December 18, 2011 - 11:21am
I have type 1 diabetes that is very strictly controlled by an insulin pump (Humalog in the pump) and a continuous glucose monitoring system. My last HbA1c level in fact was 5.3%! I am overweight, but I lead a fairly active lifestyle as a university student. About a month ago, I was hospitalized for multiple severe blood clots. I've had blood clots in my right leg before, but all of my "teams" - vascular surgery, hematology, and my primary care doctor in Internal Medicine traced that bout of clot (which was severe as well - went from my ankle to my groin) to a femoral line (central venous catheter, an IV line that I had in place to use long term at home) in for antibiotics for my lung disease. I still required a heparin drip and lytic therapy with an ECOS machine and was hospitalized for over a week to clear the clot.
This time around, I started throwing clot, and there is no central line on which we can blame the clots. The picture is even more severe. When I entered the emergency department on Nov. 21, I had clot from my ankle to my groin (which is far as one can truly see accurately with an ultrasound) in BOTH right and left legs. I was completely *stunned*. I was, of course, admitted to the hospital so that treatment could be started. When a venogram was done in vascular surgery, we discovered that my clot extended *through* the IVC filter, which is put in place to catch clot, and the IVC was actually covered in clot (so much so that if the physicians did not know that I had an IVC filter, they wouldn't think that one was in place because it was completely covered in clot). The clot went all the way up to my liver, and I had some clot stuck to my liver and surrounding parts of my liver as well. I required lytic therapy again, which is where physicians place catheters directly into one's legs and areas where there is clot and have a direct drip of tPA, tissue plasminogen activator, and also an IV drip of heparin. Each day, a new picture is done to see if the tPA can be stopped, or if another day is required. While on tPA, one has to lay flat and the head can be raised no more than 30 degrees.
I was in the hospital for a week, and then sent home on Coumadin (warfarin) and Lovenox (Enoxaparin) - the Lovenox until my INR was in the right range which just happened this past Thursday!
I've had a back and forth with the hospital - having to be admitted once more because my right leg and side swelled just like it when I went in with the blood clots. Fortunately, I do not have another clot. I just had my follow-up appointment with vascular surgery and they did another ultrasound, and I do not have any clots, but I do not have normal blood flow to my leg either. This is because of the extent of clot. We are not sure whether normal flow will return or not, but I'm doing everything that I can do, and the doctors are doing their part. There is a time when we have to step back and say "will this intervention help me, or will it end up causing another problem?" We could place a stint in the femoral vein to help try to gain better blood flow, but at the same time, that becomes a clot risk. At some point, my immunodeficient body is going to try to fight off anything foreign, no matter how helpful it is to me, no matter what it is doing to improve my life. It could eventually be the cause of a clot episode. No, we've cleared the clots, I think that we will stay right where we are, and work with the medications, see what hematology has to say in January, and continue to have regular ultrasounds to ensure that I am free of clot.
For those of you who have been through clots, if you have diabetes, does diabetes increase your risk of getting DVTs and PEs? Are clotting disorders more common in people with diabetes? All people kept telling me was that I should have a more difficult time clotting because of my cystic fibrosis mutations, but I was a lucky one - I ended up with a rare form of a cystic fibrosis like lung disease with a mutation and polymorphisms on the CFTR gene, and type 1 diabetes.