It’s called hypoglycemic awareness, the body’s ability to produce and recognize the symptoms of low blood sugar. The longer you have Type 1 diabetes, the fewer symptoms and the less awareness you have. After almost 20 years on insulin, my threshold of awareness is precariously low and the symptoms are subtle. Gone are the days of sweating, shaking, and feeling anger or restlessness when my blood glucose (BG) dropped to 70; now the key signal for me, when my blood sugar approaches 50, is cognitive impairment.
Confusion: that’s what I felt last night as I stood in front of my class of 15 undergraduate scientists and tried to deliver the remarks I had prepared for the presentation slide with one simple sentence on it. I said the words “poster” and “coherent” and “story,” and I had no idea how they fit together or what they meant. I stopped and tried the sentence again. More stumbling.
About 10 minutes earlier I had checked my blood sugar during a short break. It had been around 70, so I ate something. Standing there in front of the class and the now-confusing slide, I sensed that my BG was not back up where I expected it to be.
“Uh, kind of awkward,” I said to the students as I turned away from the screen and looked at them. “I have diabetes, I take insulin, and right now I’m feeling that my blood sugar is too low. I’m going to go to my office and get some juice or something. I’ll be back.”
Most students looked at me, smiling politely. One student asked, “Can we help you?”
All I could think about was getting to my office. The thoughts in my head were like a runaway train still on the track. Fructose, glucose, sucrose: I needed some kind of food — anything! — chock full of an “ose,” or sugar.
“I don’t think so, unless any of you have some juice or candy.”
One young woman offered me her half-full drink bottle, and tried to explain what was in it (soda? coffee? tea?), but I couldn’t quite comprehend her message. Time was racing! I wanted to flee and get my hands on some sugar and suck it into my mouth.
“Are you sure I can’t help you?” the original help-offerer asked.
My mind did not have the clarity to imagine how she could. “I’ll be back in five,” I said and left.
I walked quickly to my office. It’s amazing now that I had the power to move my arms and legs and stay upright. At my desk, I checked my blood sugar; it was 36. Scary low. I found a roll of glucose tablets (I hate those), put three in my mouth at once, and chewed like a maniac. I chewed three more. I ate the whole roll.
I sat there for five minutes and checked my blood sugar again: 56, an improvement. Still, I needed more sugar. I found six quarters and went to the vending machine and bought an 18 oz. bottle of whatever wasn’t diet or carbonated because I can’t gulp carbonation. I gulped and gulped and gulped.
As I walked back to the classroom, I tried to imagine the scene inside it. Did the students take the unexpected 10-minute break as a chance to socialize? Probably they did, and yet all I could think about was them gossiping and laughing about me and my unfitness as a teacher. How can someone so impaired lead a research poster design workshop for the intellectually elite, the young, the fit?!
I am not normally concerned with whether I know everything in my field, scientific and technical communications. If a student asks me a hard question, I have no problem saying, “I’ll try to find an answer and get back to you.” Teaching at MIT, I have had to become comfortable with the fact that all of the students have an intelligence that at least matches mine, and a lot of them have more. This I have accepted. Furthermore, all of them have more knowledge in their disciplines — biological engineering, brain and cognitive science, chemistry, and so on — than I do or ever will.
But I’m an expert in my own body, right? Surely, living with diabetes for 20 years has given me an expertise, and expertise should translate into mastery. Why then am I not absolute master of my own blood glucose?
The last hour of the class proceeded as I had planned. The students did an activity I had designed, and I completed the lecture with my usual comfort level. I checked my blood sugar: 140. I breathed out all the breath I had been unconsciously holding in.
Later, describing the episode to my husband Jimmy and 11-year-old daughter Grace, I vocally chastised myself for my weakness. Jimmy reminded me that I have a life-threatening illness. Grace rolled her eyes at Jimmy and said, “Dad, no offense, but maybe at a time like this you could use the word serious instead of life-threatening? Mom’s upset.”
“It’s okay, Grace,” I said. “I actually need to hear that.”
“Plus,” Jimmy said, “Don’t you think a bunch of MIT science students know what diabetes is and won’t think that your leaving class is a character issue?”
“Yeah, but I feel bad, as though I’m not on top of things enough. I should be able to keep my blood sugar where I want it all the time. When I don’t, it feels like a personal failure.”
There are no words of wisdom that can assuage this feeling. Although I am sympathetic to the diabetes foibles of other A Sweet LIfe bloggers, when I contemplate my own, though, I feel an excoriating disappointment, not in diabetes but in me.
Grace found a different angle of the story to reflect on. “You should have said yes when that student offered to help you.”
“But I didn’t know how she could help me. All I could think about was getting to my office and getting some juice.”
“If my teacher told me she was having low blood sugar and needed to go to her office to get some juice, I would be afraid she wouldn’t make it, that she would become unconsciousness and be lying alone on the floor somewhere.” She said this matter-of-factly, not fearfully, as if she were confident in her own knowledge of illness.
“What would you do, Grace?”
“I would offer to accompany her. I would say, ‘Let me walk with you.’ And then I could make sure she got to her office to get her juice.”
Near-misses give us an opportunity to plan what we’d do in the future to prevent calamity. I must be vigilant and make sure I have juice or glucose tablets in my bag — not just in my office — all the time.
And the next time someone offers to help me when I’m low, I will accept the offer and ask her, “Would you walk with me?”
Photograph of the author by Grace Guterman. Title credited to a favorite Joan Armatrading song, “The Weakness in Me“, from her CD Walk Under Ladders (1982).
Jane, thank you for sharing this piece of your life with us. It’s so fascinating to me that we fellow bloggers are so quick to offer a reassuring (and true!) statement–it’s not your fault–and yet we do not take that message to heart. Why are we hardest on ourselves? When I’m explaining ratios and timing and hormones and insulin resistance to people who are invested enough to ask, I am always met with an appreciative and surprised attitude from the listener. Why do we not take this same stance with our own diabetes care? All this to say, it really… Read more »
I had no idea that one’s awareness went down over time–now I better understand why my sister is always so worried about my nephew’s levels, since he’s been diabetic for 25 years, and is also developmentally disabled. So scary. Grace is a remarkable kid, you know? Most *adults* wouldn’t be so tuned in and thoughtful!
Your post made me cry! My partner has diabetes and we live with this as a dark cloud over us all the time. She was diagnosed 23 years ago and her symptoms of low blood sugar are lessening as well.
Oh man, Jane, you just made me cry. I’ve been worrying a lot about hypoglycemia unawareness recently, too, and have been very frustrated to feel just mildly weird — and then realize that my blood sugar is 45. The worst I had recently was in the 30s; I was lying face-down on the bed willing my glucose tablets to work, and only started sweating and shaking once my blood sugar had started to go back up. And, of course, I blamed myself — on that particular day I’d been traveling all day (which usually makes me insulin resistant) and had… Read more »