Wednesday, March 08, 2006

How low can I go?

Over the last week and a half, I’ve been low about 6 times. None of this “Ooh, I’m almost 80 mg/dl, better have a nice, safe snack and patiently wait for the rise,” but a complete crash and burn low that renders me helpless and 31 mg/dl while I sleep.

I used to wake up on my own when I was dropping. A bloodsugar tumble to 54 mg/dl would either have the cat meowing insistently and pacing around my head or my own adrenaline would rouse me sleepily, sending my arm on autopilot as it reaches for the black zipper case that houses my kit. Test myself, roll my eyes at the number and stumble into the kitchen for a glass of cranberry juice. Still getting sweaty during that low, still feeling lost in that fog, but coherent enough to treat my own reactions.

Something has happened in the last few weeks.

I’m not waking up on my own.

Chris wakes up in the middle of the night to me, sweating profusely as my body searches its cells for glucose, blankets tossed off and hands wrapped up in my t-shirt in panic. Grabbing my shoulders, it takes more than two fierce shakes to wake me enough to prick my finger.

The numbers are Officially Scary. 44 mg/dl. 37 mg/dl. 31 mg/dl. 27 mg/dl. He runs to the kitchen and pours a glass of juice, holding me up as I drink it. He stays awake until I've tested that second time, letting me sleep again once I'm up to 80 mg/dl.

I don’t even know I’ve had a reaction until I wake up for work the next morning and see the glass on my bedside table, ringed with the red residue of the last sip of juice. Then I check the memory on my meter and see the number from 3:11 a.m. A text message from Chris while I’m at works comes in around 9 in the morning: “You had a rough low last night.” Now the messages read: “You had another one.”

What scares me the most is that I’m not able to help myself anymore. It could be that my bloodsugars are running so close to almost, maybe normal that I don’t feel the lows until they’re frightful. Or it could be that unexplained hypoglycemia unawareness. I feel like my body is betraying me. And my stupid cat is leaving me in the proverbial lurch, too.

But it’s happening at work now, too. I had to excuse myself from a meeting to grab a bottle of juice, my heels clacking against the tile floor as I’m almost running to the cafeteria. I’ve cut my basal down. I’m monitoring my levels as often as is financially feasible. I’m trying to keep track of what I’m doing that could be causing these lows.

And I’m still experiencing a 221 mg/dl or two, confirming that I do still need this pump thing hiding in my pocket. I’m really looking forward to the CGMS/pump hybrid, because if the last few weeks are any indication of my sensitivity to insulin and insensitivity to lows, I’m going to be a prime candidate for this machine.

Prime… like priming the pump.

A good pun goes a long way for me.

30 Comments:

At March 08, 2006 10:10 AM, Blogger Kieran said...

I was eaten by a dog once, but only a bit. What do you think of that?

I really like The Mighty Boosh. Perhaps you do too?

 
At March 08, 2006 10:18 AM, Blogger Kerri. said...

Only a bit eaten by a dog? I'm not sure how to respond to that other than to quote it...

 
At March 08, 2006 10:41 AM, Blogger Kieran said...

That's fair enough. After all, you are only a car.

 
At March 08, 2006 10:44 AM, Blogger julia said...

Wha? I feel like I've stepped into the twilight zone of comments here....

Those are some freak-out scary lows, Kerri. Have you called your endo? Tried lowering your night basals? Try having a high protein snack before bed?

 
At March 08, 2006 11:41 AM, Blogger Johnboy said...

Kerri, I can relate (though not in the middle of the night). Hypoglemic unawareness is scary and serious.

I just posted on something related.

I would call the endo ASAP.

 
At March 08, 2006 12:46 PM, Blogger Tekakwitha said...

Unaware hypos scare the shit out of me.

Talk to your doctor and don't take candy from stranges (unless you're low!). That is my only advice.

Hang in there Kerri.

tek

 
At March 08, 2006 12:50 PM, Anonymous Shani said...

Kerri,
I was diagnosed 24 years ago yesterday and have had a number of Hypo unaware episodes. They seem to happen in bunches with little or no explanation. I did find that for a while after I moved in with my boyfriend (maybe a year after) I started having more of them at night. (This was pre pump) I thought about the possibility that I might feel comfortable having him next to me in bed and some how knew that he would protect me. Since I considered this possibility it rarely if ever happens. Maybe it is because I prefer to take care of it myself. It was always really messy when he held the glass of juice to my mouth/cheek. I know that this doesn't change the reality of your situation but, I like knowing that I am not alone.

 
At March 08, 2006 1:36 PM, Blogger Jen said...

Could you be pregnant? The only time I have had low unawareness was while pregnant. Lows come on REALLY fast early on in pregancy. I never felt them until after I had treated.

I hope I'm not scaring you more than the lows...

Jen

 
At March 08, 2006 1:53 PM, Blogger Kerri. said...

Before any rumors start (and my mother calls and Chris has a mild heart attack): Definitely not pregnant. Confirmed.

Debating calling Joslin, though. Maybe I can fax over some results and have them assess over the phone, vs. hitting my insurance up via a visit.

 
At March 08, 2006 2:07 PM, Blogger Jen said...

Kerri,
I'm sorry about that. I just now realized that I should have suggested that one in a private email. Duh. Having two kids and talking with other moms so much kinda makes me forget that not eveyone is at my same station in life where pregnancy comes up in all kinds of casual conversation. Again, I'm sorry about not thinking that one through before posting a comment.
I'm glad that you were available to post right back before the freak out occured.
Jen
foot in mouth

 
At March 08, 2006 2:31 PM, Blogger Rachel said...

What Shani said about hypo unawareness situations coming in bunches - yep, seen that with my husband from time to time.

Seems to happen when he's under stress (usually with work, but the first bunch I remember was concerning a family situation). He usually doesn't let stress get to him, but it happens.

Will be waiting to hear what you hear.

 
At March 08, 2006 2:35 PM, Blogger Ellen said...

I hope the endo can help.

I was also going to suggest pregnancy although you ruled it out. For those who want to know more on the subject:

Declining Insulin Requirement in the Late First Trimester of Diabetic Pregnancy

http://www.medscape.com/viewarticle/406021

 
At March 08, 2006 2:45 PM, Blogger Kerri. said...

Jen,

Absolutely no issue with you asking if I was pregnant. I am, after all, 27 years old and in a serious relationship. It wouldn't be out of the realm in the least bit. And it could have been the cause of the wild bloodsugar fluctuations. But for this round, it's not the cause. Seriously, though, I'm the most difficult person to offend. So don't worry!

Trust me, when I'm pregnant, everyone will know!

 
At March 08, 2006 3:10 PM, Blogger Alex said...

Wow! Those are some scary numbers. If you remember the same thing was happening to me during basketball. As far as your body goes, I doubt it's giving up on you. The opposite thing happened to me a while back. For a while my blood was nothing but high so then 150 started feeling "low." I hope your night-time numbers start staying up. Keep us posted.

 
At March 08, 2006 3:37 PM, Anonymous Theresa said...

Hi Kerri,

This is my first time posting here, although I often read your blog. I have had type 1 diabetes for 40 years and also have hypoglycemia unawareness.

When your diabetes is under tight control, your body gets use to the low bgs and the lows become the new "normal range." The low range where you have symptoms becomes lower. So your body may not respond with any symptoms until your bg is very, very low like in the 30s or 20s or you may not experience any symptoms at all. It sounds like this is starting to happen to you.

An important question I have for you. When you are in a meeting at work or any place for that matter, why don't you have glucose and food with you. You should not have had to go to the cafeteria to get juice. It should always be with you. This is not the first time I have read in one of your posts that you did not have glucose with you or at least not enough--like the time on the highway driving.

Here is an important rule for myself considering I have hypoglcemia unawareness: I must always have a source of glucose and other food with me no matter where I am. It is not other people's responsibility to get it for me.

Here is what works for me. I use to buy those bottles of 50 glucose tablets, but when they started going up in price, I stopped buying them. However, I saved several of the bottles and I now put sugar cubes in them. I have one bottle in my purse, one on the night stand next to my bed, one in the living room, one in the bathroom, and an opened box of sugar cubes in the refrigerator. I also have graham crackers in my purse.

It seems like you prefer juice. How about buying small cans of juice or those small juice boxes. Although, good luck getting that little straw in when your bg is low. Just some suggestions.

Hypoglycemia unawareness really irritates me. Here I am keeping my diabetes under tight control and I have to have a complication related to tight control! Boy, the diabetes challenges never end!

 
At March 08, 2006 3:48 PM, Anonymous Caro said...

I can absolutely relate here, Kerri. I go through cycles of hypoglycaemia unawareness that only a period of running on the high side will reverse... for a short while, at least. It's scary, it's horrible and it's a damn cruel trick of the body.

The main difference is that I live alone. I'm not dead yet, and I guess that is because although my body has funked out on me by not waking me up when I'm low, it still remembers how to pull me out of it while I'm sleeping, and wakes me with the gift of a monster rebound in the morning.

For that small thing, I'm disproportionately grateful.

Hang in there.

 
At March 08, 2006 3:57 PM, Blogger Kerri. said...

Theresa,

It's not so much that I'm unarmed for these lows, but it's taking more than the "normal" amount of juice to bring me back. I had a low about 1/2 an hour before the work meeting and overtreated by 50 grams of carbs in efforts to avoid embarrassing myself. But instead of rebounding up to 200 mg/dl plus, I'm plummeting to 50 mg/dl.

While I have juice bottles and glucose tabs stashed in the car, my desk, and all over my house, it's the fact that I'm not feeling these lows until they're intense that bothers me the most.

I'm definitely hydrated, though.

Thanks for delurking! I appreciate your comments and I'm glad you read the blog. :)

 
At March 08, 2006 4:17 PM, Blogger Shannon said...

Firstly, Kieran had me thinking I was going through a low, and you know I'm not diabetic!

Second, how scary it must be to not have any control over your senses or thoughts to help get you out of those lows. I guess the Guardian would be something for you to look into so that you could be woken by alarms when you start getting to the low point. Boston is one of the cities where the Guardian is available.

 
At March 08, 2006 5:37 PM, Blogger Scott K. Johnson said...

Hey Kerri,

Scary numbers indeed.

Not sure what to suggest about that, just wanted to let you know I feel your pain and wish the best for you!

And I'm sure that while it may be a little concerning for Chris, it's only in the best way possible, rather than an irritated "damn it disturbed my sleep again" kind of way...

 
At March 08, 2006 5:51 PM, Blogger J said...

Lows like that are not fun I was thinking the same thing does it help to have something before bed or increase it I know you have probably done all you can do and hearing it again you probably do not want just a thought :-) it is funny I was thinking with all these lows you could go pumpless but then you said the 221 hits to remind you how much you need it ugh ! so frustrating. Keep me posted thinking of you.

 
At March 08, 2006 7:25 PM, Blogger Sandra Miller said...

Kerri,

I'm hoping that the folks at Joslin can help you figure out how to prevent these overnight lows.

Very, very scary.

Please take care.

Sandra

p.s. Thank you so much for the insightful, heartfelt comment you left on my site. It was hard to read... tears just kept getting in the way.

 
At March 09, 2006 8:36 AM, Anonymous Kerri's Mom said...

Whoever coined the phrase "parenting is forever" is so right. After reading my daughter Kerri's post on her recent lows, I am reminded of how badly I handle her disease at times. Hard as I may try, her situation is never far from my thoughts. It's always there, sometimes more pronounced than other times. I was getting ready for work today, combing my hair looking in the mirror and I just kept thinking that I am 55 years old and she is only 27 and wishing that I could take away her diabetes. I was bargaining with who knows who, God or the devil. I would take this disease from her. Let her live her life, get married, have children free from the ever present threat of diabetes and it's complications. I would make the deal...what parent wouldn't. Knowing that's not how it works, made me sad and angry. I thought that when she was old enough to live on her own, I would not worry so much. Not so! If a few days go by and I don't hear from her, the thought that something is wrong immediately pops into my mind. Can't control that first inclination to think that. As her Mother I should try to keep her and myself optimistic and hopeful. When I read about what you all have to go through it makes me think of how unfair life can be and it's hard not to be sad. That's the self-pity part of me speaking. My favorite phrase is "This too shall pass" and it will. I will regain my "the glass is half full" attitude and help Kerri weather the "diabetes storm" in any way I can. But for today my thought is "Get the hell out of her you old legged beast!!"

I am truly blessed with wonderful children and I love them all dearly so as Kerri says "She still smiles".

 
At March 09, 2006 8:01 PM, Blogger Jamie said...

I had trouble getting through this post - and it's a very good post at that. I just kept relating it to my daughter - and what will happen when she's grown up and on her own. I was scared for you - and scared for your Mom too - because I would be scared myself.

Those lows freak me out in a bad way - the ones you don't catch are my worst nightmare. I am so glad you have Chris there - really, I am, and I hope the folks at Joslin can come up with a new regimine of insulin for you so that this doesn't happen as frequently as it has (or happen at all, for that matter - although we all know there are no guarantees).

I love the comment your Mom made. She is such a good Mom to you - I could totally relate to the things she wrote - as a parent, YES, I would take it away from my child in an instant - if I could.

You are both strong women - I can see where you get your wonderful strength from Kerri (even though we are all entitled to have meltdowns about it from time to time).

Take care and keep us posted on how you're doing. I'll be thinking of you.

 
At March 09, 2006 8:23 PM, Blogger KSC said...

Hypoglycemic Unawareness (as clunky a name as the condition) SUCKS!!!!!! I've had it in the past, badly, but have managed to teeter above it since getting a pump. The trick for me was to keep very careful track of signs that might misinterpret at highs (sweating for me, or a headache) and also to ALWAYS treat anything under 80. I would let 70's and sometimes 60's go, and this lead to the loss of adreneline (sp?) pumping around at those numbers. The thing is, you highten your tolerance for lows when you regularly wait to treat mild lows. Joslin has a great book/workbook thing to help train yourself back (and if my experience is any indication you need to do it again every once in a while). See my blog posts about some-times hilarious incapacitations due to unawareness sometime.

 
At March 10, 2006 9:16 PM, Anonymous mary ellen said...

Hi Kerri -
Before I wrtie my message to you, here's one for your mom:
"You rock! Write a book on how to deal with a children with diabetes, that grows up and leaves home. I will need that in about 18 years ( my type one son is 4). "

Ok Kerri - here's yours. Can Chris set his alarm at say 1 and that at 4 and test you? I do that for my son now, and I tell you what,: I plan on doing that until the day he moves in with someone who can do it for him!
Also - do you keep an arsenal of juice, icing, etc - near your bed? Might be easy for Chris to put some icing in your mouth, before sitting you up for some juice. Just a mom's thoughts...
I will be thinking of you when I test Tom at 1 AM! ( need a phone call? I am up!) LOL

Oh, and a message to Chris? You are an angel on earth.

Mary Ellen

 
At March 10, 2006 9:30 PM, Anonymous JustLinda said...

Tonight, I went out to dinner with my Type 1 husband and our 3 children. Afterwards, he was driving and I noticed how badly. I asked if he was low, no sweating, no yawning, no signs at all. He assured me he wasn't. About 30 seconds later, he turned the wrong way on a 1-way entrance into the mall lot. I was terrified. It took me a good half mile more to convince him to pull over and let me drive.

No outward signs at all, and while he was full awake and even when asked he swore he wasn't low. We got home to find him at 50, must have been a fast crash downward.

I hate this disease.

 
At March 11, 2006 2:23 AM, Anonymous Tiffany said...

I like to call this kind of thing a learning experience :)

OK Miss Kerri, two words for you:

TEMP
BASAL

You have it; use it. It is, IMNSHO, one of the top benefits of the pump. If I have more than two consecutive lows (either in a row or during certain time frames) I temp my basal down by at least 80%. And, if your intuition is telling you that your hypo is just gonna keep on going, and going, and going...treat your hypo and temp your basal down by at least half for a half an hour.

Additional words:
How long has it been since you've tested ratios? Basal, bolus, ISF? Have you ever tested your overnight basals?

Side note:
Doesn't anyone (ok, I know Sandra does lol) tweak their own numbers without having to check with their physician first?? I see my endo once a year, and the first thing he asks me is "What changes have you made now?" I'm a firm believer in complete personal micromanagement. Makes me question the quality of healthcare that you Yankees are getting...

 
At March 14, 2006 9:00 AM, Blogger Kerri. said...

Tiffany,

I have cut my nighttime basal by a considerable percentage. And I tested my basals and ratios in January. I also don't speak with my endocrinologist unless it is an emergency. I prefer to tweak my own numbers.

My main concerns with these recent episodes was that I wasn't experiencing the symptoms and that I was staying low for hours on end. Since I'm trying to manipluate my own numbers, I'll be waiting a few days to see how things pan out before I consider calling Joslin.

We "Yankees" get considerably adequate healthcare, don't worry. :)

 
At March 21, 2006 12:27 PM, Anonymous Lori said...

I'm a week late on this post. My son (15) has just had two Hypo Unawares and they were terrifying for me. Not really terrifying for him. The first time it took paramedics to help us and the second time it took 5 bottles of juice, a couple of power gel packs and some frosting to get him to where he could communicate with us. He recently went on Metformin to help with his insulin resistance. That stuff kicked in and his numbers are way down. Thankfully so is his insulin use--from nearly 200 units per day to 100-140.
Kerri's Mom--you certainly do rock and you give me hope that I'll let my son live his life! I tease him that he can e-mail me his numbers every day!

 
At September 13, 2006 2:02 AM, Anonymous Anonymous said...

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