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Posts tagged ‘hypoglycemia’

DBlogWeek 2017: Diabetes and The Unexpected.

Diabetes Blog Week prompt for Monday: Diabetes can sometimes seem to play by a rulebook that makes no sense, tossing out unexpected challenges at random.  What are your best tips for being prepared when the unexpected happens?  Or, take this topic another way and tell us about some good things diabetes has brought into your, or your loved one’s, life that you never could have expected?

Diabetes Blog Week YAYYYYYY!

Unexpectedly, my iPhone decided to update itself on Saturday night.

I must have “agreed” to terms of service and scheduled the update, but I didn’t think the process through, because if my phone is updating the operating system, that means the processes on my phone are sort of stalled.

Including my Dexcom data transmission.  Which means I didn’t have any CGM data streaming overnight.  The low blood sugar came out of nowhere, a product of stupid poor planning and over-correcting a high in the wee hours of the morning.

Mother’s Day morning broke open with my body outlined in damp sweat, my color ashy, hands shaking, but my mind still sharp, considering my blood sugar was 35 mg/dL.

Super low glucose result - crappy way to start the dayOnly once or twice before, in thirty years of diabetes, have I ever felt close to passing out, but the precursor feelings seem to be waves of unconsciousness that lap at the edge of my mind coupled with a calm, reasoned mind, as if I knew I was about to go under and I needed to mentally take the biggest breath I could.

I had the sense to call Chris (he was downstairs with the baby) and ask him for juice.  I was afraid to sit up, thinking that might be enough to tip me into the abyss.

I asked him to put the baby in the crib in case I needed physical help.  I spoke to him through a mouthful of glucose tab dust, asking if he knew how to use the glucagon on the bedside table.  He said yes.  I asked if he could please hand me a towel so I could mop the sweat off my forehead.  The whole discussion was so calm, so structured, so oddly practical in contrast to the panic of being intensely low, the voice in the back of my mind screaming “AAAHHHHHHHHH!”

Makes me think I could solve quadratic equations while putting out a car fire while sitting in said car.  And the car is moving.  Fast.

Actually, that’s sort of what we do when severely hypo.

Unconsciousness due to a low blood sugar is the unexpected I think about the least, but prepare for the most.  I mean, I think about it, but not obsessively.  I just prepare all over the place, just-in-casing myself with juice boxes and raisins stashed in my frequently visited spots.  I try to always have fast-acting sugars on hand no matter where I am.  I share my CGM data while traveling. I keep that glucagon shot on the bedside table.

We’d talked about glucagon a few weeks early, after I’d refilled my prescription.  We almost used it when I was throwing up from the flu and my blood sugar was stuck at 45 mg/dL, not able to keep down the juice or tabs I was consuming.  It’s part of planning for the scary moments while simultaneously pretending, “Oh, that could never happen.”

Eventually, my blood sugar came up.  Exhausted from treading the hypo-waters for so long, I almost immediately fell back asleep on the damp pillowcase.  When I woke up again, I looked over at the glucagon kit, thankful for the fact that it was still sealed and hoping it continues to collect dust.

Dealing with Overnight Low Blood Sugars.

Quick confirmation:  Yes, you are reading this on the Internet.  No, this website is not written by a doctor.  Or a medical professional of any kind.  (Or a professional of any kind.) This is not medical advice.  I have been living with type 1 diabetes for over 30 years and this is just how I do it.

Such a good song.

Anyway, overnight low blood sugars are gross.  During the day, am I struck by the urge – need? – to consume 10 times more carbohydrates than I need to correct a low blood sugar?  Nope. I don’t eat glucose tabs by the fistful at 11 am.  But in the middle of the night I am able to consume 1400 calories without blinking twice thanks to the panic and chaos of middle of the night low blood sugars.

Over-treating lows has been a tricky trap for the last three decades, but there are a few strategies I use to hit back against hypos.

No IOB before BED.  
I try to keep my snacks very low-carb after 8 pm in order to keep my boluses at bay.  While I’d love to dive head first into a bowl of rotini before bed, I feel safest going to bed without insulin on board.  Sometimes it’s hard to avoid a bolus here and there, but on the whole, a big fat zero on my IOB brings better sleep for me.

Timing Exercise.  
This is a tricky one because my schedule changes every day, but I do my best to exercise before 4 pm on most days to mitigate midnight lows.  If I exercise in the evening, the chances of bottoming out overnight are high, so if I’m able to get things done before dinner, I feel safer.  (This does not always work out for my workouts because of kid 1, kid 2, work stuff, family schedule, etc. but I try.)

Pre-Counted Carbs.  
What do you mean, eating two nutella and peanut butter sandwiches to treat a 54 mg/dL at 3 am isn’t a good idea?  If I wake up low, I want to inhale the fridge.  Sometimes I over do it so hard that I’m bolusing while low to compensate for the carb overload.  This usually results in a high blood sugar.  And also bigger pants.  Keeping my low blood sugar treatments pre-carb counted helps a lot.  This means using glucose tabs or a juice box instead of a bag of candy that I can take too much of or a bottle of juice that I can drink too much of.

Bedside Snack Table.  
I need to keep snacks on the bedside table instead of daring my low legs to make it down the stairs.  My bedside table is almost always armed with a jar of glucose tabs or a juice box.  This is easiest because it keeps me from taking field trips while low.

Continuous Glucose Monitor.  
THIS.  This thing is the best battle tool against nighttime hypos because I can set my threshold to 80 mg/dL which, in turn, alarms and wakes me before I actually end up low.  In the last ten years, since starting on a CGM, my overnight hypos have decreased significantly simply because I catch them before they become disasters.  Of course lows sneak in here and there, but they are fewer in number thanks to this technology.

My next goal is to figure out how to stop the cleaning fits while low … although they are terribly productive …

Target Lows.

“Can you scan these so I can open them now?”

“Sure thing,” as she reached her arm over the conveyor belt to scan the package of Skittles in my sweaty palm.

BEEP.

I ripped open the package clumsily, my phone screaming out the Dexcom urgent low alarm tones.  Jammed a handful of Skittles into my mouth – way too many to be chewed at once – while simultaneously and awkwardly unloading the carriage.

“Do you have a Target red card that you’ll be using  today?”

” … mmmfff …”

My jaw was busy processing a dozen Skittles at a time.  I took a second to hang on (hopefully casually but most likely looking like a drowning man clutching the edge of a raft) and concentrated on chewing.  When I remembered, I would retrieve another item from the cart and place it on the moving track.

The lady behind me switched lanes, properly assuming I was a hot mess.

“Are you okay?”  The cashier was about 20 years old and probably accustomed to a flurry of weirdos coming through her cashier line.

I finally mashed the Skittles into something I could swallow.  “I’m fine.  Sorry – I have diabetes and my blood sugar is really low.  It happens here a lot.  Target makes me low.”  I was rambling and couldn’t stop.  “It always makes me low.”

She nodded slowly, putting my items into a bag as I loaded them onto the conveyor belt, one every fifteen seconds or so.

“I bet.”

She was kind.  I was probably drooling colorful drool.

“You can keep eating those,” she added.

So I shoved the rest of the package into my mouth, a hypoglycemic cow chewing on taste-the-rainbow cud.

BG 56 mg/dL. Eff off, Target. You always make me tank. (But I ❤ you anyway, you sassy store, you.) #diabetes

A post shared by Kerri Sparling (@sixuntilme) on

Emergency Plan.

Was just 106 mg/dL.  Tumbled fast to 40.

Took minutes.  Felt like seconds.

Dizzy.

Wait – get phone.

Put the baby in his crib.

He’s safe in there.

Already drank juice – plenty of it – now wait wait waaaaaaaait.

…. waaaaaaiting.

Wall edges seem wiggly, like if I poked them they’d shudder like Jell-O.

Baby is safely in the crib, giggling and playing with his feet.  I sit on his floor with my phone in my hand, ready to make a phone call to a neighbor if the waves of confusion start to erode my mental shore.

Briefly wonder what I’d say if I called.  “Hey, this is Kerri.  Can you come over?  I feel like I’m going to pass out.”  I’m sure I’d try to sound casual when casual is not how I feel.  I keep 911 dialed so if I need to just hit the call button, I’m ready.

Emergency plans.  I have them.

My tongue becomes less thick, less clumsy in my mouth.  I flex my fingers, which are attached to my still-shaking hands.  They feel responsive but like their wings are still clipped.

Juice starts to change the course of my blood sugar.  CGM alarms still blaring from my phone, less urgently now.  Walls seem less gelatinous.

Baby burps and then laughs at his own burp.  I laugh, too, the fog of hypoglycemia unwrapping itself from my brain.  I remember that it’s morning.  That it’s a week day.  That I’m due on a
conference call in 20 minutes.

CGM shows me a comforting arrow.

Emergency over.  Status quo returned.

Before I retrieve the baby from his crib, I grab a cloth and clean up the juice that leapt from the glass while my hands were birds.

 

 

That Low, Though.

The low blood sugar hadn’t rooted firmly enough in my brain yet, but I knew something was wrong.  My feet were heavy against the treadmill belt, and I kept rewinding the show I was watching because the dialog wasn’t making much sense to me.

BEEEEP!  BEEEEP!  BEEEEEEEP! hollered my phone (aka surrogate Dexcom receiver) from the cupholder of the treadmill.

57 mg/dL with the pigeon head facing south.

Dexcom G5. Looks like a cute little pigeon who wants a hotdog until you realize, "Fuck – I'm really low." #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

“Oh hey,” I said, all casual, while my brain was throwing itself against the inside of my skull, shouting “That low, though!  Go get something to eaaaaaaaaat!”

Instead, I felt compelled to wait until the treadmill had reached an even number of minutes left (WHY?? This sort of compulsion happens regularly.) before I would head upstairs to grab a snack.

Upstairs, I walked through the living room into the kitchen, passing Chris, who asked, “You okay?” and I responded with a grunted, “Low.”

Reaching the fridge, I opened it up and grabbed the first thing I saw:  an already-opened juice box.  The straw was at the ready, making my fumbling fingers flex with relief.  Slightly dizzy and with the low blood sugar almost fully acknowledged by my mind, I drained what was left of the juice box.

Trouble is, the juice box had apparently been left in the desert to ferment and was then tucked back into the fridge.  The fizzy, nasty grape taste in my mouth woke my brain up completely, only urging me to throw up instead of deal with the hypo.  I ambled over to the sink and stood there, holding the edge of it, the breaking news ticker in my brain reading “DON’T PUKE DON’T PUKE.”

I didn’t puke.  

I chased the fermented juice box with some raisins.  I returned to my work out. I wondered briefly if I was somewhat drunk. This isn’t the first time this has happened, and it sure as hell won’t be the last.

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