Wednesday, April 29, 2015

Hypoglycemia 202: the hard way.

I’ve been procrastinating this post for a while now.  I’ve had a couple opportunities to sit down and write it, but I’ve been practicing my avoidance.  I’ve started to draft it once or twice, but found the delete button highly effective.  I’ve even had a couple “just do it” moments that instigated nothing short of the my slamming the computer closed out of complete frustration.  It’s not that I can’t find the words to write about the walk I took last week, it’s just that I don’t want to write about the walk I took last week.  You see, if I write about it, then I have to think about it.  If I think about it, I have to address how I feel about it.  And if I have to address how I feel about it, well, the can of worms just opens and makes for one heck of a mess that I frankly don’t have the time, patience or emotional fuse to clean up. However, if I never get around to writing this post I'll never actually move on from it, so I might as well get it over with.

So, I went for a walk last week.  Not a particularly noteworthy thing to do as it was scheduled at a somewhat predictable time, in a fairly typical place and it was with a girlfriend I see more often than anyone else in town that I’m not directly related to.  It started out just as normally as our previous walks had with swapped inquiries and empathetic anecdotes, but instead of being a refreshing jaunt and enjoyable time it turned into an uncontrollable tailspin as my glucose brought me crashing to the ground.  Literally.   

But to explain the situation fully, I have to go back a few weeks to frame the disaster: 

Since the baby was born I have been struggling with my diabetes.  I don't know if it is because of the baby weight that I am just. not. loosing. (uggggg!!), the stress that we’ve been under, the restricted diet I’m following or what, but my blood sugars are all over the map.  Shooting high when I expect to have them in control and conversely bottoming out when I’m fully prepared to fight them down from the rafters, I feel like glucose predictability and regularity are two key factors that are currently missing from my diabetic self-care wheelhouse.  Finding that I can sit down to eat the exact same meal with the exact same insulin dose from one day to the next and have my resulting postprandial be anywhere from the mid 50’s to over 350 mg/dL with zero rhyme or reason, I've somewhat resigned myself to a terrible HgA1C at my next endocrinology appointment since my blood sugar just doesn't want to play nice and I simply don't have the wherewithal to fight it.   

Unfortunately, no matter how emotionally satisfying this apathy and slack may be, this unpredictability is complicating my life because I am experiencing new symptoms that may or may not be diabetes related and with my blood sugar so out of whack I cannot confidently rule it out as the source of these new problems.  Knowing full well that hypoglycemia can cause the loss of sensation in extremities - something I am quite familiar with in my hands and, oddly enough, my mouth - the worst sensation I’ve recently started to experience is wide spread tingling and numbness in my legs that I’ve never before felt.  And while it’s entirely possible that this could simply be a new expression of my maturing diabetes (just kidding, it’ll always be juvenile), the occurrences of this numb sensation do not necessarily correspond with the low readings on my continuous glucose monitor and make me think they could be something entirely else.  Maybe a result of my muscle atrophy from all those pregnant months of non-exercise? Who knows. But, not feeling a dire need to know what's up immediately and finding comfort with the knowledge that my doctor's undivided attention is just around the corner, I've conscientiously pushed my concern for the hot mess that is my diabetes down the list of daily priorities. 

So, bringing this all back to the infamous walk, I double checked my glucose before we left the parking lot and found my numbers to be at a safe walking-pace of 130 mg/dL (which I'd like to point out is notably and randomly less than the previous day's 320 mg/dL for the same breakfast scenario) so I suspended my pump's insulin delivery to be on the safe side.  But, about a mile into the three mile loop, I started to feel the initial inklings in my quads that my legs were loosing sensation and my friend noticed that my stride began to be audibly sloppy.  Unsure if this was because of my diabetes we took a break to look at my glucose monitor.  Finding that my sugars had dropped down to 65 mg/dL, a minor low and a number I've always been able to power through, I reassured my friend that I felt capable to finish the remaining mile and a half back to our cars. Not feeling any other familiar symptoms of a low, we passively discussed that there was food back at the car to correct my glucose and set out down the path at a slower, less coordinated pace.

Found this, and a few others like it,
on my phone two weeks after the
 incident happened. I don't
remember taking pictures and had
 no clue these were there. 
With every quarter mile we knocked out, I felt like my body became more alien.   Conscientious that this low might be getting more serious, I felt trapped within my own head as the unfamiliar symptoms overwhelmed my faculties and I sank into the confines of hypoglycemia:  my arms weren't my own and pushed the stroller too fast or in the wrong direction... my feet were independent from my body and, in both pace and basic function, impossible to coordinate… my fully formed, yet simple thoughts were too complicated to translate into articulate sentences… my cheeks were tingling and prevented my lips from forming intelligible words... 

Ultimately, the carbs in my car were too many blocks away to aid the rapidly deteriorating situation my friend found on her hands.  Already pushing a single stroller of her own, she took over pushing GV in my stroller as well with three quarters of a mile to go... with a half mile to go she helped me remove FG from my Ergobaby carrier and strapped him to her own torso... with the second to last road crossing in view, she asked me if she ought to call HB for help, to which I think I said "no" since, logically thinking, he was farther away from the situation than we were from the car.

What happened next is fuzzy.  All I can confidently recall are snapshot like memories: a happy looking man sitting alone at a picnic table; my hand touching a black metal fence railing; my friend's voice above me; the distant sound of sirens echoing through the seemingly empty halls of my head.  I remember sitting on the side of the path and mutely trying to figure out which of the three electronic gadgets in my lap was my glucose monitor (doesn't help that my pump, my glucose monitor and my cell phone are all the same shade of blue). I knew I needed to figure out what my blood sugar reading was and that insulin delivery had to be stopped (I'd forgotten by that point that I had placed my pump on suspend at the beginning of our walk), but how to go about doing those tasks was completely beyond me despite my efforts to the contrary. 

More snap shot memories followed:  a woman and a man, both dressed in blue, asking me and then my friend questions when silence was my only response; someone holding my palm out to test my blood sugar;  the number 33 mg/dL being said over a radio; a male voice saying something about rapid glucose as my mouth filled with a sweet tasting gel; my friend mentioning something about shade and walking away with my baby and little girl; a random woman using the phrase "poor dear" in passing... 

And just as if flipping on a light switch, the world became clear again. I knew where I was.  I knew what'd happened.  I recognized the blue-clad individuals to be paramedics.  I registered the oversized bandaid on my finger tip from where it'd been punctured.  I easily picked up my glucose monitor and read that my sugar was up to 55 mg/dL.   

"How you doing?" the male paramedic asked.  "Want to take a trip over to the hospital?" 

"Much better," I responded.  "I'll be fine now that I've had sugar." 

"Let's at least get you back to your car before making that call," the female paramedic said. 

Insisting on walking the remaining block to the car rather than receiving yet another ambulance ride (the two I have already done are enough, thank you very much), I let the paramedic escorting me ramble about the heat and her job and Lord knows what else as I silently focused on getting to the kids.  Don't get me wrong, I knew they were in good hands and that I was the one in danger rather than the other way around, but with my world so severely rocked by this hypoglycemic episode I needed them - at the very least - to be back within my comfort zone.  Upon getting back to the car and signing the paramedic's waiver that I was stable and had declined further medical intervention, my friend informed me that she'd called HB and that he'd given her strict instructions to not let me leave until he arrived at the park in about 15 minutes.  Insisting that he work from the house for the remainder of the afternoon, HB took us home and let me collapse from the exhaustion that thoroughly consumed my body.  

Having never suffered the consequences of a low this severe before, I am still reeling from the enormity of this experience.  Physically speaking, my head has felt foggy and my thoughts slow in the waking periods between the hours I've needed to sleep the shock away.  My legs were weary and fatigued for several days to follow, difficult to lift and tiring to move.  The cuts on my knees from where I must have fallen - something I have no memory whatsoever of - are still red, but the scabs have long since closed the open wounds.  

And while I expect these bodily symptoms to fully pass with time and rest, I am fearful that the emotional ramifications of this walk are lingering in a way that may prove to be permanent.  Bruising my pride and mettle, the fact that I have never before fallen out from under my own vigilance and become prey to a low has me unsure of my own abilities -- the symptoms were there, but they weren't what I'm used to and they progressed faster than I ever had hope to catch.  Unconfident in my hypoglycemic awareness and insecure in my capability to execute independent action, I feel like my lifetime's accomplishment of adult autonomy collapsed along side my body on that path and both shattered into an all too scary reality of helplessness.  I was fortunate this go around to be with a friend who is capable of action in the face of crisis, but the reality is that I am at the mercy of my blood sugar and, in the bleakest of moments, all I can do is pray that the circumstances I find myself - and potentially my children - in isn't life threatening and that someone capable of help is at hand.   

But where does that leave me?  Should I risk a solo-training run or wait for a pair of babysitters - one for the kids and one for myself?  Is another solo half marathon even remotely responsible?  Does that first alarm on my glucose monitor mean the heads-up it has historically or should the cavalry be called in to  forcefully drive my sugars back up from whence they'd come?  Must I broadcast my disease as my summary introduction or does my name still suffice?  Should I resign my aggressive glucose control for my nursing or potential future pregnancies and accept a higher HgA1c for the "safety" buffer it places between me and hypoglycemic oblivion?  What of the organ damage such a compromise would present -- do I risk dialysis, neuropathy and blindness to guard against seizure and unconsciousness? 

Half of me feels the answers to these questions are crystal clear and the other half is no longer sure.  I've worked so damn hard these past four years to have my sugars under tight control that the corresponding risk of increased hypoglycemia is logically increased, but at what point does one's good intentions cause right to become wrong?  I thought I knew, but now... I don't know. 

Do you know how to help someone suffering from hypoglycemia? 
Check out my post Hypoglycemia 101 for more information

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