LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Saturday, December 31, 2005

Hurricane Hypo

I knew the hypo was coming. I took a bed time finger stick. My BG was 103 with more than 2.2 units of insulin “on board,” with a tail stretching out over more than two hours. That didn’t look too good for the home team. I checked with the Guardian, clicking backwards in time in five minute intervals: 129, 136, 146, 152, 158....

Hmmmm.....we got us a trend here. One of the things that drives me bonkers is the lack of a real-time visual interface. I’m not too good with lists of numbers. Takes too much brain power. Give me a chart, map, blue print, or graph and I’ve go it down in seconds. I’m getting better at scrolling through the five minute records, but I’m still not super good at it. I can see this is a downward trend and moving at a pretty good clip. But I’m not number savvy enough to look at them and say gosh, that’s a 29 point drop over 25 minutes that’s about one and a quarter mg/dl per minute; I’d better pay attention.

I could see that we had some action going on, but it didn’t seem too fast. I’d also had a high fat dinner, so I was anticipating a kick in the BG down the road. It might go hypo, it might level out, or it could even drift up. I reported the findings to my wife (as per our New Compact) but told her I thought I was still too high for cherry slices. What are you going to do? she asked. I’m going to go to bed, I’m tired. The girl will wake me up if I go much lower. I’ve got the alert threshold set all the way up to 85.

That wasn’t good enough for Debbie. She set an alarm clock for an hour and a half down stream. She’d check on me then and make sure I was still with the living.

So with both my girls watching over me I slid my tired body into bed. Clean sheets, such a luxurious feel against the skin. Smooth, cool, crisp. Oh yeah. I close my eyes, but sleep eludes me. I check the Guardian. Still coming down.

I roll over and try to press all thoughts from my mind and let the fatigue wash over me and take me away. But deep down, I know the hypo is coming. About every ten minutes I sneak a peak at the monitor. At least I’m not wasting test strips. An hour after I went to bed she reads 86. At the next check she’ll alarm. OK, I sit up, swing my feet to the floor and turn on the red flash light. I open the case and caress the key board. Getting my fingers into position.

I don’t have long to wait.

The monitor shakes in my hands, fireworks scream, cork-screwing down out of the sky. I silence the flying saucer noises. Time for a finger stick. I know it will be lower than the Guardian reading, but of course I can’t feel a thing. I’ve got a higher alert setting, and its a fairly slow moving hypo so my money is on the low 70’s or high 60’s.

What a crappy gambler I’d be. The Cozmo clocks me in at 55.

As per our new compact, hammered out after the fast moving hypo last week, I wake the wife FIRST. Then take sugar. Just for in case, as her family likes to say.

This hypo may be slow, but it is a powerful storm. It takes three sugar hits fifteen minutes apart to stop the decent. I can watch the numbers slow on the Guardian. Still artificially high, but a great direction indicator. If she’s clocking lower each time she reports I know I’m not winning the fight yet.

Usually I just knock the hypo out, get back above 90 and call it a night. I’ve never followed up the sugar with a light meal like the ADA and others suggest. Tonight, given the length of the fight, I decide to eat half a flour tortilla with some peanut butter on it chased down by a half glass of cold 2% milk. My stomach is topsy turvery. Maybe a little food will settle it down. I don’t know if the stomach trouble is from the hypo or the lack of sleep.

After my snack I collapse in bed until a hyper alert wakes me up at 6:30 a.m. I guess the P&T was not such a great idea after all. Later I’ll study the trace on my computer. It is truly weird. It looks like a sign wave. A graceful sweeping downwards curve mirrored almost exactly by an opposite upward sweep. Too low too long then too high too long. It takes repeated poundings of insulin correction boluses followed by a long walk with visiting niece and nephew (and Rio, of course!) to get back to sane BG levels. I’ve never seen such a stubborn high. Must of been all the sugar needed to kick back the stubborn low. It was so high for so long that I was on the very cusp of yanking the infusion set and replacing it. But the girl stopped me. I did a quick review of data and saw the curve starting to drop. I decided to give it a little more time and finally the BG’s began a nice graceful sink to normal levels.

I’m super happy with the girl today, for several reasons. Although it was the finger stick that first told me about the impending hypo, the girl could have easily done the same if I’d looked at her first. But she let me study it, watch it approach like watching the gathering clouds of an approaching storm. Had I fallen asleep she would have woken me.

Plus I was able to use her to gauge my efforts and plan my sugar. I still did the finger sticks, but I liked having the real time feedback during the 15 minute intervals between sticks.
She also saved me from wasting an infusion set today too. Bonus points for the girl!


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