The fear of nighttime lows, including mine

2 yrs old heh heh hehMe at three years old

I serve as a communications advisor to Dex4, maker of glucose products, lending them my patient perspective and expertise. 

I’ve also done a number of writing/editing projects for their “situational lows:” web and print information on “managing weight and lows,” “exercise and hypoglycemia,” “safe driving and hypoglycemia,” and “school days and hypoglycemia.” They’re all under the Learning Center tab on their web site. Great information about correcting and preventing low blood sugar.

So how uncanny that just as I’m working on another situational about nighttime lows, the most dreaded of all, my mother just spent the last two days thinking I had suffered one. Luckily as of this morning she knows I’m not sprawled in my bed or on the floor unconscious.

This is what happened. Every time my mother called my landline she got a busy signal because the last time I used the phone I had used my earpiece and hadn’t properly hung it up. So she’s hearing the phone ringing and ringing when, for me, the phone isn’t ringing at all. 

Meanwhile my cell phone was in my coat pocket for two days because I had put it there when I walked my husband down to the car service to take him to the airport Tuesday night (just in case they didn’t show) and completely forgot to take it out of my pocket. So, even though my mother left three messages on my cell phone, my phone battery was dead. Only last night did I look for my cell phone, realize it needed to be charged and it spent the night on the charger.

When I pulled my cell phone off the charger this morning I saw I had three messages, two from my mother and one from a friend she had called in Florida to see if she knew where I was or if something had happened to me. 

I called my mother right away and her relief was palpable. I can only imagine her picturing that little girl up there in the photo in dire trouble. I’m not usually a ditz. Actually, never. But I have had a horrendous body (and obviously mind) numbing cold/flu where all I can do is walk myself from my bed to read and doze to the couch to watch some TV and doze to the kitchen to make some soup, to barely lifting my ipad to check my emails. Work has largely gone by the wayside so I didn’t even realize the phone hadn’t been ringing.

All to say, I’m really sorry mom and we really do have to teach you how to email! But I also want to use this as an opportunity to remind you that if you suffer from lows and are alone, it’s wise to have a plan so you can get help if you need it, and assure your loved ones if you don’t. 

My current plan is if my mother experiences the same again, she is to call my brother and have him email me. Yes, even in a stupor, I check email. If I really had had a devastating low, (which in 39 years I never have thankfully) I have glucose tablets several places in the house. I also know I should have a better plan. All I can say is I’m working on it.

 

2:10 A.M. to 2: 25 A.M., just another night with a low

I woke up last night at 2:10 AM and just felt off. My first thought of course was low blood sugar, even though my thoughts weren’t rising like scrambled eggs and my heart wasn’t beating out of my chest. I crept out of my bedroom into the kitchen, flicked the light and tested. Darn, a borderline 65 and it was only 2 A.M. I should have known when I was 123 before bed that I wouldn’t make it through the night. 

Typically, when I have some wine with dinner my blood sugar needs to be about 140 before I go to sleep since I’ll drop about 60 points overnight, and there I was 20 points shy. I wore a CGM once for 3 days to see if my blood glucose followed any trends. What was revealed to me was that indeed it did–I drop significantly overnight. When I asked my diabetes educator, “Why?” and, “What can we do about this?” the answer was “We don’t know why, it’s just how your body responds” and “Let’s move your Lantus from before bed to the morning. The drop may be less severe.” And it is. So now I follow a fairly doable system  knowing where my blood sugar needs to be before I go to sleep based on whether or not I’ve had two glasses of wine. I just have to be alert and make the effort even when it’s the last thing I’m in the mood to do at midnight.

Anyway, back to the kitchen. After discovering I was 65 I ate one glucose tablet, a few strawberries and a small bite of an Extend Bar. A few bites before bed help keep my blood sugar more level overnight. Then I tiptoed back into the bedroom. My husband who was now on the verge of wakefulness said, “Are you OK?” I said “Yes.” And I was, and I wasn’t. I don’t often have this thought but I did last night, How unfair and frustrating that this is how I have to live! How amazing that this is my life?! The thought that followed seconds later was a resigned acceptance, Well, if this is how I have to live then this is what I have to do. This is my life.

But there’s a second act to last night’s show. Now back in bed I lay there having a debate with myself whether my 1 glucose tablet, 2 strawberries and bite of Extend Bar was enough to get me through the next five hours. After a good ten minutes debate, because I really didn’t want to get up again, my sleepier side lost and I walked back into the darkened kitchen and retrieved and chomped down another glucose tablet. 

This morning I woke up at a stellar 86. Yet I’ve been mulling all morning about how hard I work at managing my diabetes and the only reward is maybe I’ll get less complications, maybe they’ll be postponed, maybe I will make it to 80 years old and won’t have more than my share of heartache. 

Of course now that the sun is making its way over to my living room window, my thoughts shift along with its brightness. Living side by side with my intermittent anguish is the hopeful expectation that within the next five to ten years there’ll be more advances in diabetes research, tools and procedures that will make managing diabetes almost effortless and ensure us much better control. 

How odd that all that we do to manage diabetes, particularly for type 1s, just becomes mundane in an egregious life, and that we exist in a constant ebb and flow from fear to faith and night to day. 

Even diabetes gods have occasional hoofs of clay

So there I was at the Norfolk, Virginia airport having just gone through security and Starbucks (aren’t they both required?) when I feel my  heart beating rapidly, my hands shaking and I know that it’s not the caffeine: I’m entering low blood sugar land. The airport is relatively empty so I drop my rolling case where I am, not far from my gate, fish for my key, unlock my case, then open the zipper of my packed knapsack and rustle out my meter. 

What must I have been thinking, (or not), when I packed my meter inside my knapsack and locked it inside my small suitcase that would get handed to the baggage guy just outside the plane door as I board? I had flown down from New York to Virginia to speak at a health fair to fellow patients about developing healthier habits for living with diabetes — admittedly this isn’t one of them! Was I unconsciously packing away my diabetes now that my job was done and taking the day off? Going incognito so to speak?

My meter on top of my case now proves my suspicion correct: 51 mg/dl, and while I don’t have a CGM I clearly know I’m going down. I close up my case and wheel it, and me, to my gate so if anything should happen there will be others around. I sit not far from a grandmotherly looking passenger in the waiting area and unpeel the tangerine I also packed in my locked case. Well, at least I was smart enough to bring a sugary food in case this should happen. So somewhere at base camp riva I wasn’t going to let anything too drastic happen. (Yes, I had my SweeTarts with me but wanted to use up that tangerine already, and knew I had the low blood sugar window open enough to do so.) I actually brought that tangerine down with me from Brookyn two days earlier. Now it was doing its job. Peel, munch, ask grandma where she’s going like I’m perfectly in my body, peel, munch, “Really, on a cruise you say, around Asia? How nice.”

Fifteen minutes or so later, another low handled and danger averted. As my collective brain cells kick in I revisit why I didn’t have my meter easily accessible and was willing to have it in cargo during the flight. After all I was in the perfect situation to have a low: traveling, off my routine, and while I ordered from room service that morning my usual hot oatmeal, the hotel didn’t know the secret “riva receipe:” a dollop of low fat yogurt and cottage cheese on top for stabilizing protein, bits of apple and berries for more rapid glucose, and a tablespoon of peanut butter for fat to sustain and level my blood sugar rise. 

Best I can figure, on some unconscious level there are just times I want to be an ordinary jane (I’d say ordinary cow, see photo, but it doesn’t sound very nice even in a frilly pink dress) and I yearn to put me, riva, before my diabetes. Judging from results I guess I’m willing to walk the line at times between being fully at the ready and knowing I can pull out my Super-Diabetic cape at any moment and save the day. 

I’m sure that confidence comes from knowing that cape is with me wherever I go: All my knowledge, learning and experience, and so maybe that’s why at times I pack it rather than wear it. For all of us who recognize this scenario, yesterday was just another day in funky-town, one for rebooting and reflecting and with that, maybe I’ll see if that cape can drape over these cow shoulders if I do want to wear it next time. 

…And then I was 36 mg/dl!

I shoulda known some drama was coming. After all, my fluctuating blood sugars have been on my mind these days on the road, as evidenced by the post below. 

So here it was yesterday another beautiful morning in Sydney and I took my first plunge in the pool: 30 laps – mind you they’re mini laps given the size of the pool. Yet apparently I experienced a delayed low, or a stacking problem taking two many mini injections back to back. At one point when I thought I was dropping, I grabbed a piece of a fruit scone only to discover, no, I was going up! So, I dosed another unit of apidra which two hours later had me breathing shallowly and testing to discover my blood sugar was 36!

The husband jumped into sound panic mode. I said, “Go downstairs and bring me a glass of juice. I’ll be O.K.” (or so I hoped). Moments later the juice arrived, the husband was playing watchful nurse and according to the ‘The Rule of 15 ‘(15 grams of fast-acting carb and test in 15 minutes for a low) 15 minutes after downing the juice I was a splendid 82, and 15 minutes later a stable 119. And so today it’s ferrying into the city, meeting friends for lunch, testing, calculating, and so it goes, and goes and goes…………

Glucose Rapid Spray – quick glucose to delay a low

UnknownHelps delay or defray a low blood sugar incident

Glucose Rapid Spray was one of my finds at the American Association of Diabetes Educators’ (AADE) Conference a few weeks ago as I ambled through the Exhibition Hall. I think it’s a most innovative product that offers three distinct advantages–it provides what it says “rapid glucose delivery” with quick absorption through the surface of your inner cheeks. It offers great portability as its tiny size fits in the palm of your hand, and, it can delay and possibly deflect a low. My only word of caution, however, since we all react to things diabetes differently, is if you give it a try, since it’s uncertain just how many sprays will lift your blood sugar how far, test your blood sugar response over an hour after using, to see how your body reacts. The directions call for 5-10 sprays but you may require more, or less. Also, it’s not marketed as an emergency remedy but a way to keep your blood sugar from dropping like a stone before you can treat it.

My unexpected test of Glucose Rapid Spray occurred the other day when I took my usual one hour walk around my local park and returned at 11 AM with a blood sugar of 50. Great, I said, now I can try out Glucose Rapid Spray! The label directs you to spray 5 to 10 sprays into your mouth directed to your cheek and repeat as desired. So I sprayed 5 sprays into each cheek. While I have the orange flavored version, it also comes in raspberry, the taste is strong, and almost simultaneously sweet and slightly bitter.

I checked my blood sugar fifteen minutes later and it had lifted me to 60. Not bad I thought, but wanting to see what would happen over a bit more time I tested my blood sugar again in another fifteen minutes, now 30 minutes from my initial blood sugar of 50. I was 53. I had risen to 60 and then dropped to 53. Obviously I needed more than 10 sprays to lift me higher. As the directions instruct, I could have sprayed several more mists, but I opted since I was already home to chomp on some glucose tabs.

The takeaway: this may indeed be a valuable product to have with you when you’re on the go to delay a major low, but I’d suggest testing it to determine how many sprays you require to lift your blood sugar sufficiently before you can get your hands on some fast-acting carb or your next meal.

10:03 A.M – 56 mg/dl

Checking in on Amy’s blog this afternoon, reading her story, In Which I Contemplate the Details, I feel the type 1 bond wrap snuggly around me and spur my fingers to be part of the, “Try as hard as you might, sometimes you have no idea where you’re going to land!” club.

Yesterday I awoke with a blood sugar of 63. No scare there, I felt perfectly fine and I am of the group who like numbers on the lower side of 100 rather than the higher side. I took my usual 3.5 units of Humalog for my steel-cut, slow-cooked oatmeal I make every morning with its dollop of plain, low-fat yogurt, tablespoon of peanut butter, hit of cinnamon, sprinkling of flax seed and wheat germ. 

An hour later I was trembling behind my computer. My brain thought, hmmm… low blood sugar? But it was so out of the ordinary following my everyday routine that I ignored my brain’s suggestion, and invited this one, it’ll pass. But ten minutes later it hadn’t and I couldn’t ignore it so I gave in, got up, and tested. 56! Dang, 56 an hour after breakfast! How is this possible. Isn’t this when all those lovingly prepared oats are rushing into my cells raising my blood sugar? 

My husband asked what I thought happened. He suggested maybe it’s the few pounds I’ve lost. Maybe I’m more insulin-sensitive. Nice try, honey, but those pounds have slowly and gradually sloughed off over the last year, nothing’s different today than it’s been in months. Maybe, he suggested, you mixed up your insulins. Of course, I really had no way of knowing, except that if I had I would now be in a very deep coma and not participating in this conversation. I was completely flummoxed, and then I knew. 

I had met a friend for dinner the night before, and while I ate what I typically eat, and enjoyed the same amount of the grape I typically do, I did do something different. I power-walked home. A solid 40 minutes. And there, in that desire to be even healthier, I created a sustained drop in my blood sugar that carried over to the next morning, and most of the day.

So, as another voting member of the blood-sugar-blues-gang, sometimes you just don’t know why you’re 56 one morning and 186 the next. Sometimes trying to do all the right things, you mess it up even more. But something I know that will always be true is while I didn’t ask to be in this diabetes club, I’m awful glad for all the fine company.