Another Shoe Dropping

I was suppose to have treatment #5 last Wednesday. I had a monthly appointment with the Oncology RN the previous Friday. I had been very thirsty and consequently had to go to the bathroom frequently on the previous several days. I ended up very sluggish and vomited my breakfast before going for my appointment. In discussing what was going on with the nurse I became nauseous and vomited in the exam room. The preliminary thought was I was having a diabetic episode. They hooked me up to an IV and gave me anti-nausea medicine. My blood test came back with a Random Glucose count of 556. Normal is in the 100-200 range. I had Diabetic Ketoacidosis (DKA). I got an ambulance ride to the Westside Hospital where the ER doctors tried to figure out what was going on (I vomited again in the ambulance just before we got to the hospital). My Opdivo treatments seem to be the culprit. They elicited an auto-immune response where my T Cells attacked my pancreas and killed my insulin producing cells. The doctors and nurses worked on bringing my blood sugar level down. Later that evening they moved me to ICU where they checked me at least every hour. Bright and early the Saturday morning the doctor and his entourage took my history and went off to research instances of Opdivo causing diabetes. Apparently its quite rare, ~ 1%. Aren't I lucky. They put me in a regular hospital room where I was monitored until my blood sugar got back down to normal with regular insulin injections. Then the education started: visit from the dietitian on carbohydrates and how to count them, how to use the finger sticker to take my blood sugar level and how to give myself shots of insulin. I finally got home late Sunday afternoon with a blood tester, insulin, needles and lots of literature to read and digest. I've been giving myself insulin shots, morning and evening ever since. And will continue to do so for the rest of my life.
Good thing I'm not scared of needles or poking myself.

We had to meet with a Nutritionist last Friday for more detailed information about managing diet and insulin. There are lots of options and possibilities. Just have to make it all work together to moderate insulin and glucose levels. Last Monday we met with my regular doctor who will be managing my diabetes care. There are a number of things that I need to be aware of in terms of what can go wrong. Have to make sure my feet do not start loosing feeling or develop sores and the like. They will test the bottoms of my feet every time I see the doctor from now on. Also, I need to get my eyes checked and have them take a picture of the back of my eyeballs. That will be an annual thing. My eye appointment is in three weeks. I've noticed that I can't see as well in my peripheral vision. It's doubled when I look more than 45°s right or left. I can see things there but I can't recognize them very well. I need to turn my head so I can see it almost head on to make sense of it. The doctor said it's know that a small muscle in the side of my eye is affected and it may take several weeks before my body makes necessary adjustments. The sooner the better I say.


It seems that each thing that has happened to me has been worse than the last, changing our focus and giving us something worse to think about and deal with: a rash on my arm, melanoma on my back, surgery, liver and kidney biopsies, renal cell cancer, diabetes. I hesitate to ask for fear of the answer but what else could possibly happen???

We've compiled a list of questions and sent them off to the Oncology Team. Currently I'm scheduled for Opdivo treatment #5 a week from today. I expect we will be discussing my case with the Oncologist before that next treatment.