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. 

Work out buddies...

I was reading a blurb recently from Real Simple Magazine about how thin people stay thin and I was particularly struck by one point the article made: thin people have thin parents.  Citing that only 30% of this is genetic, the rest is environmental factors I am hopeful that HB and I are on the right track to keep our kids within healthy BMI ranges.

By modeling healthy choices and an active lifestyle, GW and GV are growing up with exercise as a regular, normal thing rather than something they'll have to learn about after possibly accumulating excess weight.   HB and I constantly take them out with us when we go for runs and they both seem to take their role in the process quite seriously - GW always yells "go go GO!" and GV wails whenever we slow down or stop, so it's definitely a family event.  Ultimately, when they're big enough, I fully plan to take them out jogging with us but for the time being their motivation is enough participation to keep us all satisfied.

Course, now that we are four days into Insanity both little ones are figuring out just how to be involved in our new exercise routine.  GW has decided that he's big enough to get his interval training groove started and, GV, well, as long as she's within arms distance (if not actually in arms) she's happy.  Perhaps it is not exactly the best way for us to do the work out and perhaps they're both trying to run before they can crawl (figuratively for one, literally for the other), but hey, they're at least starting down the road of a good habit and it's time together.    

Insanity!

Alright, people, the time has come... Sean T has officially re-entered the building!

For the first time since Fall 2011, HB and I restarted the Insanity work out routine today and, seriously, there is a reason the program is named what it is!  For those who aren't familiar with it, this 60 day program combines plyometrics, body-weight lifting and cardio interval training in a way that would make even the most fit, manly, stoic marine cry.  Constantly encouraging quicker speed and therefore more reps, Sean T makes a 30 minute work out feel like a three hour lifting session... it's insane!

The first day of the program is a fit test that is comprised of eight exercises lasting one minute each.  So along with before pictures (over my post-pregnancy body will those be posted until I have after shots to post as well!), this is a way to track your physical improvement as you progress week by week through the program.  While I am not exactly happy with my initial results here they are --

Switch Kicks: 84

Power Jacks: 49

Power Knees: 99

Power Jumps: 35

Globe Jumps:  8

Suicide Jumps:  15

Push-ups Jacks:  33

Low Plank Obliques:  53

The last time we did Insanity, we made it about four weeks into the program before we were worn out and in need of a much needed break (which we took as running a half marathon).  I'm really hoping that we can physically last longer this go around and get the same - if not better - trimming and toning results as before. Starting with a BMI of 20.3 and body fat reading of 18.3%, I have 6 lbs to go to get back to my pre-pregnancy weight and 14 lbs left before I am back to my ideal weight.  We'll see how long this takes.

That said, I am disconnecting my pump, putting on three bras (so not kidding), rolling up the living room rug, and cursing Sean T for the ridiculous awesomeness that is INSANITY!

2 miles down, 22 lbs to go

I CANNOT TAKE IT ANY MORE.

I made it four, almost five, weeks without exercising, but waiting another two will drive me absolutely mad.  Between the beckoning my running shoes are incessantly doing, the taunting the scale does each morning and my mental stream of expletives each time I have to put on maternity pants rather than normal jeans I'm just about at the end of my post-bed rest couch potato rope.  So, to quote Rafiki, "it is time."

Godiva exercise fuel...
 quick carbs or extra calories?

After a much needed trip to the local Target to pick up running pants that fit (ug, how mortifying!), HB and I laced up our dusty sneakers, packed the kids into our new Bob Dullie (thank you CraigsList) and hit up one of our old running loops for a "test run."  Between his ACL reconstruction this past August and my involuntary pregnancy induced running hiatus, it's been months since either of us have put one foot after the other for more than a gimpy shuffle or waddle.  Clearly we weren't going for much in the way of distance or speed and, considering this was only day one, I must admit that our one goal was to prove to ourselves that neither of us are either too old, too out of shape or too broken to do it... which I am tickled pink (maybe it's just my asthma?) to report we accomplished! Granted tomorrow we might be a bit sore, but by jove, such mental exercise was well worth it. 

With my starting blood sugar reading at 177 mg/dL, we ran five minutes on one minute off for four sets around the local YMCA sports fields.  The high wind was an additional challenge and I over bundled myself for the weather something fierce, but we kept it mutually positive and pushed at an average ten minute mile pace (okay, HB pushed the pace and I tried to keep up... BUT I'LL FIX THAT!).  By the end of our second mile, my legs were exhausted, my blood sugar had dropped to 84 mg/dL and my body was soundly expressing it's disproval for my bra selection.  It's normal to have glucose ranges drop that far when exercising, but seeing that this was my first time running while breast feeding and diabetic I am thrilled to see that my sugars are acting like they did when I was running and simply diabetic.  Obviously I'll monitor it each time we go out, but hopefully the numbers I saw today will be a trend (and how about next time I nurse GV before we go, rather than after... ouch).  I'll keep you posted.

So with two weeks remaining before I'm officially cleared to exercise at my six week check up, I'm taking my life back and saying screw it.  HB and I both have about 22 pounds to lose before we get back down to our pre-pregnancy weight - and, for me at least, this is after losing 20 lbs in child birth! I definitely gained more this go around than with the first baby (only 26 lbs gained with GW), but hey, I was allowed to exercise in the first pregnancy and I didn't have to scarf simple sugar to keep myself going.  I don't think it'll be all that hard to drop the baby weight with the right amount of effort, the real challenge will be seeing how much time it takes to get back into competitive running... I'm thinking maybe going for a full marathon this year, so hopefully the pounds will shed right off and I can start training to step up into the big leagues of diabetic endurance athletes! I mean, really, half marathons are so last year... 

9-11 Memorial 5k

On Saturday HB, GW and I competed in the Arlington Police, Fire & Sheriff 9-11 Memorial 5K road race at the Pentagon.  Of course I use the word "competed" extremely loosely since HB isn't cleared to run for another four to six months (ACL reconstruction surgery three weeks ago), I'm restricted to the brisk walking pace of 140 beats per minute and, let's face it, GW only wanted to come for the fire trucks.

2011 9-11 Memorial 5k

This particular 5k has a very special place in my heart as the 2011 race was the first road race I'd ever signed up to compete in.  When I was younger, running was about the last thing you could pay me to do and that only changed about 3 years ago when I figured out that I love to pass other runners. So having spent the past couple years enjoying running around (literally) other people and wanting to honor those in our local community who were directly impacted by 9-11, HB and I signed up and trained to beat a 30 minute mark. Keep in mind that I'd never run competitively before and 30 minutes seemed remarkably reasonable for a first timer goal.

People always warn new runners to watch their starting pace coming off the gates because it is really easy to go out too quick... well, the 2011 race started and I definitely forgot all that boohockey when my feet hit the pavement.  Over and over again I put the next high-and-tight hair cut in front of me in my sights and tracked him until I passed him... Well, much to my surprise, my finishing time wound up being a 4 minutes faster than I'd trained for (26:10.8).  For my first time in a race and having trained at a 9 - 10 minute pace, I didn't think that was too shabby!

And so a running addict was born. 

2012 GW & HB waiting out
the rain pre-race

Well I've been out of the exercise loop for months now with these pregnancy complications and I was heart broken to have been benched from the Marine Corp Half Marathon last May, but now that I'm cleared for some level of exercise this particular 5k seemed to be the right race for me/us to get back on the horse.  Unfortunately, I underestimated the difficulty of walking a race I'd under any other circumstances be chomping at the bit to run in...

26 1/2 weeks pregnant and still
going at mile 2.5

HB and I held off to the side near the back of the crowd when the race began and started our self-pitying walk.  Fortunately, right near the starting line we came across a seven month pregnant woman and her husband with their 2 year old daughter who were stuck in the same boat... Banding together we waddled our way after the pack with our patient, supportive, amazing husbands in tow and practically a personal escort from the police cars marking the tail end of the race.  Even with most of the runners out of sight, it was very nice to have someone equality as impatient for November walking along side me and our two bellies brought on extra cheers and even some cow bell from the nice people on the side of the road who waited for us.

Needless to say, around mile 2.5 my competitive side kicked in and I wanted to at least not finish last. Motivated by the imminent arrival of dinner time and an escape from the drizzling rain, we spent the last leg of the race right at the Pentagon,  passing as many people as my swollen ankles and HB's knee would allow...

Ultimately clocking at the breakneck pace of a 18:12 mile, we crossed the finish line in 56:33 minutes with 23 out of 3069 other racers behind us.  My blood sugar was of course low (63 mg/dl) from all that "exertion" but at least we participated and went the distance - which, at this point in this pregnancy and HB's recovery, is definitely saying something.

I'm not planning to sign up for any more road races between now and Baby's delivery since so much with this pregnancy has been week to week and I've resigned myself to expect the unexpected, but I am really excited for race season next year.  I'm not yet ready to announce what schemes for post-baby body recovery I have up my sleeve, but God, Baby, GW and (grumble grumble grumble) diabetes willing it'll be effective, fun and worth the effort!

Ridiculous!

What you hear me say out loud: "Huh."

What you'd hear if you were in my head:  "What the bleep do you bleeping mean you bleeping stupid meter! Why the bleep is my bleeping blood sugar so bleepity-bleep-bleep-bleep-bleeping high?!"

The past three days have been absolute blood sugar hell.  I haven't been on track with my blood sugars nearly as often as my mental commentary has been inappropriately explicit in my opinion of them.  The last two nights in a row I've shot up into the 260s and even with active insulin in my system my body isn't responding to the "excess insulin" I'm rage bolusing to cover down on it.

Take last night as an example, I made this amazing poulet au porto rissoto a la Julia Child (yum) and I measured out my serving so as to bolus appropriately. Two hours later as my pump is reminding me to check my sugars, I see the numbers 186 mg/dl come on the screen of my meter.  Knowing that is high but will typically come down with the remaining active insulin, I let the high slide and decided to check again an hour later to make sure things were headed in the right direction.  So an hour later my meter reads 262 mg/dl and my jaw just hits the floor (probably making room for the commentary in my head to fall out my mouth).  The active insulin did nothing to fight off that high! So I rage bolused an additional 2.0 units of insulin to force my sugars lower sooner rather than later and set my alarm clock to wake me up in another hour to check on the progress... So off goes my alarm clock and I check my sugars again and they've barely moved down to 216 mg/dl. Frustrated beyond belief I bolus an additional 1.0 unit and set my alarm clock again, which I admittedly slept through until morning.  But when I woke up, my sugars were still above 100 mg/dl and my morning target numbers are between 60 and 90 mg/dl...

BOO HISS!!

As I've discussed before, such numbers are either indicative of carb miscalculations or insulin resistance as a result of pregnancy.  I've been really careful about my carb counting, so that means that the insulin resistance I've been expecting is off to an aggressive start... to fix this, I've decreased my carb ratios for almost all of my meals.  Pre-pregnancy my bolus ratios were roughly 22 grams of carbs per 1 unit of insulin, but now I'm down to 12 grams of carbs per 1 unit of insulin.  I've also increased my all of basal rates (the body doesn't need the same amount of basal insulin all the time for various reasons such as the dawn phenomenon) by several many tenths of a unit which has added up.  Pre-pregnancy my basal rates amounted to a daily total of 8 units of insulin and now I'm up to 11 units of insulin.

For those of you who aren't diabetic and aren't hypersensitive to the daily statistics of your life, such increases in insulin dependence are overwhelming (insulin:diabetics :: gold:pan miners).  The scary part is that I have somewhere between 8 and 12 more weeks of insulin resistance to work through, so these abnormally high glucose readings will persist and my increasing usage of insulin will continue until the placenta is delivered. 

Again, say it with me now: BOO HISS!!

The good news is that as of the appointment I had earlier in the week, I've been cleared to "exercise" again and that is another tool I can use to combat high glucose readings.  By hopping on the stair stepper and creeping along at a slow enough rate to keep my pulse at 140 beats per minute or lower, I can slowly but surely drop my blood glucose over the course of a half an hour from "exertion."  Unfortunately, with such high readings as the 260s, the risk is that I am spilling ketones and at that point exercise will only make my sugars go higher rather than helping me to correct.  So this additional solution is only helpful if I am at a lower high than the excessive numbers I've seen lately...

I am extremely relieved that I have another endocrinology appointment this next week to get some professional help to fix these issues.  From my understanding, I can pretty much expect my insulin requirements and bg numbers to be changing on a daily (or even hourly) basis, so at least one day this week I'll have exactly-exactly what the doctor prescribes.