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Posts tagged ‘hypoglycemia’

Hypo Kick.

“I heard the alarms going off, yeah.  But what woke me up completely was when you started screaming,” Chris said over breakfast.

“Oh yeah.  That was a thing,” I agreed, remembering that moment clearly.

On the whole, I’m a very quiet sleeper.  I don’t snore, I don’t move around much while I sleep, and generally I’m silent, except for the occasional whimper (apparently I make small yapper-type dog noises while falling asleep).

That explains why my terrified screams  jolted my husband awake last night.

Dexcom alarms started going off around 2 am, at which point I woke up, had a juice box and some raisins, and went back to sleep.  But it wasn’t a restful sleep, still punctuated by the low blood sugar alarms blaring into the night.  I woke up to the low alarm five minutes later, decided to wait a little longer to see if my blood sugar was going to climb, fell back asleep, the alarm went off … this cycle of interrupted sleep and CGM soundtrack went on for the better part of an hour.

But eventually, I was back up to 75 mg/dL, so I thought I was fine.

Only the snack wasn’t cutting it, and my blood sugar started to tumble yet again.  My Dexcom started bleating out alarms once again, but I wasn’t awake.  I was dreaming, actively, only in my dream, I was aware that I was low.  And also that I was asleep.  I don’t remember the storyline of my hypo-induced nightmare, but during the course of it I realized I was low and, if I didn’t wake up, I would be in some serious trouble.  Dreaming Kerri decided that, in order to wake up Actual Kerri, she needed to scream.  Loudly.  It was the kick my Inception-influenced mind needed to bring me fully into consciousness.

So she did.  I did.  (The pronouns are starting to tangle.)

“AAAAAAAAHHHHHHHH!!!!!!  AAAAAHHHHHHHH!!!”

“What?  WHAT?!”

I clumsily reached past my blaring phone towards my meter, with 48 mg/dL the result on the screen.

“I’m very low.  Could I have juice, please?”

(Our communication skills about lows, especially 3 am ones, has been diluted down to screams, jolts, and polite, disembodied-voice requests juice.)

A full glass of juice and two hours after the lows started, it was done and sleep finally returned.  But my dreams were still strange, still restless, still confused, and when I woke up to ready my daughter for school, I wasn’t entirely sure if I was really awake.

Hypo Perspectives.

Last night my low alarm went off like a siren in my bedroom, partly because I had hooked my phone up to a bluetooth speaker to (successfully) help amplify the Dexcom alarms, but mostly because my blood sugar was 50 mg/dL.

How the alarm didn’t wake up my daughter (clad in Captain American pajamas and asleep in my bed because Chris was out of town last night) is beyond me.  How it didn’t wake me up the first few times it went off is beyond me as well, since I was low for about 35 minutes before actually acknowledging it.  A text message from my husband, asking “Are you awake and drinking juice?” grabbed me from the fog.  (Thank you, Dexcom Share, for making the “Big Brother” moments worth the moments when I need a hand.)

Some lows are textbook ones in that they employ symptoms like a sweaty forehead and clumsy hands, but a juice box or some glucose tabs or a banana can take the edge off those symptoms at first bite, the adrenaline surge of the low quieted by a chewing jaw.  These lows don’t leave a hangover or a residue of panic.  They just happen, and then they’re over.

Other lows are so odd, so disconcerting, so thick with confusion and hypo fog that I find myself unable to put the straw into the juice box, or to even reason with my brain that a juice box is necessary.  Last night, my hypo-addled hands weren’t able to push me up onto my elbows so that I could eat or drink anything without spilling it all over the bed. 

My kid slept beside me, unaware and occasionally stretching so her hands tangled in her hair.

I frigging hate these kinds of lows.  Somehow, I ended up treating with juice and felt the need to wander downstairs into the kitchen and have a box of raisins.  And then a second box of raisins.  And then another glass of juice.  I remember standing at the kitchen island and taking two units of insulin after grossly over-treating this low, still wobbly from still being in the low.  I know I didn’t need to eat anything else after that first juice box but for some reason, my body needed comfort.

In that moment, I’d trade a 250 mg/dL for the waves of nausea and unconsciousness that lapped at me.

I went back to sleep damp with sweat, covered in juice.

This morning, the plastic sleeves of two juice boxes were on the bedside table.  I corrected the high blood sugar I had eaten myself into.  The bedsheets are in the wash in efforts to remove the carb count from their thread count.

The trench of a very unsettling overnight low blood sugar and the mountain that followed. #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

All Night Long.

It started out innocently enough.  Just a wiggly little drop before bedtime with a bit of insulin on board, so the need for snacking was elevated.

With .8u IOB. Snacktime. #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

A small handful of raisins and I’m on my merry way.  No worries!

But then 2.30 am hit and I was in the trenches again.  Dexcom alarms were blaring, texts from my Share friends were pinging, and the sweat was beaded up on my brow.

At least my phone is fully charged this time? #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

But no worries!  All night long lows?  I’ve got this.  Juice box plus temporary basal rate should bring me up juuuuuust fine.

Then Dexcom alarms went off again at 4 am (this time, I was a little high from over-treating the low). Corrected that shit.  No worries.  (Kind of worried.  I am tired.  When do I sleep?  Maybe tonight.  Aw fuck it – let’s dance.)

Diabetes is all night long.

Pulled Over.

I had just buckled the girls into their car seats and was ready to make the drive home from day camp, and as I turned the car on, I reflexively grabbed my Dexcom receiver to take a peek at my blood sugars before I started driving.

Shit.  68 mg/dL with an arrow straight down and a blood drop signaling a need for calibration.

“Hang on guys,” I said to my daughter and her friend, who were already singing camp songs in the backseat.  “I need to wait a minute before we head out.”  I pricked my finger quickly to check my blood sugar and, sure enough, saw the 63 mg/dL on my meter waving its arms at me.  No worries – I always have a jar of Glucolift in my center console.

Except this time.

Shit.

“Hey girls. Do you guys have anything left in your lunches?”

“Yeah, I have strawberries and a pouch left in my lunch.  Do you want it, Mom?”  Birdy offered.

“Yep.”  I climbed out of the car and went back to the trunk to rummage around through her lunch bag.  Pulling out the snacks, I gobbled them while standing at the back of my car, a mom on a mission to bring her blood sugar up before driving.

We sat in the parking lot for ten minutes or so, and I watched the CGM graph arrow relax and point sideways.  A glucose meter check showed me at 78 mg/dL, so I felt I was on the rise.  We started the ride home.

Except the CGM alarm went off 15 minutes later, only this time it showed double-down arrows and the BELOW 55 mg/dL message on the screen.

“Shit.”

Certain parts of Rhode Island are relatively rural, and sometimes you have to drive for a while before you pass a gas station or a convenience store.  I immediately started calculating when I’d pass the next place to stop.  I also assessed my symptoms (none) and instinctively reached over to disconnect my insulin pump from my hip.  I thought the two little kids in my car.  I thought about where I could pull over.  I worried about what was safer: driving for another minute or pulling over and not having any food in the car.  And I hoped that worrying so intensely would make me feel stressed and hopefully jack my blood sugar up a little more.

But then, just ahead, I saw the familiar orange and brown sign of a Dunkin Donuts coffee shop.

“Yes.”  I put on my blinker and pulled into the drive through lane of the coffee shop.  “Girls, I need to stop here and get an orange juice, okay?”

“DOUGHNUTS!!!!!” they yelled in unison.

“Not this time, guys.  I need to get some juice and wait a few more minutes before we can keep going.”

Minutes later, I was in the parking lot with an empty bottle of orange juice and two patient kids in the backseat of the car who were peppering me with questions about diabetes.

“Why did we have to stop?”

“Because I needed juice to treat a low blood sugar.”

“What’s a low blood sugar,” asked my daughter’s friend.

Birdy piped up.  “It’s when you have diabetes and you have too much insulin or not enough food in your body and you need glucose tabs or juice or doughnuts but not today because these doughnuts have gluten in them.”  (All in one breath.)

“No doughnuts?”

“Sorry, guys.”

“Can we drive soon?”

“Yes.”

“Okay, can we sing until we start driving?”

“Sure.”

We sat in the parking lot while I waited for the orange juice to do its thing, keeping an eye on my CGM graph and an ear on the two little kids in the back of my car who were belting out songs they learned at camp and who trusted me to take good care of myself in order to take good care of them.

Only no doughnuts, because gluten.

 

My IOB and Me.

There’s a lot of data that PWD (people with diabetes) spin through on a daily basis – carbs counts, insulin units, blood sugar results, blah, blah, blaaaaaaah there’s so much shit sometimes.  I’ve been encouraged by my endocrinologist to download my data and review it every week or two in order to assess trends over time, but I don’t do that as often as I should.  I’m more of a monthly downloader, and I definitely download every night-before-the-endo-appointment, but a systematic review of my diabetes data is one of those things I could do more consistently.

However, the data is crucial to my health success.  I just tend to lean more heavily on the daily data than the month-long reviews.

Like my beloved IOB.  IOB stands for “insulin on board” and it’s a tool in my insulin pump that calculates how much insulin from my most recent boluses is still “active” in my system.  And I don’t know if most pumpers love their IOB data as much as I do, but I LOVE mine.  Love.  Stupid love.  It’s part of the trifecta of diabetes that I rely on every night before bed.

The checklist is short, but always, always the same: every single night before I go to bed, I check my blood sugar on my meter, comparing that number against the CGM graph.  Then I click through on my CGM graph to get feel for how the day has mapped.  And then I click through on my pump to check my beloved IOB to see how much insulin might be in play.  (Okay, honestly I check on my daughter in her bed first.  She’s usually asleep with her hair tousled into a huge mess against her pillow, with Loopy curled up against her legs.  But then I do all the diabetes garbage.)

Checking the IOB in conjunction with the CGM graph and my glucose number gives me a fighting chance against middle-of-the-night hypoglycemia.  And in the last year or so, it’s been a check that’s worked really well.  Several times (last night, for instance), I will look at my data sources and determine that a low might be teased out overnight, and I can pop a glucose tab or run a temporary basal rate on my pump for an hour or two to keep me in range.

My overnight lows are way less frequent than they ever have been before, and that means I clean juice and sweat from my sheets way less often, so there is a practical bonus aside from the whole “not going wicked low while sleeping” thing.

There’s the takeaway:  IOB monitoring helps cut back on laundry.  Use all the money you save on detergent to buy a bionic pancreas!

 

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