All I’m Asking For

My schedule has been pretty hectic for the past week. I’ve been in Orlando, FL attending the 2010 CWD Friends For Life conference and the Roche Social Media Summit. I’ve got a TON of stuff to share about both of them, but I need some time to digest and process everything that I’ve experienced. That will come soon, but I wanted to share a story about Friday night before too much slips away.

Running high all day, I was happy to finally fall below 200 mg/dl as we ordered dinner. Eating at a new place and trying new food, I gratefully accepted opinions on how many carbs to bolus for. Having four other people with type 1 diabetes (Chris, Elizabeth, Heidi, and Lee Ann) around me was really nice. You should try it sometime.

After eating, I watched my blood sugar zip right back up into the mid 300’s, then slowly crawl back down. While visiting with David and Andreas, and seconds after having my Diet Pepsi delivered, the floor fell out from under me.

Confident that the bartender has fielded much stranger requests, still sipping on my Diet Pepsi, I ordered a regular (sugar) Pepsi. Drank it down. We kept talking, I watched my CGM and tested again after a little while. That first regular Pepsi kicked me up a little bit, but now I’m dropping again. I grabbed my tube of glucose tabs, there’s only four there. 16 grams of carbohydrates (carbs), plus that regular Pepsi. With the ice in the glass, there might have been 30 grams of cabs in there. I should be fine, or on the way to high.

Engaged in the conversation, another 20 minutes goes by, and I’m feeling funny again. Check the CGM, dropping, check my blood sugar, dropping. By now it is about 6 hours after dinner. Still sipping on my Diet Pepsi, I order anotherregular Pepsi. Boom, another 30’ish grams of carbs into the tank. I make a mental note to myself to evaluate things before bed so I don’t spend the night sky high – surely with all those carbs I ate I’ll be high soon.

David and Andreas leave after a bit, but I bump into another old friend, and visit with him for a while before heading to my room. By this time it has been well over 8 hours since dinner. As I step out of the elevator, I catch my toe on the carpet and stumble a little bit. My reflexes are slow, and I feel “funny”. Maybe it’s the hour (late or early, depending on how you see it) and lack of sleep? I don’t know, but take a quick mental evaluation of how I’m feeling. Sure as shit, I’m low. I just know. My CGM still has me above 80 mg/dl, but I know there is a lag between its reading and my actual blood sugar.

When I get to my room, just a minute after stumbling out of the elevator, I test, and I’m low. Nothing horrible or scary – mid 60’s or so, but I’m starting to get a little frustrated. It’s late, I want to go to bed. I unwrap one of the two snickers I have, head out onto the patio, and start eating. I went through some twitter replies, e-mails, and download today’s pictures. After a while I decide that I’m exhausted enough to go to sleep, and that all unfinished business is going to wait

Checking my CGM, I see that I’m still not much higher, but I know that I ate a full-size Snickers bar about 30 minutes ago. I lower my basal rate by 25%, perfectly content to be high to avoid being low. I collapse into bed and fall asleep, only to have my CGM start buzzing me because I’m low again. I shoveled down a handful of glucose tabs, still convinced that Snickers bar is working its way into my blood sugar, and that within a couple hours that temporary basal rate will help too. Back to sleep again.

Another CGM alert jars me from my sleep. In frustration, I rip into the second Snickers candy bar. Chocolate pieces from the outer chocolate shell fall into the bed, and I don’t care. Parts of my mind start chattering, wondering what the hell I did wrong?! How could I have messed things up so bad? I finished the Snickers bar, dropping the wrapper onto the floor and laying down on top of all the pieces of chocolate, peanuts, partially hydrogenated soybean oil, and whatever else Snickers are made of.

Stop here for a second. I hope you are actively following this. I had dinner over 10-11 hours ago, lowered my background insulin by 25%, and have eaten a BOATLOAD of carbohydrates. I had a single (1, one) glass of red wine with dinner, 10 hours ago. What the hell is happening to me?! My blood sugar should be 800 mg/dl, not 80 mg/dl! Before morning arrives, I’m buzzed one more time and finish off the bottle of glucose tabs (it was maybe half full before bed).

Morning rushes into action and alarms are buzzing – this time I’m glad it’s not my CGM, but I’m in rough shape. Again, I wonder what the hell happened, and how I could have possibly messed up anything bad enough to cause all of that trouble. I even check my pump clock, which I haven’t touched, to see if my AM/PM might have been accidentally switched or something. Then I took this picture.

Image of a Dexcom Seven Graph

I can spot four low blood sugars in there. Half of them are while I’m trying to sleep, on a night that I’m hoping to get four hours of sleep, max. Chris is rooming with me, and I start telling him about my night. He passively participated in the whole thing every time my CGM alarmed for a low, poor guy.

We tried to tally up how many carbs I ate, reaching agreement somewhere between 150-200 grams of carbs. Insane. The whole time I am just beating myself up and trying to figure out what I did to make this happen.

That is the wrong question to ask myself. While it’s probably Ok to think about what happened, it is not Ok to ask myself what I did wrong. I didn’t do anything wrong. In fact, I did everything right. I made it. I woke up in the morning.

Sometimes this crazy shit happens, and all we can do is hang on with both hands.

 

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15 thoughts on “All I’m Asking For

  1. I know that was a rough night for you, Scott. A persistent high or a relentless low is frustrating enough, but when one immediately follows the other, it can make you feel like you just can’t win. As you said, though, you did everything right given the circumstances diabetes handed you, and that’s pretty much all any of us can do. I’m still amazed that you woke up with a CGM reading of 115, but you totally deserved an in-range number after all that!

  2. Sorry about your bizarro BG night. I’ve had days like that in the past: glucose, juice, granola bar, glucose, glucose…oh look, I need more glucose! Not fun. But, you’re right. You totally rocked the situation.
    Thank you for this post. I am always beating myself up over my numbers, constantly seeking answers when I should probably just correct and chill. The next time I’m trying to decipher what I did make things go awry, I’ll try to remember the last line of your post; I’ll simply do my thing and hang on with both hands.

  3. I kept expecting you to say “And then my blood sugar sky rocketed…” but it never came! Diabetes can be a b-word sometimes, and I’m glad that you came out the other end okay.

  4. Like I said before, another episode to tolerate. It’s helpful to read all the comments, and to know that all the folks that have responded (who have diabetes) understand. I understand. I like the comment on “parallel universe” as the answer to where the carbs (and sometimes the insulin) have gone. I’m a CDE and that’s the best explanation I know of. Thanks, again, Scott.

  5. Amen, brother. And when you are on a wild ride, all that button pushing is reflected in your CGM receiver battery indicator!
    Every blue moon I have a similar occurrence during which I wonder if those seemingly ineffective, accumulated boluses hours earlier were somehow trapped in a twilight-zone, alternate-reality pocket of sorts only to be unleashed in full force all at once! What an emergency PITA!!
    Glad it turned out well for you, Scott.

  6. Wow, you sure had more then your fair share to deal with that night! And like Dean I was expecting you to be sky high in the morning. Hope that you were able to enjoy the Roche Summit and can’t wait to hear about all of your adventures!

  7. Ah, the bizarro world of bigD. Hope things are settling down (up?) for you.
    I’ve had an insane week too. The lows and the highs hang on (and on and on).
    And don’t forget to charge your CGM receiver (looks like you have no battery bars left…).

  8. oh man!!the punch line is supposed to be”the next morning i was at 400″!!
    that had to suc.
    lol
    “I gratefully accepted opinions on how many carbs to bolus for.Having four other people with type 1 diabetes (Chris, Elizabeth, Heidi, and Lee Ann) around me was really nice. You should try it sometime.”
    uuhhh think i will pass on that option does not sound like you had fun!! lol
    im glad you ended up fine so to speak.

  9. Scott,
    That is so weird! The whole time I’m reading I was thinking, “certainly NOW the carbs will catch up.”. Glad everything turned out OK. I hope the Snickers weren’t from the mini-bar. That would be. One expensive low!!