Interact: Suzie’s story
Suzie has type 1 diabetes. She usually takes fast-acting insulin at mealtimes, and long-acting insulin at around 10 p.m. Her blood glucose is well managed, with a few mild highs and lows, and her last HbA1c was “not bad”, according to her doctor – though it could be lower. She’s had a few piercings previously – a few in her ear piercings and a nipple piercing – and she’s now planning to get a tongue piercing. She knew a tongue piercing would probably be painful, but didn’t think it would be much worse than her other piercings, and assumed it would all be fine if she followed the piercer’s instructions.
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In the afternoon, Suzie started to vomit. She checked her blood glucose again, but the meter only read ‘high’ as it was above the 33 mmol/l the meter could read. Her boyfriend took her to A&E, where she was diagnosed with diabetic ketoacidosis. Her blood glucose was 38.4 mmol/l and her ketone level was 3.6. She was very dehydrated, and had to be admitted to hospital for two days, where she was treated with IV fluids and insulin to hydrate her and restore her blood glucose level. She was given antibiotics to combat the infection in her tongue, but she needed to have the piercing removed. When she had recovered, the hole was gone – if she wanted a tongue piercing, she’d have to get it done again!
This experience is a true story, and it highlights how important it can be to keep your diabetes in mind when you’re thinking about a piercing or tattoo – or anything else that might cause stress or infection.
In particular, it’s important to:
- Keep your blood glucose levels well controlled
- Follow your aftercare instructions
- Take the right amount of insulin, including correction doses if your blood glucose is high
- Keep carb snacks or sugary drinks on hand if you’re worried about hypos
- Check for ketones if you’re over 15 mmol/l
- Drink plenty of water
- Follow your sick day guidance if you feel unwell
- Contact your diabetes care team, GP surgery or NHS helpline if you have any concerns or start to feel unwell
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Question 1 of 4
1. Question
She was a bit nervous on the day of the appointment. She had her normal breakfast and insulin dose and checked her blood glucose levels. She was a little high, at 12 mmol/L, but she didn’t want to have a hypo around the time she was getting pierced, so she didn’t take a correction dose. She checked her blood glucose just before her appointment at 11 am. It was 15 mmol/L, which was a bit high again, but she was happy that at least she wouldn’t have a hypo.
Should Suzie have been happy about her blood glucose level?
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Question 2 of 4
2. Question
Suzie got her piercing without a hitch, although it was a bit more painful than her other piercings. She took some ibuprofen once she got home, which the piercer had recommended. She didn’t want any lunch, since she was in a bit of discomfort from the piercing, and was tired from the stress of the day, so she decided to have a lie-down.
Suzie woke up at 2 pm and checked her blood glucose again. This time it was 18.1 mmol/L. She still didn’t have an appetite, so just had a glass of milk. She took a small dose of fast-acting insulin, as she was worried about having a hypo while she wasn’t able to eat anything.
Can you think of anything Suzie’s done wrong at this point? Select all that apply.
CorrectIncorrectHint
While she missed out a few things, she did do some things properly.
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Question 3 of 4
3. Question
A few hours later, Suzie had more ibuprofen and a glass of water. She noticed that her tongue was slightly swollen, but the piercer had told her this was normal, and that the ibuprofen would help. Just in case, she rinsed her mouth out with alcohol-free mouthwash, as instructed on her aftercare sheet.
She had been planning on having a few drinks with her boyfriend after dinner to celebrate – however, she’d read on the aftercare sheet that she should avoid alcohol. She also wasn’t feeling up to eating the pizza they were planning to have, so she asked her boyfriend to cook lasagne because it would be softer. She checked her blood glucose just before they ate at 7 pm and found it to be 19.5 mmol/L. She took her normal fast-acting dose with a couple of extra units since she was worried about taking extra insulin before bed.
What has Suzie’s done right at this point? Select all that apply.
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Question 4 of 4
4. Question
The day after she got her tongue pierced, she checked her blood glucose a few times and saw it was running between 15 and 20 mmol/L. She was still scared of hypos, so she didn’t calculate her correction dose, though she had a couple of extra units at mealtimes. She felt very tired, but this was normal, according to the aftercare sheet. She had noticed that her tongue was oozing small amounts of yellow fluid, but dismissed this as being part of the healing process, as some of her other piercings had oozed yellow fluid as they healed.
Suzie woke up on the third day after her piercing with her tongue very swollen and painful. It was also leaking a brownish-coloured discharge. She couldn’t eat anything because of the pain, and she was starting to feel sick. She took a few units of fast-acting insulin, less than her normal dose, as she was worried that she couldn’t eat anything. She checked her blood glucose and found it was 21 mmol/L.
What do you think is the MOST likely reason Suzie is feeling unwell at this point?
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