Hypos...?

"Ehh, Hypos?"asked, in a thick Israeli accent, by the doctor who takes care of my Diabetes. The question is to inquire about hypoglycemic episodes (low blood sugar). The answer, unfailingly, is "Yes." Not only a couple of episodes in the past few months...but, often, a few a day. No big deal, right...just eat something, have some juice, right? Well, in my experience, although some healthcare professionals and most lay people view low blood sugar as an occasional "something to take care of." It's often an actual medical emergency and, even when treated diligently, can affect the way you feel, not only during the episode, but for hours. It can also contribute to blood sugar swings and rebound highs. So if you have 2 or 3 or more a day, then "poof" there goes the day.

I've been laughed at by a nurse, while NPO (unable to eat), in the hospital when I tried to calmly explain how fast my blood sugar can drop and that we needed a plan (my blood sugar was already in the 60's). I have learned to hoard juice from meal trays in the drawer next to my hospital bed because, often, no one responds to the call bell in time... or at all (even though I never ring the bell for anything frivolous). My personal favorite is when a PCA is sent in by a nurse with a sugar-free "gelatin" or drink. When I explain that I have low blood sugar I am unfailingly scolded and told "you can't eat sugar, you have Diabetes"...Thanks...now you can get back the guy in bed 3 who is in urgent need of more salt packets.

While pregnant, I've been told by a Nurse Practitioner-Certified Diabetes Educator (CDE) that I needed a "Cognitive Reframe" if I inadvertently had too much carbohydrate to treat the constant 30s I was waking up to in the middle of the night. The dazzling ineptitude of that one still makes Matt and me laugh. If he hears me treating a low at 3am he'll wake up and say "are you ok," and I'll sometimes respond "yep, just need a reframe." If that lady only knew I had trained and worked as a cognitive behavioral therapist...I never mentioned it to her. There was that time when two doctors (one of whom touted a focus in "Diabetes") stood next to my bed while I, coincidentally, had a glucose in the 40's and they said to each other in amazement "wow that's low." With looks of concern they paused at my bedside. I calmly told them I needed someone to get me some juice. There are so many stories like these, but no room to write them all here.

My first real hypo outside of the hospital was bad. It was a couple of weeks after I was discharged and we were back in Pittsburgh. We had just eaten lunch. I took insulin after ordering my meal as I was instructed to...roughly 15-20 minutes before eating. I got my meal and ate. I shook visibly and sweated through my clothes as we walked to the parking lot and continued to shake and sweat after gobbling, and gagging on chalky glucose tablets. I felt cold from the sweat and my tongue, lips and cheeks were numb for quite some time after. My mouth tasted of metal, which I found out years later was probably Epinephrine and maybe some ketones. 

A blood sugar of 49 is low and can be dangerous especially for someone taking insulin, but I no longer feel those obvious symptoms at 49. 60-45, I sometimes feel hunger, butterflies in my stomach and start to lose concentration. If my husband is with me, he notices the difference before me. At 44 I start feeling jittery and shaky and fumble for sugar or food and I drop things. At 35 I sweat and feel lightheaded. 25 is all of the above with a racing heart, cold sweat through my clothes, and the metallic smell lingers in my pores. At 25 (thankfully, I usually avoid these) and lower I usually need a shower and a nap after it's treated. Think "Shelby from Steel Magnolias"except without the Southern accents and dramatic crying... Wait, you didn't know? yes, Shelby was a Type 1, when treatment wasn't as good, I bet she was on NPH insulin...or NPH and Regular....I digress!Treatment gets more difficult the lower the number is and the longer it lasts.

Unfortunately, no matter how much my insulin is adjusted, how diligently I check my blood sugars, or use a continuous glucose monitor with an alarm, I have hypos. It can be very frustrating. My sleep is often affected. Normal activities are constantly interrupted. Running to the supermarket. Going for a walk. Going to a preschool open house (and stealthily eating loose glucose tablets along with some pocket lint). Taking the railroad. Walking in Manhattan. Laundry. Cooking. Going to a kid's birthday party while trying to talk to other moms, watch my kid and subtly treat (multiple times) the 45 that has lasted the better part of an hour. I could write a whole entry about the many adaptions I made when I was working. I've had lows while running to doctors appointments...

Once my glucose was 33 at a Opthalmology check up. I was pregnant with my second child. I regularly experienced multiple hypos a day, often sustained, during my pregnancies. I was sitting in the waiting room  with my two year old waiting for the eye dilation solution to kick in. I didn't feel the low yet. Just a little tired. Just a little nauseous and shaky. I just checked my blood sugar when I started the 5 minute drive to the appointment, it was in the 90s. I sat in the chair in the exam room and it hit me like a truck. I winced and pulled away as the Doctor neared my eyes. I froze a little. I said awkwardly, "I need to check my blood sugar." Sure enough it was 33. I calmly told him I had glucose tablets and started to eat them. He asked if I needed something else and, although I said "no," he came back with a small (lime) lollypop for me. I politely gave it to my son who was applying stickers to the walls at this point. The Ophthalmologist was kind to help, as is his usual personality, and it would have been unfair for me to expect him to know how to treat a serious Hypoglycemia. He gave me extra time with the appointment and checked up on me. He admittedly had never once seen a hypo this low (and it sounded like he had never seen one at all). The blood sugar swings I had often told him about were now illustrated and it seemed to, thankfully, make an impression. 

Long story short...Hypos are frustrating. Blood sugar swings make me feel sick every day and cause me to work extremely hard to function adequately. Thankfully, though, technology is improving rapidly. I think it will get better soon. I've been cautioned not to be naive about the swings "going away," but I remain faithful that they will be more manageable. There are some scientists out there who care, and have direct personal experience with Type 1 Diabetes which must drive them to make sure it gets better. It's gotta get better.