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

My Photo
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!).

Monday, April 23, 2007

Caveman Low

ParaPump is like the national weather service: it can’t stop the weather but it can give you time to batten down the hatches. I saw the hypo coming, a nice gentle downwards slash across the three hour BG screen. Looks way more terrifying on the 24 hour screen. Significantly more perpendicular. The alarm never actually went off before the storm hit.

I’ve go my low alarm set at 75, which from my own experience is actually a bit too low. For those of you not in the loop yet, the ParaPump CGM readings “lag” behind fingerstick glucose. There are a couple of reasons for this, and it is not a fault or design flaw. They are the simple results of biology and mechanics.

First: sugar in interstitial fluid, which is the “water” between your cells, tends to lag behind the blood flow a little bit; not unlike how a forearm test will lag behind a fingerstick test. Did I remember to tell all of you that the MedT sensors measure interstitial fluid? Second: Continuous Monitoring isn’t continuous at all. In reality it is one measurement every five minutes. Anybody know how fast a hypo moves? That’s right, just slightly faster than a brick dropped from a supersonic airplane. You’re BG can drop quite a bit in four minutes fifty-nine seconds.

So back to threshold settings. Ideally, you should set your “low alarm” quite a bit higher than where you would actually intervene. After all, a dainty beep that you probably won’t hear anyway doesn’t require you to actually do anything. This is not a tornado warning that requires immediate action. A low alarm on a CGM is just a head’s up. A clearing of the throat. A nice way of saying: pay attention!

Best advice, set your alarm at least 10 points higher than your intervention threshold. Higher still would be even better. Some folks even use 95. I used 85 a lot with good results until recently. The problem got to be that my sugars in the wee hours of the night would gently drift down into the mid-eighties. It was basal driven, the bolus insulin on board had long since run its course. It was safe, solid mid-eighties. With alarms every hour. I was a zombie. So I backed my alarms off. Probably too much. By the way, you can set different thresholds for different times of day on ParaPump. In theory, during the day you could use much higher thresholds for tighter control. An alert that requires no real action is less of an annoyance during the day than at night. Of course, you could argue that at night is when you are more at risk and so…. Well, anyway…

So watching the steady drop, I told myself I needed to go do a finger stick. I knew the “real” BG was ahead of the curve. In other words, dropping at a steady clip it was almost a guarantee that the fingerstick would be lower than the readout on the ParaPump.

I headed for my night stand. Then the peanut incident happened. Rio decided to open a container of chopped peanuts on the bathroom countertop. Yeah, the one with the rough tile surface and deep grout lines. Then, just for good measure, he peed on the floor and decided that the safest course of action was to not mention it to anyone.

So between mopping and sweeping and putting away toys I neglected to test my blood. What was I doing? Oh, yes, I was going to do a fingerstick. Let’s see where ParaPump calls the game. ESC button once. Hmmmmmm….down to 76. The alarm will go off at the next sampling. Still trending down on the graph with no sign of a plateau. Where’s the nearest Accu-Check? Nightstand. Pop! flip canister open with thumb. Remove KING SIZED test strip. Snap! lance finger. No blood. Damn. Snap! lance finger again. Still no blood. Switch finger, set dial for deeper punch. Snap! Ouch! OK, now we got us some blood. Ummmmm…. lots of blood. Ziiiip! And the winner is:

58. Oh crap!

Well, that got quite a bit ahead of me. No Cherry Slices left in the house, a sad story I’ll post about some other day, all I have so far is the title: Ode to Cherry Slices. I pop a glucose tab and wait.

One minute. Two minutes. Three minutes. Four minutes. Five minutes. Six minutes. Seven minutes. Eight minutes. Nine minutes. Ten minutes. Eleven minutes. Twelve minutes. Thirteen minutes. Fourteen minutes. Fifteen minutes. Time to retest.

Pop! Snap! Ziiip! 59. You gotta be fucking kidding me. Of course, I don’t feel a thing, other than fear. No shakes. No sweats. No dropping elevator.

Now a little known medical fact is that once you are below 100 BG your IQ drops point-for-point with your blood sugar. At this moment in time my IQ is a caveman low of 59. I’m now running on pure instinct. The brain has left the building. And what are cavemen most famous for (other than fabulous cave art)? That’s right. Killing wooly mammoths with stone-pointed wooden spears and eating them. Eating the mammoths that is, not the spears.

I closest thing to a mammoth in our house is the pantry. Through my fogged brain I recall that somewhere in that cavernous cabinet is some trail mix with dried pineapple. My salvation! Quick acting sugar in the pineapple, slower carbs to re-fill the liver in all the nuts and stuff. I grab my spear and head for the kitchen.

I never did find the trail mix. I did, however, find the caramel covered popcorn. And the gummy worms. And the jelly candies. And the cookies. And…why the hell do we have all of this crap in the house? Ooooooo, Fruity Pebbles! Need milk. Go to fridge. Strawberry milk? Why not? The Pebbles are Fruity, why shouldn’t the milk be Strawberry?

It is all a fog. I don’t remember what or how much I ate. It was like an out-of-body experience. I knew I didn’t need to eat that much. But I couldn’t stop. The safety’s were off.

It was a caveman low.

I went to bed when I was too full to eat another bite. As my IQ returned during the excursion I threw four units on the fire.

And then I slept through the high alarm.


Blogger Kate said...

Oh my gosh you had me laughing-because I can totally relate:)I call it the "I want to eat the fridge" feeling where you just go on auto pilot and have hardly any control over how many carbs you are eating- and at some point, your brain starts working normally. And then you're sitting there with something half eaten in your hand thinking, oh, I've already ingested way to many carbs, so what the heck I may as well finish this too. I like your cave man description a little better:) Also, when I got to have the sensor for 2 weeks, I set my alarm at 90 because I drop so quick after that but it is annoying when it goes off and it's not needing to be fixed. I'm hoping to get coverage for the sensor now- I'll be hearing soon from my insurance company.

12:12 AM  
Blogger Carey said...

Very well-written and entertaining post. Thank you.

7:49 AM  
Blogger Scott said...

Thanks for the info on the MedTronic Minimed sensors measure interstitial fluid, as my endo has suggested it might be something I might consider. But I'm not sure I'm willing to do it without a "test-drive"! Thanks for chronicling your experiences!

8:10 AM  
Blogger Val said...

You know, I'm picturing the caveman from the Geico ads reading this and shaking his head in disgust... Funny post!

9:19 AM  
Blogger Scott K. Johnson said...

Caveman lows kick ass man.

It's so difficult too because we have so much less "room for error" on the low end of the spectrum. I mean, the difference between a 240 mg/dl and a 270 mg/dl does not mean too much. But the difference between a 70 mg/dl and a 40 mg/dl can mean the difference between a "keep my head on straight" low and a "caveman" low.

And man - Fruity Pebbles with Strawberry milk actually sounds kind of good...

I got a kick out of Val talking about the geico caveman commercials. I love those!

3:50 PM  

Post a Comment

<< Home