Posts Tagged ‘low bloodsugar’

This Sh** Just Got Scary

Something very scary happened to me the other night.  I was woken up by my baby to discover that my bloodsugar was 1.8 mmol/l (32 mg/dl)!

Oh, you thought that was the scary part?  Not so.  Just wait…

Lately I’ve been very tired, due to an unusually restless baby sleeping in a bed about two feet away from me and waking me multiple times every night.  (She was such a good night sleeper, but not lately.  I digress…)  So I’ve been wearing earplugs to sleep.  They let me hear her when she really needs me and tune her out when she doesn’t.  I’ve also been using my short stints of good sleep to sleep extremely soundly.

One drawback to the earplugs and the sound sleep is that I haven’t been noticing my CGM alarms.  My pump is set to vibrate for alarms, and I have it on the waistband of my pajamas up against my belly so I’ll feel it.  (NOT between my boobs!!)  Normally the vibration wakes me.  But lately, between my exhaustion and my earplugs, my husband has been waking me quite often to tell me I’m sleeping through my CGM alarm.

This hasn’t been ideal because it’s meant that my pump has tried to wake me with vibration, then with an alarm, then resorted to waking my husband, who then wakes me.  It gives my bloodsugar time to drop further before I notice a problem – and the CGM already has the (approximately) 15 min. delay, so timeliness leaves something to be desired.  In the past, I actually used to wake up to nypos quite easily, but this has changed with the aforementioned exhaustion.  All in all, timely bloodsugar-related wake-ups are sketchy at best these days.

So when my baby girl woke me up, I realized I was pretty darn low.  My CGM said 2.3 mmol/l  (41 mg/dl), and must have been alarming – which is probably what woke the baby. I wobbled, bleary-eyed, into the bathroom to test and could barely stand up.  When the 1.8 appeared on my meter, I cursed, inhaled seven dextrose tabs (3g carb each) summoned all my energy and dragged myself back to bed .  In a case of bad timing, the baby wanted to eat at this very moment (she’s breastfed).  So I lay in bed and fed her (thank goodness for the side-lying breastfeeding position!), while my husband kept a watchful eye on us.

By the time she was finished, my BG was going up at a reasonable pace (quite quickly, actually), but I tacked on a few crackers with peanut butter for good measure. (Am I the only one who craves peanut butter when I’m low?) It was another 10g of carbs at most.  I was pretty impressed with myself for managing a wicked nypo like that with only 30g of carbs, since I’m just as prone to face-feeding during a nypo as the next PWD.

By breakfast time, I was in the 8s (that’s about 150 mg/dl), which was too high, but really not too bad considering what had happened overnight.  I had my breakfast of high fibre oatmeal/flax/etc. and proceeded to feel hungover.  By mid-morning, though, I was a whopping 17.8 mmol/l (320 mg/dl) – WAY higher than I usually see.

It was at that point (or, rather, after my BG came down to a more reasonable level) that I decided to start logging again to figure out what the hell needed to change in my diabetes management to keep this from ever happening again.

I sat down at my spreadsheet template (because I’m a geek).

I entered in my bloodsugar readings from my meter memory.

I started to enter in my boluses from my pump’s bolus history.

That’s when I saw this:

What the…..??

Something important to know at this point is that I was 8.7 mmol/l (157 mg/dl) when I took this correction bolus during the night.

Something else important to know at this point is that my regular correction for an 8.7 mmol/l should have been about 1 unit.  I would only ever take 7.4 units of insulin at night if I were eating a second supper of about 40g-50g of carbs.

Something else important to know is that I don’t remember taking this bolus.  I do remember fiddling around with my pump – trying to take a smaller bolus or calibrate my sensor or something – but the details are fuzzy.  Thankfully I do have a recollection of doing something or I’d be likely to blame my new pump and would be very afraid to continue wearing it.  But I’m quite sure this was human error.  My error.

Yikes.

I’ve never, in all my 30 years of having diabetes, done something like that before.

Presumably my liver kicked in to bring my bloodsugar up, because I don’t know how 30g of carbs, plus a bowl of oatmeal (with breakfast bolus), would have brought my bloodsugar up to 17.8 otherwise.  So it’s good to know that something was working – since I couldn’t feel the low, feel the vibrating pump, hear the alarming pump, or even think clearly enough to bolus properly.

This mistake has me very freaked out.  Lows like that are so dangerous, and I can only imagine the speed at which I must have been dropping after that whopper of a bolus.  I don’t want to think about what could have happened if the baby didn’t wake me.  Do I owe my life to her already…?

The question is, how do I keep from repeating this mistake?  My pump’s Max Bolus had been set to 12 units, and since this mistake it has been changed to 6 units.  If I ever want a bigger bolus than that, I’ll do it in two parts.  Also, I no longer wear earplugs to sleep.  I’d rather have a restless sleep than continue to sleep through my CGM alarm.  And I’ll be wearing a CGM 24/7 for the foreseeable future – at least until I’m less exhausted and easier to wake.  (Funny how even an unusual breath from my baby can wake me, yet a beeping pump won’t.)

Beyond that, I’m not sure what to do.  Will I do it again…?  I’m crossing my fingers that this was both the first and last time, because that was just way too scary.

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Two Quick “Grrr”s

I keep forgetting to change my infusion set early enough.  As a result, I keep having either occlusion problems or absorption problems.  Because I’m on a pretty teenie basal rate most of the time, and because I don’t think these are true full occlusions, I don’t get an alarm on the pump…I just find out when I become uncomfortably high.  Grrr!

Last night was one of these times.  I woke up around 1:30 am last night when my daughter was making some noise, so I figured I’d check the ole BS.  9.2 mmol/l (166 mg/dl).  Blah. Took a correction bolus and went back to bed.  At 4:30 am I was up again and incredibly thirsty, so I tested again.  17.6 mmol/l (317 mg/dl)!!  Yuck!  I changed the infusion set, took a large correction, and went back to bed. It worked, because when I got up at 8:00 am I was 6.3 mmol/l (113 mg/dl).  Not too shabby of a recovery! 

But apparently I experienced some insulin stacking when I bolused for breakfast, because now I’ve been low all morning!  Grrr! And I have lots to do this morning and no time to sit and rest.  But if I don’t sit and rest, my bloodsugar doesn’t come up no matter how much I eat!  So I’m sitting and resting and bitching and complaining to you about it! 🙂  Another example of how diabetes may not run my life, but it sure gets in the way of it sometimes….

Reason #458 Why I Hate Diabetes

Reason #458 – Diabetes gets in the way of me doing what I want, when I want.

For the most part this isn’t true.  For the most part it doesn’t get in the way at all.  I test, I correct if necessary, and I go on doing what I want.  But there are exceptions, and it’s these exceptions that are driving…me….NUTS!

My current problem is this: I can’t go for walks shortly after a meal.

Scott blogged about something similar to this a while ago – the idea of spontaneous exercise, which is even more difficult and frustrating, but I’m finding a bit of the same phenomenon to exist for me here, even when it is planned.  Obviously, it’s definitely worse when I want to walk shortly after a meal and haven’t planned it so I have loads of insulin on board and those little insulin dudes are doing their little insulin thing with my recent meal at breakneck speed.  But even when I do plan it, I can’t seem to get it right! 

Here’s an example:

This morning I had breakfast at about 7:30 am.  I always eat a low-GI, low(ish) carb breakfast (under 30g carbs), and my bloodsugar is typically very stable in the mornings.  In fact, the mornings are usually my most stable time of day.  My post-meal peak in the morning doesn’t usually get much above 7.5  mmol/l (135 mg/dl), and then usually I float down to a lovely pre-lunch number over the next couple of hours.  Usually.

This morning I was home with my daughter (as I normally am on Fridays) and the weather was gorgeous, so I decided that the kid and the dog and I would go for a walk.  The kid was going to need a nap around 10:00, so I wanted to be home by 9:30, but I wanted to walk for a full hour so that the dog and I could get some decent exercise.  That meant leaving at 8:30.  Now, because I’m an accountant and am good with numbers, I realized that 8:30 was only an hour after 7:30, which is when I had breakfast.

So…I planned accordingly and took a teenie bolus with breakfast.  Teenie.  Wee.  Very small.  At 8:30 we were ready to walk and I was feeling sluggish, so I checked my blood sugar and rang in at a whopping 14.8 mmol/l (266 mg/dl).  Ick (ick).  To not take a correction bolus at that level went against everything my body was telling me, but to take one would have gone against everything I knew from experience – post-meal walking experience, anyway.

So we went.

It was a lovely walk.  It was nice out.  We got our exercise.  But….

…getting close to home I started to feel low.  I (of course) had my dextrose tabs (which I greatly prefer over glucose tabs) along, and started popping them, glad that I could see my house coming up.  We got home and got everybody in and I started having the familiar blotchy vision that comes with a low for me.  (Not the I’m-going-to-pass-out vision, but the I-can’t-see-a-darn-thing-through-these-blotches vision.)  I tested, and was 2.9 mmol/l (52 mg/dl)!!! (!!!) 

GAH!

I don’t know what I should have, or could have, done differently!  Having a snack at 14.8 wasn’t a logical option, but neither was taking a smaller breakfast bolus to start me out even higher!  If I did this every day (or even every few days) I might consider creating an alternate basal profile on my pump for it, but I don’t.  Plus, I wouldn’t necessarily go at the same time every day.  Tomorrow I might have breakfast at 9 am and go for a walk at 10 am! 

I know some of you are thinking “suspend your basal, doorknob”.  And while I resent being called a “doorknob’, I have to respectfully disagree, because I do this crazy thing called a superbolus at meals (maybe someday I’ll blog about it), which means that after a meal (even with a teenie, wee, bolus like today…which contradicts the idea of a “superbolus”, but we’re not talking about that now…) I’m on 0.05u/hr of basal after breakfast.  Note the extra “0” after the decimal point.  If I suspend that, it’s not going to do a whole hell of a lot…especially in comparison to what my meal bolus is doing.

The only remotely realistic option I can think of is to bring a snack along to eat after about 1/2 an hour of walking.  I’ve tried this when I’ve started a walk with a lower bloodsugar (which is what I really prefer to do), but I always end up low (which is why I aimed for the higher starting level today).  And, as we all know, stuffing our faces when we exercise kind of defeats at least part of the purpose.

I’m fed up.  But I love walking.  And I have to work around other schedules besides my diabetes’ schedule – e.g. my daughter’s! 

So as much as diabetes doesn’t keep me from doing the things I want to…sometimes it really gets in the way of them!

The Nypo

The other night I had a nypo.

For those of you who don’t know, nypo = nighttime hypo (i.e. low bloodsugar).  I didn’t make up this catchy little term, and I don’t know who did, so I can’t give credit where credit is due.  If I could, I would.  It’s a great word.

For some reason, a nypo is so much worse than a daytime hypo.  I actually handle daytime hypos quite well, for the most part – but a nypo turns me into a shaky, frantic, carb-inhaling lunatic. 

I hadn’t had a nypo in a while.  I’ve actually been having more trouble with nighttime highs than lows for a while now (I still don’t have it totally figured out, but it’s improving), so this one was a surprise. 

I woke up with my heart racing and the familiar weak/shaky/hungry feeling.  My first inclination was to just go back to sleep and let someone else take care of it. 

Mmm….I’m sure it’ll go away on its own if I can just close my eyes for a bit longer…. 

Thankfully I don’t fall back asleep well during a nypo, so  I dragged my ass out of bed and into the bathroom (so as not to wake my sleeping husband, baby, or dog) to test.  I was shaking and seeing spots and the frantic hunger was kicking in already. 

2.6 mmol/l (47 mg/dl).

Popping a couple of glucose tabs, I stumbled downstairs to the kitchen, opened the pantry and flicked on the light.  I’m sure I heard angels singing at the sight of all that food.

Normally I eat fairly low-carb.  As a result, I don’t take a ton of insulin.  And as a result of that, it doesn’t take much to bring my bloodsugar back up from a hypo (or a nypo, as the case may be). 

But during a nypo every cell in my body is saying “FEED ME!”, and I want to ingest everything in sight!  I am completely incapable of putting on the brakes until I feel better.  And during a nypo it takes a while before I feel better.  So I typically end up eating a lot more than I should.

Thankfully, even in my nypo stupor I’ve learned to trick my sugar-starved self by switching to low- or no-carb snacks part way through the ravenous rampage.  It sounds pointless and kind of stupid – and it is, really – but hey, whatever works, right?

So, leaving a trail of honey, cracker crumbs, and cheese, I climbed back into bed and thought, “I should probably bolus for that….” just before I nodded off.

When I woke up the next morning, that last thought came back to me and I pulled out the meter again. 

14.4 mmol/l (260 mg/dl).  Damn. 

I guess it could have been worse if I hadn’t made the switch to cheese at about 2:41 am, but still…a bolus definitely would have come in handy.

So, once again the nypo won – making a feasting fool out of a perfectly rational and well-managed person with diabetes….