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Long Term Lows.

Last night, just before bed, I did what I do every night before turning off the bedside lamp:  checked the IOB (insulin on board) on my pump and looked at the Dexcom graph.  IOB was okay (0.21u from a small snack bolus two and a half hours earlier), but the Dexcom was showing 146 mg/dL and heading in a southwesterly sort of way.

It was midnight-thirty, and I had to wake up at 5 am to catch a flight to California, so I knew I wasn’t going to be asleep long anyway.  Since my blood sugar was in the 140′s and not the 40′s, I decided to run a -90% basal rate for an hour and hoped that would stave off the low.

(This shit never happens on a night when I am able to sleep in and I don’t have any responsibilities the next day.  It ALWAYS happens when I’m scheduled to catch an early flight and have a full agenda for several days straight.)

Fifteen minutes later (close to 1 am), I saw double-down arrows and my meter confirmed me at 70 mg/dL.  A jar of glucose tabs on the bedside table showed I had four left in there, so I chomped them all down in an abundance of caution, pretty sure I’d end up in the 150′s when I woke up at 5 am.

Twenty minutes later (close to 1.30 am), I was 52 mg/dL.  And I stayed in the 50 mg/dL range for three hours.  THREE stupid hours.  For three hours, the Dexcom wailed, I checked my blood sugar, and steadily consumed carbs made out of dreams and air, apparently, because they didn’t touch the low.  This low wasn’t symptom-free, either; it was one that made my shirt damp between the shoulder blades, and had me flipping the pillow over repeatedly in search of something cold.  And once it was starting to taper off and the Dexcom arrows were pointing back up, the adrenaline from waiting out the low for hours had my muscles tense, like a cat who had been stalking the same dangling ribbons for hours.

Only instead of rolling over and taking a cat nap, I was wide, wide, wide awake.

“Are you awake?” I asked Chris at 4 am, who had been awake for part of the night, when the low dipped into a tough range.

“No.  Unless you need juice, and then yes.”

Just past 4 am, I fell asleep, and the alarm set to get me to the airport on time went off an hour later.  Pity party time?  No, but it will explain why most of this post is rambly and might smell like glucose tab dust.  So far, today has been a hazy, confusing shuffle of airplanes, connecting flights, and awkward naps on the shoulders of strangers (but we know each other better now, don’t we, Tom?).  And the low hangover is impressive, making me actually want to put on sunglasses and have a glass of that Naked Mighty Mango drink (which seems to cure every hangover I’ve ever had – shit is magical).

But I’m glad that today’s destination is somewhere warm (Los Angeles) and I’ll be seeing some of my favorite people from the diabetes community at the Medtronic diabetes forum taking place this weekend.  (Hashtag to follow is #MedtronicDAF, and by way of disclosure, Medtronic is covering my travel, lodging, and expenses, although my opinions and poorly-timed jokes remain, as always, mine.)  Other people posted that they were attending and asked for discussion points from the DOC, so I’m doing the same. If there’s anything you’d like me to be sure to bring up to the Medtronic team, please let me know.

… only I’ll be wearing my Animas Ping and my Dexcom G4 and a host of dark circles under my eyes and hopefully clutching a Mighty Mango drink.  We’ll see how that goes.

 

 

24 Comments Post a comment
  1. “Unless you need juice, and then yes” <—so romantic.

    01/9/14; 12:42 pm
  2. Say hello and give hugs to Christel and Sara and all our other DOC friends for me! And hug yourself while you’re at it :) Here’s to no more lows and no crazy highs while you travel, either!

    01/9/14; 1:51 pm
  3. Amanda #

    Ugh these nights are the worst!! I think there’s nothing worse that a low except for a night time low, totally draining :-( hope you get a better nights sleep tonight!

    01/9/14; 2:27 pm
  4. Sheri #

    Not sure if the right people will be there, but I would ask about the rationale behind forcing their customers into the 530G system. I wanted another Medtronic pump last November, but was told that the 530G system (pump, meter, CGM) was my only option, and they proceeded to sing the praises of their new technology, how much better my control will be, all of the propaganda sales crap you would expect. I’m happy with my Dexcom and my insurance won’t pay for Contour strips, so I have no need for 2/3 of the 530G system. Even worse, I was told that I could get a stand alone pump but I would have to pay out of pocket ie they would not submit to insurance. STUPID!!! I told them that this was an unfortunate marketing decision and that they would lose me as a customer. I have since switched to Animas. Thanks Kerri, and have fun in warm LA!

    01/9/14; 2:37 pm
    • I will absolutely bring that up, verbatim. Thanks for lending me your thoughts!

      01/9/14; 2:47 pm
    • Sandy T #

      umm, if only there was a like for Sheri’s post!
      They forced me to buy the entire thing also. And guess what? Th CGM does NOT work for me. They keep trying to tell me that I should use it for trends…but what is it trending? The fact that it’s worthless? (It seems to think I’m in the fifties, ALL day long) ARHHH. So annoying. I have all the supplies, and yet I refuse to toss them because it’s a LOT of money to toss in the trash. But that’s what they are trash.

      Big Failure medtronic. Animas is looking really good right now.

      01/13/14; 9:57 am
  5. Kristee Kruse #

    Hi Kerri. Hope you have a much better night’s sleep tonight. Your post makes me wonder if I should be checking my son, he is 11, in the middle of the night, EVERY night. His Endocronologist said he is not yet a candidate for an insulin pump, since he was just recently diagnosed. However, I think I would sleep better knowing that this device would alert us should he go low. Thoughts?????

    Have a Great time in LA :)

    Kristee Kruse

    01/9/14; 3:34 pm
    • Jane Sarphie #

      Kristee, As a parent of a 9 year old who has been T1 for three years now, I can tell you that for my peace of mind we check him every night sometime between when he goes to bed and when he wakes up in the a.m. Sometimes the best we can do is check at 11 when we go to bed and sometimes it is a 2 or 3 a.m. check but we have caught him down in the 40-something range too many times to not check any more. He is a very sound sleeper and so we don’t trust that he will “feel the low” and wake us up.

      And just a point of order, an insulin pump will not alert you to a low in the night, only a CGM (Continuous Glucose Monitor”) will do this. Our little guy is on a pump but no CGM as of yet. I feel he does not have enough body fat to support two sites on him at all times yet:-)

      Different parents have different strategies for their kids. We have some D-parent friends who do not do the check, and some who have an assistance dog AND a CGM to alert them during the night, and what we have found is a happy medium that we can feel secure with.

      Jane

      01/10/14; 6:18 am
  6. Kris #

    I just recently started using a CGM since I am pregnant…and I have to say my first night with it was much like this! Actually, a lot of my nights have been close to this recently. I feel like I have so much more information now with the CGM but it’s terrifying to realize I probably had the same trends before, and just didn’t know! Here’s to hoping I can get a few FULL nights of sleep before this baby comes. With all this new technology I feel it shouldn’t be so hard to make the needed adjustments! :) Hope you have a wonderful trip. I don’t have any questions for the Medtronic team, but I do have to say I have enjoyed the 530G with Enlite so far. I’m only a few weeks in, but I can already see the better control I am having!

    Ps. Thank you for sharing the way you do. You often describe the feelings of lows and highs far better than I can. I have told my husband so many times, “You don’t understand?? I have a website for you to visit! She words it better than I can!”

    01/9/14; 3:57 pm
  7. John #

    Wondering if Medtronic will ever produce a logbook App (preferably Android!). I don’t like any other diabetes apps I’ve tried so far, and still write out all my info in a Medtronic Daily Insulin Pump Journal. I’d love an App that copied these logbooks! Also wondering if they have anything in development for future pumps that include today’s/future technology – bluetooth, touchscreen (with color!), wi-fi. And how about a pump that has more than just 3 programmable basal rates?!?! Sometimes I exercise in the AM, sometimes at lunch, sometimes none, sometimes I bike to work and back (sometimes with lunch exercise and sometimes not). Life would be much easier without trying to remember (and often forgetting) to do temp basals.

    Thanks!

    01/9/14; 5:48 pm
  8. Kerri, I enjoyed reading your blog. Laddie from Test Guess and Go brought it to my attention today. I posted a blog on her site today similar to yours, called Oh What a Night!
    http://testguessandgo.com/2014/01/09/oh-what-a-night/
    I also kept dropping during a three hour period despite consuming 55 g of carbs.

    As I mentioned at the end of my blog, in a year and a half I will be on Medicare, and will no longer have insurance pay for my Dexcom. This scares me.

    01/9/14; 6:29 pm
  9. Sue Berger #

    Your blog was an interesting read. My husband has been struggling with his hypoglycemia and hyperglycemia incidents and has been without a CGMS for over a year. There are many instances when he’s very high and in trying to correct the high, he goes very low…and vice a versa. Last October, after a new CGMS was denied by our insurance company (we had both gone on Medicare a few months prior), we appealed the insurance company decision and had a Administrative Law Judge hearing on June 26, 2013. We are still waiting for the decision. It’s been rendered but is being drafted. Why this takes so long is beyond me.

    Recently, I was advised that Carol Shea-Porter, Congresswoman from New Hampshire, has introduced into Congress HR 3710 – Medicare CGM Coverage Act which amends title XVIII (Medicare) of the Social Security Act (SSA) to cover continuous glucose monitoring systems (CGMS) including a transmitter, receiver, sensors and test strips required for use as durable medical equipment. This bill is so very important for those people who are on Medicare who depend on the CGMS to enable them to live a normal life and in many instances, save their lives. And in the future, as more and more diabetics reach Medicare age, this bill will become more important as the numbers multiply.

    I blog on testguessandgo.com as Sue from Pennsylvania and would welcome any feedback from anyone concerned about this issue. I will definitely appreciate any help available to me in order to get Medicare to change the guideline for the CGMS changed.

    01/9/14; 7:07 pm
  10. Hi– Sorry for coming late to the party, but mostly sorry for your night of lows. I’m just wondering if it might have been due to the extra exercise in your life lately? Happens to me that way.

    I got nothing for you on Medtronic. There are enough people asking questions. I Just hope you enjoy the warmth, latitude and DOC-peep-wise.

    01/9/14; 7:15 pm
  11. Carol #

    Kerri,
    Please let them know that some young patients (younger than 16) were prescribed by endo to get 530g and they received it and had training. But when they call in for help in the support line sometimes we get people they say they can’t help us because of patients age even though we have the pumps! Hasn’t happened to me but several friends. One friend mentioned it seems to be more of their night staff on duty.also, hold times are fairly long right now.
    Thanks
    Carol

    01/9/14; 11:21 pm
  12. June S. #

    I feel for you! There’s nothing worse than having a serious low that, on top of everything else, deprives you of sleep. I wonder if I’m the only insulin-pumping Type I who has absolutely stopped eating snacks in the evening or at bedtime for which I need to take a bolus. I’ll take a snack without bolusing, if it’s bedtime and I’m concerned that my BG is going to drop. (I do wear a CGM.) I have great difficulty determining the proper carb-to-insulin ratio for bedtime or late evening eating!!!

    01/10/14; 9:19 am
  13. Nikki #

    I would love to know if there are any plans for developing the technology to allow you to more easily bolus/correct using something other than your pump (like a remote or meter). Currently, they offer a terrible remote that allows you to bolus by .5 increments which isn’t very helpful or intuitive when my pump is hidden and most of my settings for corrections and carb ratios are automatically programmed in the pump and not “top of mind.” I’d love to be able to use my meter to send a bolus or correction to my pump!

    01/10/14; 11:23 am
    • I just learned that the audio bolus (remote bolus) is whatever you have it set to on your pump. So if you go to your audio bolus set up, you can change the increments there.

      01/10/14; 7:50 pm
  14. First time ever to comment on anything, online.T1d for 24 yrs. First pump next week, with the Medtronics artificial pancreas(that’s what they call it) . Been up since 2:30 am not unusual for me, sleeps seems rare as of late.
    Anxious to put all of the paraphernalia on and move forward. Have 3 new Grandbabies , and a little bit nervous about it all. Great support from family always, but I just can’t seem to stop crying,just having my own pity party?!? I guess.aybe fear of losing control of all that I have controlled, giving it to a machine? Is this normal?

    01/11/14; 5:50 am
  15. Lindsay #

    This was my night last night and of course I had to get up early for work on a Saturday. I swear, I could not get out of the 50s, ALL FREAKING NIGHT!!! I am so tired and just not sharp today…ugh. I stopped and got a donut on my way to work, because well I’ve been low all night so I may as well take advantage and I deserve it dang it! :)

    01/11/14; 9:02 am
  16. June S. #

    for Mary Christopher:
    I have had Type I for 41 years. I got my first pump after 35 years of injections. Rest assured that the Medtronic pump IS NOT, absolutely NOT, an artificial pancreas. Like any other pump (and I do wear a Medtronic, and like the company) it will take awhile to learn how to properly use it. The CGM system (sensors, etc.) have proven very helpful to me. I also recall how, after getting my pump, I was sitting in a restaurant and, for the first time in my life, didn’t have to run into the bathroom to inject. You will need to have your pump settings correct (endo and pump trainer/CDE will help) and, whatever you do, make sure you change your infusion sets according to the schedule given you. I am supposed to change mine every other day; the longest you should wear one for is 3 days. Leaving an infusion set in for too long means that the skin will be resistant to absorbing insulin, and that will lead to unnecessary highs. You will come to love your pump. At first, you will need to get used to it. I recommend the Yahoo! Insulin-Pumpers group. They have an e-mail list wherein you can post questions. It’s an excellent resource!

    01/13/14; 9:21 am
  17. Mary Christopher #

    Sandy,
    Thanks so much. Great information.

    Mary

    01/14/14; 8:07 am
  18. Mary Christopher #

    June S.,
    Thanks

    01/14/14; 8:08 am
  19. Bethany H. #

    Where did you get that super cute aqua colored polka-dot Dexcom cover? I really like it! Thanks.

    01/16/14; 1:44 pm

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