situation is that the medical industry is more focused on the benefit to the "stockholders" and the managers and less on the care of the patients! From a distance, we can let some of these young care-givers off of the hook a little, they are limited by the training and rules they are given and must follow. But often one wonders about their compassion. I guess that is no longer a necessary trait of a person in the profession. Its ok that you are not the cheerleader for a day or two. If he is depressed -- well, then he is. This is not uncommon and another condition that (in my humble opinion) he also needs to address. You and I know that in all probability I will do exactly the same things you are doing to care for my Tom when he is in the same condition as your hubby -- so my words must be taken with a grain of salt. However, what I want for you is to give him back some of the control and responsibility and "force" him to stand up for himself and throw your documentation into the face of his doctors and tell them himself that he needs help. even if some of that help is medication for his depression. enough said, you know this, and it is so much easier said than done -- especially from the anonymity of the blog-world good luck -- know my heart is with you. and I hope Monday (work) brings good news. Tom's Wife

I guess I think that if you are ready to die spiritually, if you are really ready to let go of life, then one can wish themselves dead. I am a genealogist and I have seen so many cases where one spouse died within a few days of losing the first spouse. And they were healthy. They just wished themselves to death. But I also think we can never really know another person's soul. Are they clinging to life because on some level they are not ready to go? My father was not supposed to make it home from the hospital to hospice care yet he lived 2 more weeks waiting for his brothers to arrive from out of state to say goodbye to him. I mean, this guy had a zero percent chance to live 1 hour after they unhooked the heart/lung machine against medical advice. He had an 8% heart/lung capacity, no kidney function....yet he lived 2 more weeks. Just amazing.