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Posts from the ‘Diabetes Memories’ Category

Looking Back: Lows in Public.

On the road this week, so I’m looking back at a post from June 2012 about experiencing hypoglycemia in a public place.  It’s never fun to be low, but I’m always grateful for the patience and compassion of others who help see me back to being in-range.

*   *   *

I heard the Dexcom BEEEEEEP!ing in that frantic, “you’re low” kind of tone and my brain was swimming with confusion, so I went to the bar at the dinner event and asked for an orange juice.

“Do you want vodka in that, as well?”

“No, definitely no thank you.  Just juice, please.”

The bartender filled up a small tumbler with orange juice and I downed the contents of the glass in one giant gulp.

“Thanks,” I said, and wandered off, fishing my meter from my bag to get a true assessment of how far down the rabbit hole I’d fallen.

There isn’t ever a convenient time for a low.  I suppose the ones that happen when I’m at home and are only in the 60 mg/dL range and can be treated with the logical and tempered rationing of glucose tabs are better than the ones that happen in public.  When you’re at a dinner event and you’re trying to meet people and make a favorable (or at the very least, coherent) impression, it’s not the most opportune time for a 38 mg/dL to make an appearance.

Once I saw the number on the meter, I became this strange, hypoglycemic bear, foraging for food and ready to growl at anyone in my way.  The very nice waiter who was bringing appetizers around to the attendees ended up with an empty plate after I had my way with him.  (Which sounds worse than it actually was; he only had three snacks left, but I snagged them and might have bared my teeth at him in the process.)  My low symptoms were peaking, with tears in my eyes and confusion on my tongue and every skin cell buzzing with panic and adrenaline.

I do not like being low in front of people.  I don’t like that momentary weakness and the vulnerability and that empty, lost look I’ve been told takes over my eyes.  I don’t like that lack of control.  I don’t like when my knees buckle while I trying to keep myself upright.  I don’t like the look of “Are you okay?” that comes over the faces of most people, because it’s one of the very few times I have to answer, “No, I’m not.”

Thankfully, I was at a diabetes-related event, surrounded by people who either had diabetes, cared for someone with diabetes, or worked to cure diabetes.  So when I casually mentioned to Jeff Hitchcock that my blood sugar was tanking and I didn’t know what was going on, I was ushered quickly and covertly to a seat at a nearby dinner table so I could make sense of things.

“I’m fine, you know.  I had juice.  I’ll be fine in just a few minutes,” I said, folding and refolding the napkin on the table while I waited for my blood sugar to respond to the juice.

“I know,” he said, his voice calm and reasoned.  “We’ll wait.”

As it always does, the panic subsided.  My blood sugar came back up into range (and went up just a bit more than it needed to, thanks to downing that whole glass of orange juice).  And I was able to rejoin the dinner conversation without needing a three-minute lapse between thoughts, thankful for people who “know.”

Plastic Apples and Measuring Cups.

Her desk was anchored on either side by tall bookshelves crammed with pretend food.  Plastic fruit – apples, bananas, oranges, kiwis that looked like fuzzy dumplings – and the cardboard shell of cereal boxes.  Plastic slabs of steak with edging to make it look like it had a pat of butter melting on top, and the entire plastic carcass of a chicken, woefully untrue to size, making it the same size as one of the kiwi dumplings. Measuring cups and food scales, lists and charts, meal plans and index cards covered with suggested serving sizes.

It always felt embarrassing, seeing the nutritionist and the dieticians, especially when I was in my teens.  I struggled with my weight as a kid but didn’t ever dip into “overweight,” just more settled on the heavier end of the approved spectrum.  I hated meal plans and the emotional influence of food on my life.  Visiting the plastic food lady as part of the flow every few endocrinologist appointments felt shameful, and I wondered what my classmates would think if they knew I was lectured about eating and food every few months.  Would they know how complicated my relationship with food really was?  Dietician appointments felt like mini-fat camps, and even though I did feel better-informed leaving the appointments, I still felt stupid and ashamed that there were required in the first place.

Moving forward a few decades, diabetes is still very much in play.  I don’t see a dietician as often now as I did when I was growing up, but I do attend a lot of diabetes conferences where registered nurses, dieticians, and nurse educators present, giving me access to refresher courses on food, eating well, and the latest in food and diabetes research. The plastic food is still in play, only the plastics aren’t relegated to my CDE’s bookcases anymore.  Now, the plastics are invading my home.  My daughter’s room is awash with kitchen playthings and miniature versions of what my dietician used as visual aids back in the day.  We talk quite a bit about food and why we eat the things we do.  I try not to let my food-through-the-lens-of-diabetes mindset invade how she sees her plate, even though it’s hard, since we spend so much time together and she sees so much of my diabetes day-to-day management (attempts).

“We need to eat healthy foods so we can grow to be strong and smart and healthy,” I tell her.  “Yeah, and we always need to eat something green with our meals,” she adds, knowingly.  “And sometimes we have juice in the fridge, but it’s for your low blood sugars.”

I don’t want my daughter to think that there are so many food “rules.”  I want her to eat things that make her feel good and that taste good, without looking at her plate and thinking her value as a person rests there.

In her room, she ‘cooks’ up a storm, throwing random items into the plastic stock pot on her pretend stove.  “We need an eggplant, and a hard boiled eggie, and some ash … ash … ASHparagust, and Wonder Woman,” with all of the aforementioned tossed into the “boiling” water.

“What are you cooking, Birdzone?”

“I’m making soup. It will be so delicious. When I’m done, you can have a bowl.”

“What’s in it?”

“Don’t worry, Mommy.  There’s something green in there.  There’s ashparagust.”

March is National Nutrition Month (more about that on the Academy of Nutrition and Dietetics website), and this year’s campaign encourages people to “Enjoy the taste of eating right.”  The phrasing of that message is so hopeful, and without residual shame:  enjoy.  Enjoy the taste of eating right, whatever “right” might be for you.Yes!  I’d like to!  I’ll do that!

My hope is to eventually shake the preposition off “eating with diabetes” and just focus on “eating.”

Throwback Thursday: Before Diabetes.

Taken on my fourth birthday, this was before insulin injections. Before blood sugar checks. Before diabetes camp. Before counting carbs and insulin pumps and continuous glucose monitors and before A1Cs and endocrinologists.

… but not before my love of books, and of reading.  I can’t think of anything that predates that.

Looking Back: Telling Off the Paramedics.

A few things: 

This post is almost ten years old, which is unsettling on its own accord.

It also documents the only time in my 27 years with type 1 diabetes that paramedics needed to be brought in to assist, and mostly because my roommate needed help getting me to eat, not because I was unconscious.

I miss Abby and her magical, glucose-sniffing powers.

The day after this low blood sugar happened, I drove to the fire station and thanked the paramedics profusely for their help, and apologized just as profusely for my actions. They said they see it all the time. The fact that they see it all the time and continue to do what they do to help people makes me respect their profession, and all HCPs, even more.

Apologies for the language used. As you know, I wouldn’t swear unless I was low.

*   *   *

Abby. My cat.

She has never missed a low blood sugar. There have been times when I was so low that beads of sweat collected on my forehead, making my face clammy and my t-shirt damp with panic. Usually my body wakes itself up in time, leaving me just enough energy to stumble out to the kitchen and pour a glass of juice. But sometimes I don’t wake myself up.

That’s where Abby has never failed me.

She will sit on the pillow above my head, wailing like a banshee. “Meow!” She paws fiercely at my head and nudges my face with hers. I usually come around as she is pressing her nose fervently into my ear. “Me-ow!” More insistently now. She won’t stop wailing until I am trudging through the living room towards the kitchen. Siah hasn’t figured out this trick yet. But I’m sure she will in time. Or maybe Abby is just in tune with the way my body starts to panic.

Sometimes I feel waves. The ones that gently undulate and lap at the shores of my consciousness. I focus what is left of my resolve on remaining awake, waiting for the juice to take effect. Those are the worst ones. The ones where I am afraid I am going to pass out.

I’ve never passed out. In almost two decades of diabetes, I have never been unconscious. Of course it may happen. It could happen to any of us. But I have come close.

There have been some tricky lows, though.

There was one that I had in January of 2003, while I was living with my ex-boyfriend. The alarm clock went off in the morning, but I didn’t stir. He got up to turn it off. Usually I lean right over and grab my kit off the nightstand so I can test my blood sugar, but that morning I wasn’t moving at all. He had dated me for six years and he knew the signs of a serious hypoglycemic episode, so he immediately woke up and tested me himself. My bloodsugar clocked in at 44 mg/dl. He went downstairs and grabbed a glass of juice.

“Kerri, get up. Drink this. You’re low.”

Nothing from me.

“Hey. Drink this.”

Most often, I sit up, obligingly grab the glass, consume the contents with graceless gulping, and fall back upon the pillow until the tides of my sugar rise enough for me to sit up and say, “How low was I?” This time, I took the glass from his hand, told him to leave me alone, and proceeded to pour the juice all over the bed.

I’m known for being slightly combative when low.

He got another glass of juice. And the phone.

“Kerri, you need to drink this. If you don’t drink it, I am going to call the paramedics. “

After being told, repeatedly, to go fuck himself, [Note: I'm still embarrassed by this.] Roommate dialed 911. Three paramedics showed up, one slightly chubby. I am in bed, at a minimal level of functionality. I don’t remember what happened from here on in, but Roommate told me I was belligerent.

Roommate told them I rang in at 44 mg/dl. They grabbed the red and white tube of InstaGlucose from their med kit and advanced on me. In the throes of my low, I fought them off as best I could. They outnumbered me considerably; it took three paramedics to hold me down well enough for Roommate to administer the InstaGlucose in my fitful mouth. The paramedics let me loose. As the sugary substance absorbed into the inside of my cheeks, I turned to Roommate with a resounding “Fuck you!” I whirled to the most portly of the medics and growled, not unlike Linda Blair, “You too, fatty!”

I came around very slowly. I don’t remember much of how I ended up downstairs, but I am told that I wandered down the staircase and stood at the front door, clutching my blanket around my shoulders and murmuring, “I want my Daddy.” Because that’s not at all embarrassing.

Roommate told the medics that I would be fine in a few minutes, having just tested me and yielding a result of 68 mg/dl. “She’s on the upswing. She doesn’t need to go to the hospital.” To confirm my agreement, I had to sign a release form, stating that I refused to be brought to the hospital. I signed, half in a fog.

Fast forward to me in the shower, getting ready to go to work. The medics are gone. Roommate is sitting on the bathroom counter, monitoring me. I start to remember what happened. We talk about how everything is okay now, and how sometimes a low just sneaks up and destroys me.

I’m feeling much better. A little embarrassed that I was such trouble, but no harm, no foul, right? I smile sheepishly. Safe now. Abby was prowling about on the bathroom floor, making sure everything was okay now.

“Yes, Kerri. You did okay.”

And as the warm water washed away the traces of InstaGlucose from my arms and eased the tension in my muscles, I gasped in shock as I cried, “Oh my God! … I called them fat fucks, didn’t I?”

The laugh from the counter top confirmed.

More on Redefining the “Diabetes Diet.”

In keeping with the thought process from yesterday (talking about what makes me view food choices as something to hide), I wanted to reshared this video from last year about redefining my perception of what a “diabetes diet” really means.

I don’t want to view food as something I’m punishing or rewarding myself with.  But that mindset is hard to stick with, at times.

Do you subscribe to the whole “diabetes diet” mentally, or do you view your food as (gasp!) food?

If I Knew Then: Insulin Pumps.

At the Medtronic diabetes advocacy forum this past weekend [disclosure], there was a brand-agnostic discussion about the things we wish we had known before starting on an insulin pump.  I’ve been pumping since 2004, and switching from injections to the pump was a big hurdle for me, for physical and emotional reasons:


I wish I had known that wearing a medical device was going to be an easy physical integration.  Even back in 2004, the Medtronic 512 insulin pump (in “smoke” – my first pump) was smaller than a box of raisins and the infusion set was about the size of a quarter.  In terms of straight real-estate, the pump didn’t take up that much room on my body.  (Thought the first thing I had to do was confirm that.  Even though I was supposed to wait until my official “pump training” at Joslin later in the month, I wasn’t good at following those rules*, so when the pump was delivered, I had to bust it out.  I remember ripping it open and sticking a test infusion set onto my abdomen to make sure it was a good decision.  That first infusion set was a moment of panic and change.  The subsequent 1,200 have been pretty meh, though.)

I wish I had known that going to the bathroom was going to be a strange, new journey.  That first week on the pump was a precarious one … for the pump, because it was under constant threat of falling into the toilet, being dropped into the sink, and smashed against the cold, tile floor.  The act of unzipping and lowering skirts, pants, and shorts became this awkward dance (the tubing tango? the don’t-forget-to-bolus-for-the-mashed potato?  the Lantus lambada?  the basal ballet?) to avoid disconnecting the tubing or pulling out the site or getting tangled up in the damn thing.

I wish I had known that the pump would become a discreet visual cue to my fellow PWDs that we were part of the same family, so to speak.  It’s an instant connection; when I see someone on the subway with their tubing sticking out of the pocket of their jeans (or disco boobs), I know we have something intimate and intense in common.  When I hear the *boop beep boop” or the tuneless lilt of Fur Elise coming from a fellow airplane passenger, I want to send them a drink (orange juice, if they’re low).  Instant connection.

I wish I had known, and had been certain, that taking care of my health was sexier than any medical device wasn’t.  My A1C is in a range I’m happy with.  My health is very good, especially considering almost thirty years with type 1 diabetes.  It’s possible to run races, get busy, and travel with an insulin pump on tap.  All of the moments of self-consciousness I’ve had in regards to diabetes really do pale in comparison to how my hard work, my medical team, and advances in diabetes technology help keep me alive and well.  (But I also wish that the community, as a whole, wouldn’t assign pumps as “necessary” for diabetes control.  Pumps are a tool that I’m grateful we have available to us, but not using an insulin pump doesn’t equal out to “not trying hard enough.”  MDI works really well for some people.  Your diabetes may vary.)

I wish I had known how important micro-dosing would become to me.  On injections, correcting a blood sugar of 140 mg/dL down to 100 mg/dL meant taking the risk of gaffing up the insulin dose, either from drawing up too much into the syringe, or too little, or having some of the dose leak back out of my skin at the injection site.  With the pump, I can correct with precision.  As rage-bolus‘er, this is a helpful option.

I wish I had known how grateful I’d be for my insulin pump in the last few months of my pregnancy.  Constantly changing basal rates and insulin:carb ratios were tough to track, but easy to implement using an insulin pump.  And being able to track the amount and frequency of the insulin I was dosing helped me best-juggle all the chaos of being pregnant with type 1 diabetes.

And I wish I had known it wasn’t permanent.  Diabetes, and not making my own insulin anymore, is permanent.  As it stands now, there isn’t anything I can do to coax my islets into doing their jobs, but I can choose to put on my insulin pump, and I can choose to take it off.  On the days when the pump is frustrating me and making me feel like it’s going through a Grinch-heart-growing-three-sizes moment, I can revert back to multiple daily injections until I’m emotionally ready to suit up again.  A tattoo is more permanent, and way harder to remove on a whim, than my insulin pump.  Had I realized how pumping is an option, not a mandate, I would have switched over years earlier and been better for it.

What did you wish you had known, before changing diabetes therapies? 

* Follow the rules!!

Photo-A-Day: Past.

Three months after I was diagnosed with type 1 diabetes, I went to my first sleep over birthday party.  My friend Jill was turning seven, and even though my pancreas had just gone on its permanent sabbatical, I was still able to go to the birthday party. (Thanks to my mother, who drove over and spent a few hours hanging out with Jill’s mom, then tested me and dosed my insulin for dinner, then checked me again before she drove home, then went home and most likely didn’t sleep a wink only to return at 6 am and check my blood sugar again.  At the time, I didn’t realize how scary that must have been for my mom, but she knew how important it was for me to have normal childhood experiences, even if she became an insomniac by default.)

I’m thankful for how my diabetes was handled in the past.  It helped shape how I handled my diabetes in the future.

I’m slightly less thankful for my fashion choices.

[my photo-a-day guide is here]

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