Tag Archives: hypoglycemia

Guarding against the next time, preparing for it anyway.

I had a crazy low recently. They don’t happen very often anymore, but on the rare occasions when they do, they’re scary.

It’s hard to describe it to someone who’s never experienced this before. It’s one of those situations where you’re cognizant enough to know what’s happening, but you have to fight like hell to actually perform the task you need to perform to maintain consciousness.

The reason why it happened? Doesn’t matter. Sometimes it’s a more-than-perfectly working infusion site. Sometimes it’s human error. Sometimes it’s unexpected things popping up at the wrong time, a perfect storm.

It doesn’t matter. Not every day will be perfect. Let me repeat that again: Not every day will be perfect.

I tell people who know nothing or next to nothing about diabetes that hypoglycemia, especially this kind of low, is a near death experience. Especially when you’re alone in the house, having difficulty maintaining your balance, using every ounce of energy to get the will to get fast-acting carbs into your system, then hoping they’ll work faster than ever before.

It’s every bit as scary as that sounds.

Technology and Bluetooth options and careful management can only take us so far. As long as there’s insulin and an imperfect way to measure and dose, all of us living with this condition will be on vigilant alert, cautiously guarding against the next time.

And preparing for the possibility that it might happen anyway.

I’m ready to go off the clock.

I had one of those mornings last week.

Actually, it was more like one of those weeks last week.

Every time I came to work, it seemed like things were happening all around me, and my input or assistance was needed at every turn. Deadlines got tighter, and new requests made beating those deadlines harder than ever.

Then, on my way to work Friday, the subway broke down one stop from where I get off downtown. Convinced it was a fluke, and knowing I could do the extra walk (and I can use some extra walking, believe me), I decided against waiting for the next train.

I wound up walking an extra mile or so to get to the office. Of course, I never would have guessed that this would happen when I bolused for the breakfast I ate earlier. But it did, and understandably, my blood sugar tanked shortly after I arrived.

No worries… I always have juice and candy in my desk, so I was able to move on with my day. But, I started getting e-mails and phone calls and before I knew it, I was still at my desk working hard well after my usual lunch time.

Can you guess what happened next? Yes, my BG dropped again. I had to cut off a phone call early so I could walk away from my desk and get something to eat.

Many have said it… our lives with diabetes are great as long as nothing unexpected happens. But something unexpected always happens. Often, at the most inopportune time.

After all this time (26 years) living with diabetes, it’s easy to just shrug my shoulders at a day like this. But this is far more than a shruggable(?) circumstance. While experience is worth a lot on days like this, it’s easy to let experience tell us this is no big deal.

But it is a big deal. Or, perhaps, the fact that we make it look like it’s not a big deal is the big deal. I try not to remember what I’ve lost in time and effort in moments like these. However, it’s easy to tell myself that it’s time and effort I won’t get back anyway, so why bother worrying about it?

And that’s the point. So often, we make it look easy. We give the impression that it’s not hard to figure out, that everything just runs like clockwork.

It runs like clockwork because our lives, present and absent from diabetes, depend on the clockwork.

I don’t know about you, but I’m ready to go off the clock from my diabetes.

Juice boxes in the middle of the night.

You know, it’s really hard to get juice from a juice box in the middle of the night.

Think about it… you have to find the juice box (usually in the dark), you have to grab the plastic straw from the side of said juice box, you have to remove the plastic wrap from around the straw, and then you have to poke the juice box with the straw in the tiiiinny little space allocated for that procedure.

That is really difficult to do at one o’clock in the morning when you’re shaking, you’re sleepy, and your vision without all of that would make it hard to see what you’re aiming at anyway.

Well, that was exactly the scenario the other night, and as you can tell, I was successful in the end. But diabetes was also successful in scaring the crap out of me.

My last bolus prior to that was about five hours earlier. Still time for the insulin to affect my blood sugar, but past its peak, I believe. Feel free to correct me if I’m wrong. My last BG check was at 10:30, right before bed. For the record, my meter read 135 mg/dL. Not high, not super low, but okay considering my basal rates do a good job of keeping me pretty steady throughout each 24 hour period.

Yet every once in a while complacency bites me in the ass, because diabetes acts different from the way it acts under 90 percent of the other circumstances I’m used to. Those are the dangerous moments. Those are the frustrating moments. Those are the critical moments when I just have to ignore everything else and concentrate my focus on doing the one or two things necessary to keep myself alive.

And make no mistake, keeping yourself alive is exactly what you’re focused on in moments like this.

Maybe the circumstances leading up to this event can help explain why my blood sugar tanked in the middle of the night. But even if they could, it’s like much of the science surrounding diabetes. There’s a link, but you have to look really hard to find it, and when you do, you find that the details are so complicated that it would be hard to remember all of it later on.

When our brains are overloaded with math, prescriptions, doctor visits, and remembering to bolus at the right time (among other things) already, it’s easy to see why most of us don’t get too invested in the causes of our hypoglycemia. It’s very complex, and each scenario could be different anyway. If there’s something that really stands out, like over-blousing or insulin stacking or not factoring in exercise, we identify it and correct it next time. Anything deeper than that, and we’re likely to lose track of it.

Solving lows like this is often like learning the engineering behind sending a rocket into space. There’s so much to know, you can’t possibly learn it all on your own. And unlike science, diabetes changes over time, so even if you learn everything behind today’s low, it might not help you with the one you experience six months from now.

I’m glad everything turned out okay in the end. I worry about those who experience the same circumstances where things don’t turn out okay.

And I still worry about what I don’t know.

Universal truths.

I’ve been back on the workout bandwagon for a while now. I’m still finding some time to get on my spin bike at home, and I’ve been getting to the gym so I can run on the track instead of going outside when it’s 20 degrees.

But I’m no different from other People With Diabetes when it comes to working out and fears of hypoglycemia. To combat that, I don’t think of it as managing my diabetes as much as I think of it as managing my insulin. If I can manage my insulin properly, I can avoid the lowest of lows. It seems like I can’t avoid having any lows. I’m not that good at it. But remembering that I might need to tweak basal rates or bolus amounts due to workouts, and doing that properly, is really key. Just about everyone knows that.

Still, working out more often, and the worries of hypoglycemia, coupled with the fact that adding this to my schedule more often, well… it seems like there’s this double-edged sword: Volunteer for something that, in the past, has helped lead to serious hypos; or let the fear create inaction, which is never going to be something that will help me live a good, long life.

Add in knee surgery last year, and worries about how I would come back from that, plus the fact that I really hate how I look right now, and it just seems like a good excuse to either get going or sit right back down and have a drink.

While thinking of all this over the weekend, I came to the realization that there are actually some universal truths that apply to both management of our diabetes and working out. Remembering these truths has helped me embrace working out again, which I have not done for some time due to the reasons stated above.

It’s really hard to get started.
And the older you get, the harder it is to get started. The sooner you get over that, the better you will do. Trust yourself that you will, you can, get started again.

When you’re not on your game on a given day, you feel guilty.
Every day I’m not at the gym, I want to be at the gym. Which means if I don’t go, I feel bad for not going. After every day where I (try to) ignore my diabetes, I feel like I’ve done a disservice to myself and those who care about me. But we live with this disease all the time, right? We need a break (such as it is) once in a while. Which brings me to:

Yesterday is only a benchmark. The future is unwritten.
I’ve written variations of that line a number of times. This past week was when I first realized that it applies to working out as well as living with diabetes. Regardless of what yesterday tells us, there are many chapters left to life, provided we’re still game enough to author them.

Surprises can come at you pretty fast.
Since I started seriously working out again, I’ve had lows in the middle of the night that I didn’t expect, and I’ve had an injury to a toe that I was completely unaware of until my run was over. It helps me to keep in mind that the best planning includes planning for the unexpected. It’s gonna happen.

We are stronger over time than we seem to be an any one moment.
Our lives are not defined by one single day. At least I hope not. With diabetes or with working out, it’s easy to give up when the going gets tough, you’re worn out, and it’s so easy to just say I’m Done. When we don’t do that, well, that’s where champions are made. And People With Diabetes are better at not giving up than any other group of people I’ve ever known.

Maybe the real universal truth is that remaining active is actually part of managing our diabetes. That makes sense, but how often do we think of it that way? I know I don’t… or haven’t… until lately.

Have any other universal truths you’d like to add to the list?


What is it about diabetes that just knocks us off our game now and then?

Nothing about diabetes is wonderful, unless you count the people you meet who are dealing with the same things, either by living with diabetes themselves, or living with someone who lives with diabetes. The rest of it pretty much sucks.

Still, sometimes we put on airs of “I’m a tough hombre” because we deal with everything this disease throws at us, and yet we get through it… we’re strong enough to suffer the slings and arrows that diabetes sends in our direction, and often we emerge from the battle stronger than ever. How many people with completely healthy bodies do you know who can put up with what we put up with on a regular basis?

I can’t say that’s how I was feeling the other night when I went to bed. But it had been a long time since I’d experienced an overnight low, and nothing about that Thursday night was any different from a thousand Thursday nights before it.

Insert diabetes… begin chaos.

I woke up around 1:30 a.m., feeling sweaty, and a little irritable. If I’m sweaty at this point, it means my blood glucose level has already sunk pretty low. Normally, when this happens, I just need to get up, go downstairs, get the juice from the fridge… I’m good. This night, I didn’t, couldn’t, get to the fridge. Instead, I sucked down a juice box sitting next to the bed. Then another. Then a package of peanut butter crackers. Then some candy. Then some peanut butter. Another juice box. In all, it took around half an hour for me to actually feel like myself again. Like I could even stop to check my BG. Prior to that, it was all about feeling well enough to remain upright.

Therein lies the problem with feeling like you’ve nearly nailed your management of diabetes. You get surprised when you least expect it. It’s also the point where a lot of People With Diabetes feel a lot of guilt. I was a little guilty in this instance. I had a snack that evening that I probably over-bolused for. It happens. It happened Thursday night. But unless I make a habit of it, I’m not going to feel bad about it. That kind of thing doesn’t work for me. And while I don’t want to tell you what to do, I think you should consider what I’m saying here.

This might sound a bit harsh, but when it comes to diabetes, guilt is for suckers.

It’s not that we’re perfect… no way are we perfect. But what’s done is done, and feeling any guilt about anything that happens to you because of a disease that you did nothing to contract is like blaming your parents for your eyes being brown. Sure, your parents had a lot to do with it, but your eyes are still brown. After the moment passes, we still have diabetes.

So Friday came, I went to work (tired and hungover and a little afraid of my next bolus), and I continued living. That’s the final victory.

If you want, think of it this way: our imperfections are only a trivial botched play in the middle of an otherwise victorious game. If we live, we win. I want to improve my game so I’ll be successful more often. But I’m also going to realize that sometimes, a botched play is going to happen anyway, and the best way to deal with a botched play is to make it trivial by making the rest of the game spectacular.

I’d rather concentrate on the spectacular.

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