I hate that title, because it implies that I dislike Symlin. That’s not true. I like it a lot. Most of the time. The few times I don’t like it are memorable. Take this experience from about a month ago.
One of Symlin’s main jobs is to slow digestion. This helps the post-meal blood sugar spikes, which is one of the main reasons I use it. But because digestion is slowed, I have to also slow my insulin. I usually use a pump feature to spread the bolus out over 60-90 minutes.
Shortly after eating I just happened to glance at my CGM. My heart jumped. I was below 100 mg/dl and dropping fast. Two down arrows. Finger stick confirmed my fear, I was in the low 80’s. I’m too low and dropping fast. I did that quick mental review of the last half-hour or so, trying to figure out what was going on, then it hit me.
I took all of my insulin. With Symlin on board. (this is not the first time this has happened to any of us…)
In a panic, I ran through scenarios in my head. What would happen? What could happen? I really messed up this time. I’m not going to make it.
Grabbing the 50-count bottle of glucose tabs and the emergency glucagon kit, I prepare to have “the talk” with my wife. Chomping on glucose tabs, unsure of how much she “gets” about what Symlin does, I tell her what happened and that I’m not sure what’s going to happen.
Right then I start sweating like crazy. Drips and drops all over my face, head, arms. I’m watching her try to contain her panic while she’s watching me explain the worst case scenario to her.
I’m chewing glucose tabs mixed with kool-aid mixed with more sugar, all the while watching my blood sugar drop and talking my wife through jabbing the glucagon harpoon into my leg if I fall over. My CGM is saying “LOW”, my blood sugar is around 40 mg/dl and we’re not even 20 minutes into this thing. I could pass out at any moment, and I’m scared, and my wife is scared.
It’s a crazy thing knowing you could black out and fall over at any second. We moved to the couch so that I wouldn’t hurt myself if I did (isn’t that a creepy thought?).
I’m talking to her about what to expect after a glucagon injection, but in reality I have no fucking clue – I’ve never been conscious to witness what happens, or know how long it might take for me to “come around”. What does she do while I’m laying there? How do I appease the doubt she would be experiencing while waiting?
…
Scary shit my friends.
It took about 45 minutes for things to turn around, and I never went so low as to start acting funny or lose consciousness, but I had to fight hard. I felt pretty bad, both physically and emotionally. I took Symlin and had a full dinner. The last thing I wanted to do was eat or drink anything. No, that was the second to last thing I wanted to do.
The last was falling over unconscious.
I’m 32…have been Type 1 since I was 12. I started Symlin about two months ago, and for the past 3 weeks have had daily…sometimes multiple daily lows (under 40 is low for me). Just last Saturday, I was showering late evening after dinner and began to feel low. When I got out, my pump was beeping from my CGMS telling me I was 68 and dropping (with double arrows). So, I checked with my meter and sure enough…it was 21! I thought “my meter must be off” so I checked again…27. I’ve never chewed glucagon tabs…I’m a Coke drinker.… Read more »
Wow, I’m so late to this. Scott, I feel for ya and I know what that must have felt like. Be glad you actually have a CGM. At least you had a few moments to quickly plan some action…and a good plan you made with those precious moments, sir.
Cheers,
J.B.
Thank you for sharing this, Scott. I doubt an endo or a CDE could convey the experience of making a mistake with Symlin and insulin as accurately as you have, and it wasn’t a risk I was completely aware of (despite my personal research into Symlin). You definitely woke me up. Lows that you can’t really treat. Jesus. I’m sorry you had to go through that, sounds like crap on a stick and then some.
Thanks for telling us about this. The fear is so real, how do we keep going through this and not become paralyzed zombies from it all? I suppose the continually moving on from these episodes and continuing to try, try again is part of the resilience that we humans seem to develop over time. Pat yourself on the back for always getting back on the horse in one fashion or another!
Ay Dios Mio! That was intense to read, it really was. I’m glad you are alright! While pregnant with my twins I once ate a carbohydrate heavy meal (those darn cravings) and gave insulin for it of course. My morning sickness which lasted all day made me throw up my dinner and when I tested, I was 32 and dropping fast. I found my glucagon and discover it had expired. My husband brrought me juice box after juice box after juice box. I kept throwing up and kept telling myself I had to stay awake for my babies. After an… Read more »