Friday, January 13, 2006

Battles with Insulin

I am ready to give my shot. I sit with the needle poised against my skin for at least 10 seconds. And slowly, ever-so-slowly, push the tip into my abdomen. The needle sinks like a toothpick into a warm cake.

Now comes the hard part.

I deploy the plunger, sending 6 units of beef/pork insulin through my skin and layers of tissue. And the burning begins. Burning like someone is holding a match to the site of the injection. As I pull the needle out, a dark red bubble appears and an itchy, bumpy rash forms around the bubble. It has been happening every time I give a shot for the past week, every single time.

My mother makes a note to mention the reaction I'm having to the endo that next time we go. That's nearly a month away and I'm not sure I can make it that long with burning bumpy bubbling rashes cropping up on my skin four times a day. My mother tries a number of remedies, hoping to alleviate my discomfort; calamine lotion, hydrocortisone cream, bacitracin ointment, cool tea bags (at the suggestion of my hippie Aunt Kay). Nothing works. In fact, the rashes seem to be getting worse, lasting longer and becoming more painful.

My appointment with the endo is moved up. We demonstrate the phenomenon for him. He pronounces, matter-of-factly, that I'm allergic to insulin.

"Allergic to Insulin?" My mother and I both ask the question out loud.

But I've had diabetes for two years, how can I all of a sudden be allergic to insulin? What does this mean? -- You can't take something you're allergic to -- especially when your reactions seem to be getting worse.

But I had developed an allergy to insulin; I was allergic to the medication that was keeping me alive. My doctor explained that although it was rare, insulin allergies happened now and again. He suggested we start two new bottles of insulin and document any reaction I might have. He told us to call back after two days.

Home I went for more burning and itching and bumps.

We went back to his office three days after that initial visit to meet with him and an allergist. The allergist explained that it was necessary to perform skin tests to determine what types of insulin caused a reaction and which reactions were least severe. From there, I would undergo something called "desensitizaion." Although no one took the time to explain the procedure to me, its name spoke two words in my ear... "No fun."

The skin tests were itchy and painful. My arms looked like they would have if I'd done the crawl stroke through a field of poison ivy. It was determined that I am least sensitive to the beef/pork insulin combination I'm currently taking.

The desensitization process was as unpleasant as it sounded to me that day the doctor mentioned it to me and my mom. Three days on a diabetes care unit with a micro-dose of insulin every half hour, the dose increasing in small increments with each injection. Blood draws every hour to prevent any onset of DKA or hypoglycemia that might result from the change in my regimen. I fought a little at the start; then realized these micro-doses didn't sting or itch -- and, if this worked, then maybe the burning and rashes would stop altogether. I trudged through like a brave little soldier -- feeling a bit like an overused pin-the-tail-on-the-donkey game by the end of my four day hospital stay.

But my shots were more tolerable after that. And when human insulin was mass-marketed several years later, and I endured another desensitization process, the skin irriations nearly disappeared.

Here's the thing though, over the past few months, I've been developing reactions again. Some days my pump sites have been leaving huge bumps and I can't go more than a few hours without severe itching and burning at the site of the cannula, particularly if I'm giving a larger bolus dose. Plus, I don't exactly have a "rash," but my skin is a bit bumpy and pink around the areas where infusion sites have made their home.

When I called my current endo, he said he's never heard of an allergy to Humalog or Novolog Insulin. He suggested a few things to try with the infusion sites -- a different antiseptic solution, an adhesive remover, a cream that is supposed to reduce skin irritation associated with infusion sites... But -- I know what I'm feeling. I know what an allergic skin reaction feels like. And I'm pretty sure that's what's going on here.

So -- should I see an allergist? Should I go back to my endo and ask him to have another look at my diabetes history, particularly my experience with insulin allergy? Should I see an allergist and have him talk with the endo? At this point, I'm leaning toward the third option -- I think that sometimes, a doctor needs to speak with another doctor... Anyone else have opinions? Am I being paranoid/hypocondriacal here? Has anyone experienced insulin allergy -- in particular an allergy to Humalog or Novolog?


Red (Aus) said...

Just because a particular doctor hasn't seen or heard of a phenomenon, doesn't make it impossible. Doctors are supposedly taught to listen to their patients, something your endo isn't doing right now. I'd probably go with the third option too, see the allergist and get them to explain it to the endo.
Why should you beat your head against a brick wall while he tries to get his act together. In my experience, an untreated allergy will only get worse and you become even more sensitive sometimes with quite dire consequences. Skip the endo and go where you know you'll get the answers you need.

Shannon said...

Brendon uses Novolog and there is a whole section about allergic reactions to Novolog on the info sheet that comes with the vial.

On the sheet, totally unfold it and make sure the beginning of the info is facing you. Look at the lower right portion of the paper and you will see a heading for "PRECAUTIONS General" The bottom paragraph and the other side of the page is about alleric reactions.

Go to the Endo again and show him the information and insist that he review your history. Hopefully he won't blow you off again.

Jen said...

I've had a sensitivity to Novolog. I currently use Humalog. The pump site itched and was red. But it wasn't as bad as you are describing. It was my endo that suggested that I had sensitivity to Novolog. I started out on Humalog, then had to switch to Novolog for insurance reasons. The novolog gave me the itching sensation, and didn't work as well, so I switched back to Novolog and the itching disappeared. I don't know who I would see about the problem though...

BetterCell said...

Hi CuriousGirl.....When I was on the Medtronic Insulin Pump about a year ago...I also deleveloped red "bumps" at the infusion site. I maintained good hygiene and changed the site evert 48hrs, but still the "red bumps" appeared. I do not think that this was an allergy to Novolog, but more to my body reacting to the plastic insert that stays under the skin which allows the insulin to enter. Since Type 1 Diabetes, as you know is auto-immune in etiology, I took it to mean that my body was reacting to a foreign substance, the plastic insert of the insulin pump. I am back on insulin injections which I do not mind. I do know however, that my glucose control was more stable on the pump. It is just more natural and convenient. Check out my Blog Site☞BetterCell.
Feel Good.

Laura said...

I used insulin during my last pregnancy. I was started on low doses of Novalin. I never had a rash or changes in skin appearance, but the first few doses made me itch (systemic reaction). At about 6 months pregnant, I had to increase the insulin dosage, and the itching came back. Next I had burning at the injection site (no visible marks though). Then the insulin simply stopped working. I discontinued use and went back to balancing with diet alone (which was VERY difficult to do, I had to eat tiny meals every two hours). I had itching 1/2 hour after eating for the next two weeks. At the time, being very pregnant, I was scared to try any other insulin types - though I did try switching to Humulin which caused the same reaction within two days. The doctors swear they have never heard of a reaction like mine.

Anonymous said...

When my niece first started on Lantus, she immediately got a red itchy patch. Within the next month, she had a red itchy patch all over her body. When we showed it to the endo, she said to see a regular doctor and it is impossible to be allergic to insulin. Fortunately, within another month the rash was gone. I'm with you. You were allergic. From the looks of the other comments on this site, I'd say you are not alone.

KSC said...

I've been wondering about the same thing - especially the itchy red/swollen "pump bump" awfulness...have you used the IV preps every time? I've bee wondering if that's the key but...good luck sorting it out and I'd be interested to learn what you find out.

Nicole P said...

Yes, I definitely use the wipes every time. The allergist is making desensitizing suggestions again -- I might be in for a short hospital stay... I'll let you know.