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. 

Emergency Hospitalization

As the mother of three, I came out of the delivery room onto the maternity wing of the hospital as a well seasoned, veteran parent.  Treated far more deferentially than a first time mom by the nursing staff, I was given space to do my thing with our newborn and, right from the get go, I felt confident and comfortable with my knowledge, skills and the idea of introducing our latest addition to the wide world.  And given all of the experience his active, outgoing and curious older siblings have provided us over the past five years, I doubted there was anything that would surprise me as we brought home our perfectly healthy, full term baby boy.  

Unfortunately, I was wrong. Horribly, horribly wrong. 

GV circa 02/2013

While we were at the hospital for the induction and post-delivery day, our oldest boy came home from his Valentine’s Day party with a bit of extra pre-school love in the form of a cold. Congested and occasionally coughing, it didn’t raise any significant red flags when he shared his germs with our daughter (sure, they fight over the train, but this they share) and she too came down with a case of the sniffles.  Knowing it’d be unpleasant for the baby to need aspiration, we asked the big kids to wear masks and wash their hands, but despite our best efforts to contain their symptoms, their excitement about the baby resulted in not only the introduction of them, but of their congestion to FG as well. Starting the sick-little-guy routine, we turned on our humidifiers, administered saline and sucked the increasingly green mucus from his tiny nose with the notorious, yet incredibly handy NoseFrita (and, for the record, the poor kid does not like aspiration the way GV did).  So already sick for the first time going into his two week well-baby appointment, the pediatrician discovered that FG had a nasty ear infection to which she prescribed an antibiotic and instructed us that “if he’s not better after 24 hours or if he develops new symptoms, call back.”

Later that afternoon, HB and I found ourselves independently looking at FG thinking that his color wasn't quite right - he seemed almost grey.  Finding a change in position to resolve the issue or that the artificial lighting from one room to the next was largely to blame, we administered his first dose of antibiotics in hopes that the medicine would diminish his symptoms by the morning thus calming our overtired nerves and trigger-happy fears.  Sharing our concerns briefly before bed, we agreed that FG wasn't demonstrating other red flag behaviors - poor nursing, infrequent diapers, difficulty waking up and ferver - and that we'd keep a close eye on him if and when things changed.

The following day, I attempted to nurse FG every so often but found his latch to be weak (he'd had a frenulectomy at his well baby appointment the day before, so I wasn't terribly concerned) and his general demeanor to be sleepy.  Given that he's still quite new and supposed to be sleeping a lot, I didn't begin to aggressively attempt to rouse him until early afternoon.  Using our typical wake-'em-up tickle up the spine or diaper change tricks to no avail, I told myself not to panic and I began to escalate my pestering techniques - ultimately putting his head directly under running ice cold water - only to have eye lids flutter in minimal response before returning to a deep sleep.  When HB walked through the door shortly there after, I presented FG to him and, while difficult to be sure given the overcast, grey light of the day, we agreed that his color was off again and that the confluence of symptoms he was presenting warranted a follow up call to our doctor. 

With a "come directly here or get to an ER if things get worse" response from the triage nurse, HB hastily buckled our baby into his car seat as I scrambled to get our oldest to tell Grandmama we were leaving - immediately.  Sitting in the back seat of our car watching for any change to his breathing patterns, HB ignored the speed limit on I-95 and got us to the doctors office in about two thirds of the time it usually takes to get to NOVA.  Dropping me at the front door with the car seat, I bit back tears of fear as I impatiently rode the elevator to the right floor.  Walking in, the receptionists didn't ask who I was but quickly glanced at FG and said to "let the doctor know he's here." 

Escorting me back to an exam room, the nurse began to run through the typical baby appointment routine: "Okay, let's have you take off his outfit and get down to a dry dia..."  But she cut herself off mid-sentence and dashed from the room.  Seconds later three other nurses and the pediatrician were entering the tiny room with muddled looks of it's-okay-mommy/holy-shit on their faces.  Ordering for oxygen, a nebulizer and a pulse oximeter, Dr Fox held a stethoscope to FG's chest as HB joined me in the exam room.  

Directing his comment to a nurse "His pulse-ox is 61.  Call 911."

The next several minutes were a blur as firefighters and paramedics streamed into the room with what seemed to be an endless repetition of questions as they loaded FG back into his carseat and prepared to take him by ambulance to Fairfax INOVA.

The last time I rode in an ambulance was when I had the placental abruption during my second pregnancy and, while that was scary, this trip was far worse.  As the patient, all you can do is lie there, watch the lights and attempt to remain stable with whatever willpower you can muster; but as the caregiver who is, literally, along for the ride it is the most helpless, terrifying experience ever.  Just listening to the sirens blare and watching the other vehicles through the back window as they jockeyed to regain their spots on the road made me realize the preciousness of time and unleashed a torrent of regret and what if's... regret about not bringing him back to the doctor the previous day and not going directly to the Emergency Room... and what if... if... if...    

Upon getting to the Pediatric ER at Fairfax INOVA, a team of nurses and physicians swarmed our son.  Informing us that they were completing a full respiratory work-up and beginning worst-case scenario treatments to stem any serious illnesses before they have a chance to gain a leg up on treatment options, we could only stand by and attempt to comfort our baby as the doctors took x-rays, ran an EKG, took blood samples and drew a spinal tap.  

With cables and cannulas, needles and vials, cuffs and Lord knows what else coming and going from the room with various scrub-clad personnel, HB and I were in an overwhelmed trance when a sort of celebratory "whoop!" went up as a nurse reported some results to the team attending FG:  "RSV POSITIVE!" 

Taking us aside, one of the two pediatric trauma physicians in the room explained:  "So what we're looking at here with Baby F is a case of RSV - Respiratory Syncytial Virus - which is pretty serious, but the best answer we could hope for; okay? From what we can see on his x-rays, he has a partially collapsed lung which is typical with this disease and, since this is viral, there really isn't anything more than oxygen that we can do to get him through this. We're ordering him a bed upstairs right now and, hopefully, you'll be able to go home sometime next week." 

... processing... processing... processing...  

Our two week old has a virus that just caused one of his lungs to collapse, to loose almost 40% of normal oxygen saturation and to require a cannula to keep him breathing until it passes?  Right, gotcha. 

He's been upstairs in the Pediatric Intensive Care Unit (PICU) for a day now and, while he appears to be stable, I can't help but perpetually rationalize to myself that the ICU isn't some place they send patients as place holders... The reality is he's sick.  Very, very sick.  He needs oxygen via cannula to breathe which, preventing him from nursing, requires a feeding tube  into his stomach.  He is on a one nurse to two pediatric patient ratio and is visited at least four times a day by an intensivist attending or resident... in other words, he's exactly where he needs to be, getting the exact care that he requires and all we can do is wait for the worst to be over.

We simply pray that is soon.