When Bisi was first diagnosed, I couldn’t imagine how we would ever settle into a routine again, how life would ever go back to being unscary. Of course, we did settle into a routine, and my fears receded some. But on a recent Monday I was reminded in two separate ways how quickly things can go wrong with diabetes. How little things that wouldn’t cause people with a working pancreas any problem—forgetting to bring a snack on the T; getting a little tummy bug—can turn into a crisis for those with diabetes.
On Monday morning I got an email from a friend who had been upset and shocked by something she’d seen on Boston’s MBTA, and wanted advice for how to help if somehow she were again faced with a similar situation. The train had just pulled out of the Longwood station in the medical area, so all the doctors and nurses had just gotten off. A man started having a diabetic seizure, and when he came out of it, after a couple of minutes, he said he needed sugar. Then he started seizing again before anyone could find any. Eventually someone found something sugary for him and he came out if it.
I told my friend that she could carry a little tube of icing in her purse, or even a honey stick, and was impressed that she’d had the medical curiosity to ask (she also keeps a juice box at her house for when Bisi visits). But I also felt a cold prickle of dread: What if this happens to Bisi? What if she’s alone some time with no sugar to bring up her blood glucose and has to rely on strangers having the right supplies and knowing how to help her?
Later that same day, Bisi came out of her gymnastics class early saying she felt sick. Her brother, Jamie, was already home sick with a tummy bug. I took her home and tested her blood sugar. She was 68, despite the uncovered snack I’d given her before gymnastics, and had been running low all day, so I lowered her basal level. (Maybe subconsciously I was extra worried about lows because of the T story I’d heard that morning.) Then she threw up all over the place. This was her first tummy bug since diagnosis, and I knew this was something to be nervous about. I phoned the on-call doctor to ask what we should do.
She explained that even though Bisi was running low, her ketone levels could go high because of her sickness. (As I’ve mentioned previously, ketones can build up to poisonous levels for diabetics. If left untreated they can lead to a coma or worse.) She said that anything above .6 was worrisome, and that if Bisi’s ketone level was 1.0 or higher and we couldn’t bring it down, we’d need to take her to the hospital. The way to bring ketones down is to give insulin, but because Bisi was running low, we needed to bring her blood sugar up before giving her insulin—and this is hard to do if someone’s throwing up. If you give someone insulin for carbs and then they throw up the carbs, they’re in real danger of going way too low. The doctor said we should give Bisi tiny sips of ginger ale every couple of minutes, test her ketones, test her blood sugar, and, if it was high enough, give her some insulin. Then keep on getting her to drink ginger ale so we could start the process again.
We canceled the babysitter and I went alone to an event Mark and I had both planned on attending—a talk about how society’s obsession with technology and devices is damaging our relationships with family and friends. Throughout the talk, embarrassingly but in this instance crucially, my cell phone was buzzing with texted updates from Mark.
She’s at 1.
She’s at 1.8.
Since her stay in the hospital, we’d never seen her above .4
When I got home Mark was sitting on a stool by her bed, a bowl next to her in case she threw up, the floor littered with blood glucose test strips, ketone strips and wrappers, and cans of ginger ale. He’d been waking her up every ten minutes, forcing her to drink ginger ale, then testing her blood sugar every half hour and giving her insulin if he could. He’d gotten her down to 1.1. By the time we went to bed, a couple hours later, she was down to .7 Even though we needed to wake up three times during the night to continue the ginger ale/blood sugar/ketone/insulin routine, it felt like the crisis had passed.
So, one day, one disease, two different kinds of crises. The thing about living with diabetes is that you’re closer to the edge than you ever were before. You can be walking along, perfectly fine, then, boom, you get a stomach bug, or you’ve taken your insulin and your train gets delayed and you’ve forgotten your glucose tablets, and the edge of the cliff is right there.