For this story, you should know that target blood sugars are 80-120, and that my goal is to keep them 80-200.
I am an experienced diabetic. It will be 30 years on April 1, 2021. (No joke. I was released from the hospital on April 1st, 1991, so I count that the start of my journey, and it feels appropriate.) I am also a bit of a boundary pusher, so I am pretty good at anticipating the results of my own behavior. That does not mean that I am not thrown for a loop every once in a while.
That loop came in the worst way last night.
I had gone out for lunch with friends. It was a big lunch and I planned a minimal dinner. I had also increased my base insulin rate to handle the fat and carbs from the big lunch. This is common practice for me, and it was keeping me steady at a blood sugar of about 175. So I left it to play out the way I had programmed it and decided to go to bed.
About an hour later, my internal low blood sugar alert woke me up and I saw that I was dropping quickly, down to 103, which didn’t make sense because there was no active insulin in my system other than my base (there are 2 kinds: base rate to keep you even and the intermittent doses to cover food and correct higher blood sugars). So, I canceled the elevated base rate and tried to go back to sleep. Didn’t work. I kept dropping and dropping until I hit what I estimate to have been about 32 since my meter does not read below 40.
That was bad, but I had been there before. The problem was I had run out of juice, my usual treatment, and had scrapped an earlier plan to go to the grocery store. All I had was a pint of vanilla ice cream and some grenadine. I tried to be careful about how much to have, but the treatment takes a while to hit your bloodstream and I could feel myself dropping even more. If I’m honest, I could feel myself about to pass out. But I am stubborn and pushed myself out of the chair and went to get the rest of the ice cream. I ate it all. With syrup.
Then I waited. And waited. And waited. It took about two hours for me to hit 50, a manageable blood sugar for me. Not great, but manageable. I was drenched in sweat by that time, so I went and just sat on the shower bench under the hot water until I felt better.
I tried to stay up and monitor a while after that, but between it being so late, and a low like that squeezing every single drop of energy you have out of your body, I just couldn’t do it.
I paid the price the next morning.
I woke up early and exhausted. My pump, which is connected to my meter, said I had gone from exceeding the lower limit of 40 to exceeding the upper limit of 400. I wasn’t overly alarmed. It had happened before. It’s called chasing a low. I treated it with an aggressive dose and knew I would have to monitor closely. Going from really low to really high and back to normal too fast could make me sick, and at this point, I was hyper-aware that I could overshoot.
But nothing happened with that aggressive dose, and when I went to do a calibration test, it read 538. Now that was a number I hadn’t seen in decades, a dangerous number.
I started dumping insulin, which means high doses close together. I used a needle since I wasn’t sure if my pump was working properly or if my insulin wasn’t bad. It wasn’t so many carbs that I should have gone up that high. Again, it took hours to get back to normal, about five or six. Every hour, I tested manually and gave myself another dose, and waited and didn’t eat, and drank water. The risk of dehydration that needs a saline IV is pretty high in this situation.
It’s been a couple of hours since I hit the normal range. My head hurts, my stomach hurts, and I can barely lift my head. But I can stand up safely and I have Pedialyte in the fridge to address dehydration. I will be ok now.
I am not going to analyze this incident for what went wrong. Everything appears to be working properly now. No, the point of this story is that chronic and autoimmune conditions are hard. They don’t get any less hard, just different hard. No matter how long you’ve had them or how routine things have become, even the bad things like pain flare-ups, medical conditions do not conform to rules all the time.
This was a reminder, the worst in a while.