“And you’re aware that the injection will raise your blood sugars” … hah ha hahaahhaahha
“The x-ray doesn’t show frozen shoulder, but it does help rule out things like arthritis, so from what we can see, your shoulder looks good,” the clinician said, turning from the x-ray to me.
“Now let’s check your range of motion. I’m going to try and press down, but your job is not to let me,” she said, and we engaged in a strange tai chi performance where she’d provide resistance to my arm and I’d try to raise it or lower it. It was like a slow-motion fight.
“Huh,” she said. “Have you had any trauma to the area?”
“No.” After thinking for a second, “But I’m in the perimenopause shuffle, and I’ve had type 1 diabetes for a pile of decades. So no specific trauma, but there are some generalized circumstances.”
She made a note in my chart. “Yeah, those two are big ones,” she confirmed.
We talked a bit more, she pushed against my arm more, and then took a moment to formulate her plan of attack. “I’m thinking physical therapy, and a cortisone shot. And if the combination of cortisone shot and PT don’t resolve this, I’d like to order an MRI and get more diagnostics. Does that order of operations work for you?”
“Sure?”
I have no idea.
“Okay. I can do the shot this afternoon, or we can have you come back a different day. What would you prefer?”
“Today’s fine,” I said. I knew if I left the office, it would take a small miracle to get me back there in a timely fashion. Now or never.
“And you’re aware that the injection will raise your blood sugars. Are you comfortable making adjustments to your pump therapy,” she asked.
“Yep.”
(A note: I am comfortable making adjustments. I had NO IDEA how aggressive my adjustments would need to be. More on that in a second.)
“Alright, that’s the plan,” she said, and minutes later, I was chock full o’ steroids.
The shot wasn’t painful (she used some kind of numbing spray, and I don’t look at needles that I’m not controlling, so I closed my eyes like a little kid and averted my gaze), and I was good for about two hours.
And then the floodgates to blood sugar hell burst open.
I’ve been given birth twice, and during the course of both pregnancies, I watched my insulin needs increase significantly over the course of 37 and 38 weeks, respectively. My mind was blown by how much insulin diabetes during pregnancy required, and by the time I delivered both of my kids, I was at about triple my normal total daily dose (TDD).
The cortisone shot was like 38 weeks of pregnancy crammed into three days, like those time-lapse videos of seeds rooting and growing into full-on tomato plants over the course of fifteen seconds. Holy shit, did my insulin needs go up. Fast.
About three hours after the shot, I was running a 180% basal rate.
Which was cute when compared to the 350% basal rate, the increased insulin:carb ratio, and generalized rage I was hosting seven hours into the cortisone zone. The chaos lasted for about four days, causing my TDD to go from the 27 – 30u range to the 65-75u range.
My time in range by the second day was ONE PERCENT. One percent time in range!
That one percent caused me to rage basal (a new thing) at levels I’d never attempted before, finally bringing me back into something resembling in-range. And true to diabetes form, the increased insulin needs didn’t decrease at a predictable rate but instead crashed down overnight a few days after the injection. For funsies. The juice boxes lining the bedside table (and the kitchen counter, because I wasn’t prepared for that kind of trench) told the story the next morning.
I would have thought it was incredible if it hadn’t been so frigging annoying. So much insulin. Total bananas. Now, a week later, my shoulder doesn’t hurt anymore on the overnight, I start physical therapy next week, and I’m back to a time-in-range in the double digits.
There’s no moral to this story. Except maybe that cortisone shots will properly wreck you up so if you’re getting one, be prepared with a fresh vial of insulin and and humility and patience in equal measures.
