Why Am I Awake?

OwlI had one of those “Why am I awake” moments last night. Yep, a low blood sugar.

Sometimes I wake up and can tell right away that I’m low. Other times, it’s a little weird. Those weird ones are the “why am I awake” ones.

Here’s how it goes. Your eyes pop open. You look at nothing for a minute, then try to find the clock. Focus, focus, focus, rub eyes, blink real hard a couple of times, focus, focus, ah! There it is. You manage to decipher the blob of red digital numbers to realize it’s 3:38am. Somethings not quite right, but you can’t put a finger on it. You consider just closing your eyes again and trying to get back to sleep. You actually close your eyes for a minute and start to drift off to sleep again, when something pokes your brain.

“Why did I wake up?”

You think for a second about why you woke up, and can’t really come up with any good reason. Then it slowly dawns on you – check your blood sugar, you’re probably low. But, the temptation of sleep is pulling at you. Usually reason overpowers the sleep monster, as it did last night. So I fumble around for my testing stuff and check. 48. Ok, what did I mess up on? Miscalculated something I ate before bed.

And on that tangent, that is when my eating, counting & dosing gets real sloppy – evenings at home after a diligent day at work.

Anyways, you make the cold & tired trek to wherever your stuff is. Of course I can’t possibly just use glucose tablets – they make way too much sense. I’d rather go to the kitchen and indulge on something sweet and tasty. Low treated. Back to sleep.

I’ve been thinking a lot about Wil’s post over at LifeAfterDx regarding lows at night. In that post he talks about deaths from low blood sugars. It is scary, and unfortunately a real danger. I’m sure it does happen, though I’m not sure how frequently and under what circumstances. It’s my opinion that it’s not as simple as crossing a threshold (getting below a certain number) and that’s it – you fall over dead.

The lows at night are usually the most dangerous, mostly because you are not awake to notice the symptoms of the low. Or, with folks like Wil and others with hypoglycemic unawareness, there are no symptoms, the danger is present all the time. The trick is catching the low before it makes you unable to treat yourself. Whether that means you either pass out, or get so goofy that you just can’t deal on your own.

I do believe that there are certain parts of our regulatory system that still work the way they are supposed to. We still have stores of glucose in our liver that get dumped with a dose of glucagon, whether that comes from our bodies or the shot.

Isn’t there a point where the body tries on it’s own to deal with a low, by dumping adrenaline and other hormones to alert you so you eat, dumping some glucagon to signal the liver to dump stored glucose, but also beyond that others such as cortisol and growth hormones which raise sugars hours later? I think these systems still work for the most part! The thing is, does it happen before or after you pass out or seizure.

I’m not clear on how it all works, but I seem to remember stories about a farmer who would get mad about his diabetes because he would get low, get sleepy, climb off the tractor to lay down under a tree or something, waking up many hours later – mad because he lost a day of productivity.

Where it gets scary is if you have had many lows recently and your body has no glucose stores to dump – doesn’t matter how many glucagon shots you get – there’s nothing to dump! In those cases you would need to get hooked up to a glucose drip real soon or I think you really would die.

Times like this I wish I had all the details, because I know all of the above is all real fuzzy and hearsay, but I just don’t think we all need to freak out about getting below a certain number and kicking the bucket. I don’t say that in a bad way, and I don’t mean to say Wil is freaking out (he’s not). His post just sparked some thoughts for me. It just usually doesn’t work that way – at least I don’t think so.

For the record, I once tested (and retested) myself and came in at 23. I was at work and thought I should go upstairs to the vending machine to get a treat. Then the number dawned on me and I decided to keep my ass in the chair and have some glucose tabs.

Lows are not fun and should be avoided whenever possible.

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Scott K. Johnson

Patient voice, speaker, writer, advocate, and Senior Community Manager at Blue Circle Health. Living life with diabetes and telling my story. All opinions expressed are my own and do not necessarily represent my employer’s position. Read more…

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