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Posts tagged ‘hypoglycemia’

A Sobering Experience

“Do you mind ringing out this orange juice first?”  I asked the lady who was working the cash register.

“No problem,” and she went bip with the scanner against the bottle’s bar code while my Dexcom screamed BEEP BEEP BEEP! from my phone.

I opened the bottle and downed the majority of it in one, open-throated gulp.  My son, strapped into the front of the shopping cart, reached over to the conveyor belt as the groceries were unloaded, one by one, by his mother with the bird hands.

“Hang on, little guy.  Here, play with this,” I said, handing him a crinkly toy elephant that was peeking out of my purse.  I ran my sleeve against my forehead to catch the beads of sweat that threatened to run down my face.  My ankles felt weak and I know I stumbled a little when I went to unload the contents of my carriage onto the conveyor belt.

“Miss, do you have a Stop & Shop card?” the cashier asked, sizing me up.  She was my mother’s age.  She watched me fumble with my wallet in search of the card, and I dropped it instead of landing it into her hand.

“Hang on a second,” I said, carefully bending over and plucking the card from the floor.   My son yelled, “YEAH!!!” and then “HEY!” from the carriage.  My blood sugar was still dropping and the Dexcom kept hollering.  Clumsy hands and the fog of hypoglycemia made my every movement look ridiculously awkward.

And I knew, knew, knew that the cashier thought I was drunk.

I read Riva’s article about hypoglycemic episodes looking like drunk moments and shook my head in recognition of the concept, but honestly hadn’t ever been mistaken as drunk when low before.  In college, I had this credit-card sized placard in my wallet that said something like, “I have type 1 diabetes.  If I seem drunk, please allow me to check my blood sugar to make sure I am not experiencing low blood sugar.”  I never had to use it, and my college roommates and I giggled at it once in a while, probably because we were actually drunk.

But yesterday at the grocery store, I wished that card had been in my wallet.  I would have handed it to the cashier and pointed sheepishly at the orange juice.

Instead, in the fog of my low, I gracelessly unloaded and paid for my groceries while wrangling my one year old.  Running my debit card for the purchase, I said to the cashier, “I have diabetes.  My blood sugar is low,” but I’m not sure she believed me.  My brain wasn’t sweetened enough to really care.  I was more concerned with pushing through to the other side of this low.

After we paid, I moved the carriage over to a row of benches just inside the main door of the grocery store and we sat there.  I finished my orange juice.  A few minutes later, the arrow on my CGM graph started pointing in a more respectable direction.  I almost went back to the cashier to explain myself more lucidly but decided against it.  Maybe next time I see her, I’ll explain.  For now, it was time to go home.

“Mama?  Mamamamamamamama …” rambled my little man.

“Okay, sweet boy.  We’re good to go.  Let’s go.”

Break Glass in Case of Emergency

The low alarm goes off and my arm snakes out from underneath the covers in slow motion, a serpent in search of snacks.

The jar of glucose tabs sits on my bedside table, most often collecting dust but on this night, it’s an essential item.  I flip open the lid and count out four tabs, piling them on the side of the bed and chomping down one of them while I lean on one arm.

Chomp, chomp, chomp.

Seems like I’m peckish instead of panicked.  But the room is spinning a little and my peripheral vision comes and goes while the low blood sugar laps at the edge of my ability to reason.  What time is it?  Are the kids still asleep?  Siah is a fat lump at the end of the bed, one eye open and staring at me while I cram another tab into my mouth.  I’m confused about the day and time but I know exactly how to put the glucose tabs into a precisely stacked pile and slowly work my way through them, hoping they work quickly.  My husband is asleep, unaware that anything out of the ordinary is happening.

Chomp, chomp, chomp at 3 am after the blaring of my Dexcom alarm, the jar of tabs literal lifesavers on the bedside table.

Useless Juice.

We don’t drink juice “for fun” in our house; it’s only for low blood sugars, considered almost as medicinal as the insulin hiding out in the butter compartment of our fridge.

So when I came home with these juice boxes unintentionally, I was pissed.

35% less sugar?  That’s exactly what I don’t want!

Useless juice.  I’m bringing it back and swapping it out for the fixes-a-40mg/dL-at-4am kind of juice.  The high octane juice.  Proper juice.

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 …

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