Enemy in the dark

This is the “trace” of an actual hypo. The shadow of a silent killer on the wall. The signature of the devil himself.

While I slept soundly the attack was launched. The blood sugar drops, drops, drops, drops and had the Guardian not raised the alarm: Arise! Awake! Enemy at the gates! Who knows how much further it would have dropped, or if I would still be with us to write this post.

We’ll never know of course. But at 52 mg/dl with over an full unit of insulin in play in a body hyper-sensitive to insulin.....well to paraphrase my good friend Six / Kerri: it would have been an officially scary situation. Without the alarm would my life would have been at risk? Did the Sugar Reaper come knocking last night?

With these thoughts rattling around in my head I did some web surfing this morning as the film processors came up to temperature. Found some scary stuff online. According to “Evaluation of Death from Hypoglycemia” from the Department of Pathology at USC Medical Center: “...glucose of 40 mg/dl or less may lead to death from hypoglycemic coma.”

I have been lower than 40 in my life, but not for long. Striking like a thief in the night, if I had slipped into a coma it would have been at least seven hours before any one was up and about and in a mood to rouse me. According to an article on hypo by Ben Eastman at the Diabetes Health Magazine web site (by the way, if you don’t subscribe to this journal go now to their site and get a free copy): “Some research estimates that between four and 13 percent of the deaths of people with Type I diabetes are the result of hypoglycemic events.” Why the big range in the estimates? Apparently your blood sugar can continue to change for some time after you’ve kicked the bucket, making it hard to definitively label it as a cause of death. Night-time hypo deaths even have the quaint title of “Dead in Bed Syndrome,” so called because victims are found dead the next morning with no sign of distress the previous night.

We all know that the results of the DCCT found that intensive insulin treatment substantially reduces the risk and number of long term complications. But, quoting Eastman now, “What is less commonly known is that the same tight BG control that reduces the risk of complications has a darker side. The intensive insulin therapy described by the DCCT presents a three fold risk of severe hypoglycemia--sometimes with dire consequences.”

Wow. You can read the complete article at Dibetes Health. It’s really good.

Back to the mug shot of the enemy, my sharp eyed readers will notice I left a mouse pointer on the screen shot. Nope, not being careless and last night’s adventure did not eat half my brain cells. The tip of the point marks where my BG meter clocked me at that point in time. I also forgot to enter the first sugar dose. There should be another little triangle to the left of the one that shows on the screen shot. You’ll notice that the hypo’s drop is nearly a perfect straight line, and then there is a tiny little jerk to the right and then a gentle tapering out of the rate of decent. That was the first sugar dose kicking in. My take? Looking at that line plunge downward so aggressively with no sign of let up....I think without the Guardian’s alarm it would have been officially bad news for Wil.

I’m sure some of you are wondering why I’m not furious that I hit mid-fifties before the girl raised the alarm. Well, as far as I’m concerned the system worked. She woke me up in time to confirm the situation and take action. What more could I want?

I’m happy. Happy it worked. Happy to be here. Happy this hypo didn’t occur on 11-21-05 or earlier.

Looking at the plummeting trace it’s pretty clear to me it is on its way down to meet the arrow. Looks to me like the BG is dropping at about 1.25 mg/dl per minute. There is an inherent five minute lag in the sensor readings. So by the time I take the BG reading the Guardian most likely sees me at 67; still about 20% high. Why? Who knows? Who cares?

Well, that’s two lies. I do care, and I do know...sort of. Here’s my analogy. There two groups of tourists getting into a pair of elevators at the top of the Empire State Building--a group of Germans and a group from Japan. I’ve actually never been to the Empire State Building, so I don’t know if it has two elevators; I would imagine it has many more. I digress again...

The two groups start filing in to their elevators at the same time. The door on the German’s elevator closes a second earlier, and one of the German tourists promptly presses the button for the first floor. In the elevator full of Japanese, the tourist closest to the button is just a tab slower in pressing the down button.

And then the two elevators are on their way. Same make and model, same number of passengers. Both elevators are going the same distance. Both are going about the same speed, or maybe not.

Maybe the elevator with the German tourists has a newer motor and moves a fraction faster. Maybe the Germans as a group weight more than the Japanese, pulling the elevator down to earth just a few fractions of a second faster.

All these tiny factors add up. A door closes earlier. A button is pressed faster. A more efficient motor. More weight on board. By the time the Germans reach the first floor they are a full minute ahead of the Japanese.

Blood and interstitial fluid are on the same journey from the top of the building to the bottom; but they are not in the same elevator. Remember that the Guardian system doesn’t really measure blood glucose. It measures glucose in interstitial fluid. The two glucose values are closely correlated, but they are not the same. They travel the same journey, but not always exactly at the same time.

I could, and may, increase my alarm threshold to 80, or even 85 at night. That would allow me to intercept lows earlier. I haven’t decided yet.

But like the searchlights on the walls of a fortress, my Guardian angel spotted, revealed, and exposed the raiders lurking beyond the walls. She raised the alarm. She did her duty by me, and tonight I’ll sleep better knowing she’s on the lookout for the enemy in the dark.