Dangerously Low

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Since getting an insulin pump a few months ago, I’ve been very proud of my blood sugar control.  My A1c is down (I’m actually going to get my quarterly blood work done tomorrow) and I’ve had very few highs and very few lows (about one low a month compared to a few a week before pumping). The lows I’ve been having on the pump really aren’t that low, usually in the low 60’s or high 50’s.
All this was true until yesterday when I had a low that totally knocked me out.  Take that literally.

This low came with no warning signs and I didn’t make any big mistakes that could have led to it, at least none I can recall. I ran 11 miles in the morning, took the kids to school and got ready to go to a 10:00 a.m. doctor’s appointment.  I had to go see a surgeon about some serious pain I’ve been having in my lower stomach muscles since the race when I broke my 10K record.  Since I didn’t have a chance to eat before leaving for my appointment I grabbed an apple and bloused for 25grams of carb (the correct amount according to Nutrition Data).

I was a little nervous on the way to the clinic. I was scared the surgeon would tell me I needed surgery (they often do) of some kind that would put me out of commission for at least 4-6 weeks and make me miss my upcoming marathon (Jan. 12th).  But after a short examination the surgeon told me my problem is only a pulled muscle.  He ordered 10 days of rest, meaning no running. I was very relieved that all I have is a pulled muscle, but not at all happy about the idea of not running for 10 days.  As I walked home (a 20 minute walk), I talked to my coach and told him the good news. He told me that I should definitely rest, but rather than not running at all for 10 days, I should run an hour every other day at a really easy pace.

I was in a good mood and enjoying the walk, but as I got closer to home I started feeling a little woozy. Although I had my glucose meter with me I didn’t stop to check my blood sugar until I was home.   It was 47 and I could feel it was dropping fast.   It was like going from a little woozy feeling that could be anything to feeling like I was about to completely collapse.  I grabbed a banana from the counter.  Then I positioned myself in front of the open refrigerator, holding the door for balance and grabbed a tangerine. I also had a spoonful of peanut butter, not really carby, and probably a stupid thing to eat since it’s full of fat which slows the glucose absorption,  but I was a little out of control. I ate a few more things but I can’t really recall what they were.

By the time my binge was done I was dripping in sweat.   Soaked. I felt terrible. This hypoglycemia was worse than others.  It felt completely violent, as if something was attacking me.  I was so weak, dizzy, and completely depleted.

I sat down in front of my computer and tried to work.  I was getting ready to publish Catherine Price’s essay, but I kept falling asleep.  My eyes just closed.  I fell forward and hit my head on the computer screen.  I guess I passed out for a few minutes.  When I woke up there was strange text in the middle of Catherine’s essay, as if one of the cats had been standing on the keyboard.  But it was me, not a cat.  At some point I got myself to the couch and checked my blood sugar to make sure it wasn’t low again (it was 136).  Without taking off my shoes I lay down there and fell asleep for a few minutes.   I had to get up to pick up the kids from school.  As I walked to get them, I still felt dizzy and shaky.  I got through the rest of the day, feeling weak but normal-ish, and I was very happy when I finally got into bed and the day was actually over.  I really couldn’t keep my eyes open.  I was already under the covers when Jess started bothering me about my blood sugar.  “It’s 85,” I mumbled in my sleep.

“You’re not going to sleep at 85,” Jess said. 

The next thing I knew Jess was standing over me with two packages of halva (ground sesame and sugar).  Each one has 14 grams of carb.  “Vanilla or walnut?” 

“No,” I said.  “I just brushed my teeth.”

“You have to eat something.  Tell me what you want.”

“A slice of bread.”

“I’ll have one with you,” Jess said.  She came back with two slices of buttered whole grain bread. 

We had a quick picnic in bed.   Then I reached for my pump.  “I need to bolus for this,” I said.

“Don’t you dare bolus,” Jess said.

“I’m going to be pissed at you if I wake up high,” I said.  “But at least I’ll wake up.” 

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CatherineMary S.ASweetLife TeamScott K. JohnsonRandy Anderson Recent comment authors
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Catherine

Mike, I’m so happy to hear that you’re okay. (Next time if you start going low while publishing my essay, feel free to — you know — get a snack.) I also totally hear you on the “but I just brushed my teeth!” argument. I hate that. 

Glad to hear that you’re okay.  

Mary S.
Mary S.

Michael- Without getting too wordy: 1) You need to start (if you aren’t already) using a temporary basal rate for all exercise and for several hours following exercise.  (up to 6-8 hours) 2) You need to reduce all meal boluses immediately prior to and following (within 1 hour) of exercising. (IF AT ALL- I wouldn’t have bolused for that first apple at all) 3) You need to invest in a continuous glucose monitoring system.  I prefer Dexcom, but Medtronic also makes one that links directly to the pump if you already have a Medtronic pump.  4) CARRY GLUCOSE TABS WITH… Read more »

ASweetLife Team

Thanks guys,
I don’t know what happened and I just hope it doesn’t happen again. (I guess I could not eat any fruit).
One thing I do know is that I am keeping Jessica around. If I could just convince her to join me on a marathon trip… 

Scott K. Johnson

Scary stuff man.  Glad that you are Ok (and that you don’t need surgery).  

I loved how you described the low as something violent, and as though you were being attacked by it.  I really do think that lows like that trigger a serious, primal, reptile-brain level, fight of flight reaction from us.  When that happens, it’s damn near impossible to eat logically just to treat the low.  

Randy Anderson
Randy Anderson

One more thing.  Your wife sounds like a keeper for sure!
R

Randy Anderson
Randy Anderson

Michael,  I can empathize!  With T1D for 48 years now, I never had a low like you describe until starting recombinant human insulin.  I remember one where I was headed to breakfast while in grad school, a short walk from my office.  I started to feel that my leg muscles were behaving strangely.  I thought about hypo and turned to go back to my office for my candy stash, less than 100 feet away.  There were some stairs to go down.  I held tightly to the rail, but on the last step my legs simply stopped working and I fell… Read more »

Mike Hoskins

Congrats on the lower A1c and BGs since starting on your pump, but sorry for the Lows like this one you described. I’ve had those same experiences myself with completely unexpected Lows that just can’t be explained, and the uncertainty is certainly one of the worst parts of having those Lows. Sounds like you have a keeper there! Glad you didn’t totally bottom out, and there was some bread and butter for your in-bed picnic!

Sarah (@sugabetic)

Man. Dude. I know the feeling… not that I’m a runner or anything (very far from it), but in how those sneaky monster lows can zap you like that. 
But that last sentence? “But at least I’ll wake up”? That got me. Hit me right in the heart. Because it’s the truth. I need to remember that the next time I get mad at my hubby for not letting me go to sleep with a “reasonable” BG. 
Great post. 

Vegfaery
Vegfaery

That is so scary!  

My gf has been on the pump since April and she still gets some low lows seemingly out of nowhere.  Scary times! 

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