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Posts tagged ‘hypoglycemia’

Hypo Management.

“Ninety-five percent of the time, I’m fine.  The lows are ones I can treat myself, even if the number is really low.  Usually my symptoms are shakiness or like this brain fog.  When the lows are really gross, I usually cry at random.  Or I throw things.  No real in between.  But the majority of the time, I can take care of things myself, and then it’s over.  Like nothing happened.”

I tried to explain this to a friend who was asking when it’s necessary to intervene during a low blood sugar, but explaining the slide from “fine” to “holy effing low blood sugar” sounds confusing when I say it out loud.

That’s the weirdest part, for me, that whole panic-then-peace part of severe hypoglycemic events.  My lows have historically come crashing in at a breakneck speed, which is part of why using a CGM has been a pivotal change for me.  Getting a head’s up on when a low is happening, or being able to treat it even before it becomes a problem, has helped me feel safer in the face of hypo unawareness (a lack of low blood sugar symptoms) and fast-dropping numbers.

My endo suggested that I raise my low alarm on my Dexcom from 65 mg/dL to 80 mg/dL in efforts to catch lows earlier, and in the last month or so, I’ve had far fewer chaotic hypos.  Instead, I’m grabbing the lows before they even become low, snagging a 70 while it slides versus waking up in the trenches of a 40.


Low alarm at 80 has been the best suggestion in a long time. #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

Small little tweaks here and there make differences I couldn’t have imagined. … that, and I’m burning through my supply of glucose tabs with a little less vigor.

 

LOW.

BEEP!BEEP!BEEP! from the Dexcom receiver on the bedside table.

I heard it beeping for a long time.

Woke up with sweat pouring off my forehead and running down the side of my face, pooling up in my ears and in my collarbone.  The pillow was soaked.  My hair was soaked.  An outline of me underneath me, the line drawn with the panicked sweat of hypoglycemia.

Panic.  But tempered panic, since I was so deep into the low that I was slow in recognizing anything.  My status updated slowly:  This is a low.  This is a bad, bad low.  Eat something in a hurry or you’ll probably die.

The juice box on the bedside table was hard to assemble.  Plastic sleeve around the straw, poking the straw through the foil hole … all actions I’ve done before but it took 30 seconds apiece for me to figure out how the whole thing worked.  I drank the juice as fast as I could, in just a gulp or two and then I settled back into my self-made sweat lodge.

A few minutes later – maybe two, maybe twenty – Birdy arrived fresh from a nightmare, clutching her blanket and asking to sleep in our bed because she was scared.  I don’t remember gathering her up, but I do remember putting her on the outskirts of my dampness, snuggling her up against her still-sleeping father.  I was scared, too, still arranging blankets, trying to find a cool, dry section.  I looked at the Dexcom, and it only told me I was LOW and had been LOW for a long time.

Normally, I get up and brush my teeth after a low blood sugar.  Sometimes I use the hairdryer to dry my hypo-damped hair.  This time, I couldn’t move my ankles without feeling the dizziness flooding up to my hairline.  I used the edge of my t-shirt to mop the sweat from my ears.  So gross.  But necessary.

This morning I woke up chilled to the bone, the result of falling back asleep soaked to the skin and then drying off in the cool, fall night.  The Dexcom told me I had risen up safely to 109 mg/dL, and my meter confirmed that result.  My family bounced up and was ready to start their day, and I followed behind them, nursing the hypoglycemic hangover, grateful for technology that woke me up and for portion-controlled hypo treatment, but pretty fucking pissed off that diabetes was the nightmare last night.

 

Sparkly, Like Her Shoes.

As a family, we went to dinner and Birdy’s sequin-covered shoes sparkled furiously in the afternoon sunlight.  Her shoes were downright distracting and I found myself low-staring at them, focusing on the individual sparkles being projected onto the tablecloth at the restaurant.  My brain had hit an uncomfortably steady pace with the anxiety of being under 60 mg/dL for more than two hours, adjusting to the panic but still needing an outlet.  Staring at the glitter on my daughter’s shoes calmed my brain down just enough.

We ordered and ate, and a meal plated with carbs and less-than-normal bolusing still didn’t battle back against the low alarm from my Dexcom.  I felt like a failure, asking Chris to grab a glass of juice from the waitress as my empty dinner plate sat in front of me.

“I’m still low.”  I tested my blood sugar again, hoping to see a number that didn’t require more glucose tabs, hoping the Dexcom was wrong, but a bright 43 mg/dL grinned back at me.  I knew the food would hit but not fast enough.  “Yeah, I need juice now.”

In a quiet hurry, I heard the background noise of hypo management done from a distance.  “I need a glass of juice.”  “Would you like lemonade?”  “No, juice.  Do you have orange juice?”  “We have apple juice.”  “That, then.  Please.”  Chris sat back down at the table while Birdy bounced and played beside me, her shoes throwing sparkles onto the table that were spreading out everywhere, my eyes starting to cave to the low blood sugar.  Peripheral vision was being replaced by these starbursts that were sparkly, like her shoes.  I felt my body pulling in tight and rallying glucose, sending it to the places that were necessary and not caring that I couldn’t hold a fork or keep my mouth from twisting into a resting bitch face/uncomfortable grimace.

Dinner tumbled into a pile of apologies and distractions because I couldn’t get my wits about me, and even once my blood sugar was stable (back up to 72 mg/dL), it still wasn’t staying up, and tumbled again a few more times before bed.

It doesn’t look like much, from the outside.  It’s hard to explain how silent the panic is, how evacuated my brain feels when the hypos hit and stay for too long.  I don’t know how to show someone a Dexcom graph that looks like this and explain how it’s not just the blood sugar number, but the cumulative effect on my body – the exhaustion in my muscles from being clenched in fight-or-flight mode, the sleep my brain needs after a five hour low blood sugar experience, my inability to find the words for what I want to say because my mind is just like, “We’re DONE.”

I woke up with a blood sugar of 230 mg/dL this morning, the product of answering low alarms with frustration and marshmallows, and I corrected the number with the predetermined, carefully calculated amount of insulin.  And I hoped that, for today, diabetes would leave the sparkles on my daughter’s shoes.

Hypo Effery.

BEEEEEPBEEEEEPBEEEEEP!!

My purse start vibrating in a panic.

79 mg/dL and two arrows down – how the hell did that happen?  I just dropped my daughter off at preschool.  My blood sugar was 139 mg/dL before leaving the house with a steady, easterly arrow.

I pulled the car over and put on my hazard lights so I could bust out my glucose meter.  (Oh hell yes I treat low blood sugars purely based on a Dexcom reading from a trusted sensor, but this sensor is on Day 14 and due to be changed this afternoon, so my trust was getting rusty.  Trusty?  Rustworthy.  Bah.)  Meter said 68 mg/dL.

The symptoms, which weren’t strong when I pulled over, were starting to edge in.  Shaky hands and blurred vision (almost wrote “blurred bison,” which sounds like a band name) paved the way for clammy skin, which let the fog of hypoglycemia settle into my brain.

Fine then.  I reached into the glove compartment for the ubiquitous jar of glucose tabs.  Chomp, chomp on four of them only to realize they aren’t Glucolift but instead the generic chalkified glucose tabs from CVS and became grossed out.  The low symptoms were intensifying as I sat on the side of the road, so being picky about my glucose sources wasn’t an option.  Chomp, chomp on another tab, wishing I could somehow keep a soft-serve ice cream machine in the glove compartment instead.

Moments pass.  I’m still buckled into my car, eating snacks, watching cars whiz by.  The Dexcom finally shows an upward climbing arrow.  My hairline feels less clammy.  The shape of the steering wheel and the radio control knobs come back into sharp focus.  Better.

“Did you check your GPS?” my mom asks me whenever we’re about to get into the car together.

“Mom, it’s a CGM.  And yes, I did check it,” I reply, usually laughing because no matter how many times I tell her it’s a “CGM,” she still calls it a “GPS.”

But as I think about what may have happened if the low symptoms hit in full while I was driving instead of after I had pulled over, GPS might me just as accurate, giving me the location, in context, of what the hell my blood sugars are doing.

 

Put On Your Listening Ears.

Our backyard is big and lovely and fenced in on all sides so that when Birdy and I are playing outside, we’re both safe from cars and giant woodland creatures (except the ones that can shimmy underneath the fence … I’m looking at you, groundhog).  I don’t keep my eyes glued to her while she plays, and we can enjoy the sunshine and the garden without feeling paranoid about passing cars, wandering off, etc.

Which is exactly what sucks about the front yard, because that’s the part of the house that the road is closest to.  So while I still need to do things in the front yard (getting the mail, tending the front garden, drawing hopscotch in the driveway), I don’t do anything of those things without having Birdzone front and center in both my mind and my actual line of sight.

Yesterday evening, Birdy and I were working in the front yard garden (I was clearing out some weeds and she was making “houses” for worms we discovered underneath a rock), when my Dexcom started wailing from my pocket.  In retrospect, I felt a little “off,” but it wasn’t until I heard the low alarm blaring from the Dexcom receiver that the symptoms kicked in fully.

“Hey, your blood sugar is whoa, Mom,” Birdy said absently, placing another worm onto a pile of dirt.

“Yeah, we need to go inside and get some snacks, okay?  It’s important,” I replied, looking at the “UNDER 65 MG/DL” warning on the Dexcom screen.

Normally, she listens.  Especially when it’s about blood sugars, because Chris and I have talked with her a few times about how listening is important, particularly when I tell her my blood sugar is low.  But she wanted to stay outside.  She liked playing with the worms.  She liked being in the dirt and gardening.  She didn’t want to have to cut playtime short because Mommy needed a few glucose tabs that she should have brought outside with her in the first place.  [Insert Mom Guilt here.]

“Nooooo waaaaaaay!!!” she said, flouncing away from me and refusing to turn around.

Under normal circumstances, I would have laughed (because “No way!” is a great response), but I was starting to feel shaky and my brain cells connections felt loose, like thoughts weren’t coupling up the right way.  We were in the front yard and I knew I needed to gain control of all potentially dangerous situations in a hurry.

“We need.  To go.  INSIDE right now.  My blood sugar is low.  This is not a joke.” I said.

“No!  I don’t waaaaaaant to!!”

My blood sugar falls fast.  It always has.  I don’t get the long, lingering slides towards hypoglycemia but instead the quick, breathless plummets.  Knowing that I was dropping and watching yet another car drive by our house meant I needed to get control fast and without issue.

Before my body completely caved to the low blood sugar, I scooped up my flailing daughter and walked into the house.  She was freaking out and still forcefully asserting her right to “NOOOO!” but I needed sugar more than I needed her to like me.  A few seconds later, we were both safely contained in the kitchen.  I had a few glucose tabs and waited for my brain to acknowledge them.  Birdy pouted in the corner, staring at her hands and still mumbling, “No way.”

A few minutes later, I felt more human.  “Birdy, I’m sorry we had to come inside.  But my blood sugar was low and it could have become an emergency.  So that’s why you needed to put your listening ears on and come inside.  I wasn’t doing it to be mean; I was doing it to be safe.  Does that make sense?”

“Yes.”

“I’m sorry we couldn’t stay outside.  But we can go back out now, okay?”

“Okay.  I’m sorry I didn’t listen.”

“It’s okay.”

She turned around and pressed her hand into mine.  Something wriggled.  She smiled.

“I brought a worm inside.”

No way.

 

Functionally Low.

The Dexcom yelled at me from the kitchen table – “BEEEEP, BEEEEP, BEEEEP!” – and I double-checked the alarm just to make sure I was actually low, since I’d been basal testing all morning long and I’m always wary of my graph when it’s nice-happy-in-range.

(Note:  It’s really, really easy to test basal rates when you take a red eye flight from Los Angeles to Boston and don’t sleep for even a minute on the flight, causing you to fall asleep for three hours when you finally get home to RI at 7 am, leaving you in the “No Eat Zone” from like 3 am – 11 am.  Exhaustion makes for easy basal testing.)

Sure enough, the alarms were right, confirmed by the 58 mg/dL on my meter.

Four glucose tabs, down the hatch.

Symptoms were alive and kicking on this low.  Numb lips, tingly mouth, that restless feeling in my arms where I suppress the urge to flap them, and the settling in of the low fog, where all my thoughts are smoky and loose at the edges, not fitting together entirely and leaving gaps between moments of clear reason, leaving all thoughts that made sense clouded with a big, “NOPE.”

The Dexcom showed me as still dropping ten minutes later – the dreaded double-down arrows – so I went for some juice.  Only it wasn’t a “stop and have a measured sip of juice” but more “grab a swig of juice right from the bottle while you walk by the fridge” because I couldn’t sit down for this one.

Some lows are disgusting and debilitating and don’t leave any wiggle room for choice.  But other lows (like the cleaning lows or the endless lows) have their own idiosyncrasies and distinct patterns.  This low felt like a functional low, where my blood sugar is in a ditch but I’m still able to walk around and talk, despite being in the 40 – 60 mg/dL range.  And if I were to sit down and actually acknowledge the low in full, the symptoms would take over and I’d be trapped.

Which left me wandering around the house, picking up toys that had escaped from Birdy’s room and absently looking out the windows or at my phone, focusing intently upon the mundane instead on the lack of sugar in my blood stream, while at the same time snacking on glucose tabs and peering at my Dexcom.  Chris saw me shuffling around the house and gave me some raised eyebrows.

“You okay?”

“Yep.  Low.  I already had juice,” which is Sparling-speak for, “I’m definitely low and I know I look scattered right now, but don’t worry; I’ve had juice and am just impatiently waiting for it to work.”

About thirty minutes later (after I had examined individual leaves on the houseplants in order to think about anything other than hypoglycemia), the Dexcom graph showed arrows pointing back towards safety.  Only then did my brain take the nope-filters off and let me calculate the total carbs consumed, and the potential blood sugar boost that might be coming.

 

Mommy’s Little Pack Mule.

Running alone brings out the Spibelt, and I cram it full of my on-the-move necessities:  glucose tabs, Dexcom receiver, keys, and phone.  Even though it’s reasonably streamlined and doesn’t bother me too much to tote around all that stuff, it’s a bulkier system than, oh, I don’t know … making my own insulin.

But lo!  The child rides a bike!  And insisted on having a bicycle basket!  To which I said, “Yes!  Excellent idea and can you please carry all my shit, too?” only I did not cuss at the child!

The miles might be logged a little slower than when I’m by myself, but there’s nothing more convenient than making use of her bike basket to carry all my diabetes stuff, and I love sharing some outside play moments with my daughter.

And she likes being in charge of such important things, since she is a “big girl” and can “carry the glucose tabs because then if I want a very, very, very small bite of a glucose tabs, I can just reach in and have one, right, Mawm?”

“Sure.  But only if you make sure you slow down if I need a glucose tab, okay?”

Bartering with my happy little helper of a diabetes pack mule.

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