Wednesday, June 27, 2012

(Off) Target...& Under Attack

Two weeks ago, I wrote about my first experience with glucagon. In it, I said that although I was very glad I had access to the emergency injection, I hoped I wouldn't have to use it again anytime in the near future...well, it turns out that although I didn't have to use it at all during the first year and a half since my diagnosis, I've had to use it twice now within a month. I'm not usually one for cussing, general pessimism, or texting acronyms, but this is one time I have to say WTH/FML!

It started yesterday afternoon while I was grabbing a few things at Target. My mom was waiting in the car with my sweet baby, feeding her bottle to her. I was about ready to check out when I started feeling very, very faint-like I could pass out at any moment. I'd taken a few glucose tabs a few minutes before because I could feel a low coming on, but when I checked my BG at the front of the store, it was really not that low, relatively speaking. I couldn't shake the faintness, though, so I figured I must have been dropping fast or something...thanks to my lovely luck, my CGM sensor had just timed out that morning, so I had no way of knowing for sure.

I grabbed a Coke from the fridge, but even after downing most of it I felt like I was going to hit the floor at any moment. In the meanwhile, my mom had texted me that the baby was "making me a present." I texted her back "SOS." Since I was by myself, I stopped an employee and told her that my blood sugar was low and that I was going to give myself an injection to help bring it up...but that if I passed out, to call an ambulance. I mixed up the glucagon and injected it through my jeans into my thigh, then texted my mom again to let her know what was going on. She asked if I needed her to come in, and I said yes...she told me later she didn't know that I needed help when I sent my SOS-she thought I was referring to the little one's diaper situation! When I checked my blood sugar again, it was 82...but I still felt extremely faint. Through all of this, the employee that I had talked to kept checking on me to ensure that I was okay, making sure to keep me in sight until my mom got in the store. By then, my blood sugar was up to 103, but I just couldn't get rid of that dizzy feeling.

My mom took my debit card and went to check my stuff out while I sat on the end of the next lane where they place checked bags. The lady who was running the register in my mom's lane echoed my mom's orders to stay seated until they were sure I was okay, but then followed with, "I kind of feel sorry for you, but then again I kind of don't since you brought this on yourself." At first, I wasn't sure I heard her right, but then she went on to say that her mom has diabetes and eats sweets, then complains of feeling bad. She said she doesn't feel sorry for her then. Even in my sucky, just-about-to-hit-the-floor state, I explained to her that she was referring to high blood sugar, and mine was low right then-that I had too much insulin in my system and I needed sugar to bring things back up. At that point, she told me that one of the other Target employees also had an insulin pump, that she "had to push some buttons sometimes" (Ha!) and that they have to keep an eye on her. My mom told her I took good care of myself, and I informed her that mine was T1 diabetes, an autoimmune disease. Still, you could tell that she was one of those people that just wouldn't "get it", no matter how much you try to explain things, so I gave up. A lady in line behind my mom told me she was diabetic too, and that she knew how much lows sucked...thank you, person who actually knows what's going on.

I found everything I wanted, plus an ignorant employee.

Later, I couldn't believe the employee's audacity. There I was dealing with a blood sugar emergency, and she was lecturing me about how it was my "fault" that I felt that way...seriously, how much ruder can you get? I know that a lot of cases of T2 can be prevented or improved through lifestyle changes, but lifestyle choices have nothing to do with T1. Unfortunately, most people don't know the difference between the two, so we're left to deal with the rude comments and outright judgement of our health. I'm planning on calling or writing the store's manager, not to seek punishment for the employee in question, but to make sure than any other customer with T1 (or T2, or any other health condition) can get the care they need in an emergency without also having to deal with someone's judgmental attitude.

We went ahead and finished up, then went out to the car to change Baby Girl. By that time, my blood sugar was in the low 200s...and still, I felt horrible. We started to head out of town, but I told Mom that I didn't feel comfortable riding the hour and a half home with the way that I was feeling. She turned around and headed back toward the hospital. She called my endocrinologist's office, but he was out of town until next week, so we went to the ER.

After a few hours of waiting, blood work, some fluids and an EKG, they released me with a diagnosis of blood sugar fluctuations combined with the heat. All of my labs were fine, so that made me feel a little better even though I still had a faint feeling. My blood sugar peaked at 405, but came down without issue. By the time we got home, it dawned on me that my dizziness was probably actually from the sinus pressure I've been having in my head lately. Since I'm breastfeeding, there isn't much I can take that won't affect my supply, so the nurse at my OB's office told me to try Sudafed with some Tylenol. It still may cause a drop in milk production, but I can't stand feeling lightheaded any longer.

I've felt pretty bad today, but I've stuck it out at work even though I should be home resting because my dad/boss is out of the office. I think I'll head home early, though, because I have lots of work to catch up on at home too, and let's face it-there isn't anyone else to do it for me! Even though I later realized that what I was feeling probably wasn't a low (after the fact, of course), I'm still thankful for glucagon because it gives you some power over one of the not-so-great effects of this disease...even if you're sometimes powerless over the way people treat you because of it.

Tuesday, June 12, 2012

Adventures With Glucagon

This weekend, we went to my family's annual reunion, which is held about 80 miles away from where we live.  We had a great time catching up with everyone, even though it passed by too quickly! My husband suggested we should get together twice a year instead of just once, which is an amazing statement to make of your in-laws =)

One thing that wasn't so much fun, though, was having the worst low I've ever experienced since my diagnosis. I don't know what it is about short weekends away and alcohol, but I tend to forget about the effect it has on my blood sugar. Back in April when we traveled a couple of hours for the annual benefit gala for the local branch of the JDRF, I uncharacteristically indulged in a couple of glasses of wine, only to find myself battling a low in the middle of the night that I was luckily able to fix with a granola bar and some of my husband's sweet tea. This time, it was two beers...normally, I only have one-if I even drink at all. Sometimes, depending on the source of alcohol, it even raises my blood sugar and I end up with a high to deal with.

Saturday night, though, all the factors that influence blood sugar must have come together and conspired against me (and any hope of sleeping), because when I went to bed, I was at 125. Luckily, I didn't give myself the correction I considered...sometimes if I'm in that range before bed, I wake up around 100 when I'd rather be closer to 80. Yes, I'm a perfectionist. Anyway, the baby and I went to bed and slept fine until my husband came in a couple of hours later after staying to visit a little longer with my family. When I woke up then, I knew I was low, so I got up to check my BS. It was in the low 40s, so I grabbed the granola bar I keep in my purse for such occasions and ate it. 15 minutes later, I was still in the 40s, so I added 16mg of glucose tablets to the mix. 15 minutes later, I was just over 50, and had no more sugar left in the hotel room. I knew I could call my parents to steal a snack from them (even though it was around 3:00 in the morning), but at that point I realized my BS wasn't coming up as quickly as it normally does, and that I better do something to ensure I would wake up in the morning. I've never had to use glucagon before, but I remembered reading a post over at Typical Type 1 in which Jacquie recounts her night with a little too much alcohol and having to resort to the dreaded emergency injection.

Figuring my only option at that point consisted of that little red box, I told my husband what I was going to do so he would watch out for me while I got everything ready. I knew theoretically how to use it (and the pictures are pretty self-explanatory), but I did a cursory glance of the instructions just to be on the safe side. Possible vomiting, nausea for up to 12 hours afterwards...perfect. But I figured that didn't compare to the mounting fear of a life-threatening low I was currently experiencing, so that was that. I mixed up the vial, drew it up, and injected it into my thigh. I waited around, re-read Jacquie's post about her glucagon experience on my iPhone, then noticed in the comments section something about it not working as well with alcohol in your system. Great. But since it worked for Jacquie, I hoped it would do the job. When I checked my BS a little while later, I was at 78, then high-80s, then around 115.  At that point, I felt comfortable enough with the fact that it was working to get some rest, but I set my alarm for an hour later to be on the safe side...I guess it goes without saying that I had a zero-basal rate set through all of this. When I woke up when my alarm went of an entirely too short of a time later, I was hovering in the 180s. A couple of hours later, I peaked at 196, and since I was going to have to get up an hour after that, I went ahead and started correcting the high. When I woke up (an hour later than I'd originally planned) I was back down to 156, and with another small correction I returned to 91 before breakfast. At least I never had any nausea or vomiting, and I didn't feel too bad following the injection.

After eating breakfast, though, I quickly noticed that my blood sugar wasn't rising like it should from the food, so I set another zero-basal and took a couple of glucose tablets to be on the safe side. At the post-prandial check, I was around 80, so I had a feeling I'd be battling a low for the rest of the day-and I was right. At lunchtime on the way home, I thought I under-shot my insulin enough to stay in the black, but that postprandial was pretty much the same as before...and ditto with supper.

I don't know what's going on with my body, but apparently I'm becoming more insulin sensitive, at least over the past couple of days anyway. I know that the Saturday night low was due to the alcohol, but I'm not sure why I've had trouble keeping my BS up long after the effects of the alcohol should have worn off. I also know it's not from weight change, because if anything I've gained a couple of pounds from the stress of working with a baby. Also, I've only had these consistent lows over the past few days...before that, my numbers were in the normal or slightly-higher-than-normal range. I've been checking my blood sugar even more often since then, just to be on the safe side and keep a good eye on them. The pump has been extremely useful throughout all of this too, because I always have the zero-basal rate option to use.

Bottom line, I'm extremely glad I had the glucagon with me, because I don't know what I'd have done without it. That moment is the reason I always carry one in my purse, because I always have it close by then. I went to the pharmacy yesterday and had my prescription refilled because I didnt want to tempt fate and be without it!

More than anything, this experience has shaken me to the core. It's the scariest d-related incident I've had since my diagnosis and one I hope I don't have to deal with again anytime soon. I'm terrified of what this disease is capable of, both from highs and lows. At least the highs don't put you in immediate danger, though, and they don't leave you shaken and fearful like a bad low does.

I got a jogging stroller so I can start running again in hopes of losing the baby weight, but the prospect of a low like this one happening again makes me realize how important the safety precautions for exercising while on insulin really are as well. I can't risk being unavailable, temporarily or permanently, to my daughter. It's incredibly frustrating, though, to want to lose weight so badly only to have so many d-related obstacles in the way. Lows require more sugar and prevent me from exercising, but at the same time, I feel like I need to be at my ideal weight again in order to be as healthy ad possible. At the same time, I'm not comfortable with allowing my blood sugars to run much higher than normal either. It's such a tough balancing act, and at this point I suppose all I can do is my best, and make sure to follow the insulin safety guidelines to a T.

All I know is that I hope I don't have to use that red box again anytime soon, but I'm extremely grateful to Jacquie and the rest of the DOC for sharing their stories. It's in moments like these when we'd be truly lost without having each other to relate to, someone else out there who's been through the same things-even if they're on the other side of the country! I mentioned in my last post that I started this blog mainly to deal with everything that comes with a T1 diagnosis, but I can only hope that I might also be able to help someone else through sharing my experiences as other DOC members have done for me!

Friday, June 8, 2012

Making Your (Diabetes) Life Better

Back in November, I got an email from a person in marketing at Random House about Chuck Eichten's "The Book of Better: Life With Diabetes Can't Be Perfect. Make It Better." He said he'd like to send me a review copy to check out in hopes of getting the word out about it in the diabetes community after coming across my blog. Needless to say, I was thrilled...Not only do I LOVE books; I also love learning more about how I can make living with this disease a little easier. I was also amazed and honored to know there are actually people out there reading what I write! When I started this blog in November 2010 (a couple of short months after my diagnosis), I did so for some much-needed catharsis...I just wanted to let it all out, regardless of if anyone ended up reading it or not. I figured that if they did, maybe I could help someone else as other d-bloggers have helped me, because it always helps to know that you're not alone in dealing with everything that comes with T1.

Anyway, I promised him I'd read the book as soon as possible, but that since I was pregnant with our first child and dealing with the whole diabetes + pregnancy whirlwind, it would probably be a while before I'd be able to. Fast-forward seven months later, and I was finally able to finish it! It was a fast, easy read; it just took a while to get through it reading it in five-minute chunks while the baby slept (which wasn't very often in the first couple of months!).

The thing that stands out the most about this book is its approach to diabetes. Most books on the subject come off as very clinical--they're straightforward and informative, but dry and impersonal. This book is neither of those things, but still manages to be direct and educational. Not only that; it's filled with funny cartoons, charts, and interesting text, so it easily keeps your attention. Its tone is conversational, so it feels like Mr. Eichten (who has lived with T1 for over 35 years) is standing face-to-face with you, telling you about the ups and downs he's experienced firsthand with the disease. He somehow simultaneously remains nonjudgmental and still holds you accountable for managing your illness, which makes you take him seriously...and since he's been through it all, it's easy to take his advice.

This book covers almost every aspect of diabetes, from its most basic facts to dealing with its toll (physical, mental, and emotional) on your everyday life. At 288 pages, it's much shorter than most other books on the subject while still managing to be fairly comprehensive in its breadth. Each of the 12 chapters deals with a specific aspect of diabetes management, from diet and exercise to treatment options. Eichten makes it no secret that he believes the insulin pump is the superior choice for managing T1 and for some T2s, which I like. It would be very hard to argue that the pump is not the best, most technologically advanced option for dealing with this disease for the people who fit the bill for using it (because let's face it, some people just aren't cut out for dealing with a pump).

On first read, I was more than a little irritated by Eichten's portrayal of T2 as something that can "go away" (see lengthy discussion on that here); however, when I read over it again, I realized he said that through losing weight, you can make the symptoms of T2 go away. Important distinction there, because as many of us have discussed over and over again in the d-community, there is no cure for diabetes, no matter which type you're talking about. We all have to answer to the general public so often when they inform us of the "new miracle cure(s)" they heard of for diabetes, so anything that remotely reads as reference to "weight loss as a diabetes cure" immediately puts me on edge. Maybe it's because of the time that I had a stranger tell me at a restaurant that "they've found a cure for that"...the "cure" she was referring to? Gastric bypass surgery.  Yes, despite the fact that I was already at a healthy weight, gastric bypass would make my diabetes go away. It's so hard to explain to people that no, that won't make my pancreas function; that they're probably referring to Type 2, in which case it's still not "cured" my eyes at least, symptom-free (for the present at least) does not equal "cured." It may be a battle of semantics, but it's important to me. Why? Because the impression that there's already a cure out there hurts diabetes research funding that could lead to a real cure!

That little glitch aside (and really, I'm not sure I can even call it a glitch since I misread it), I think this book is pretty great, if for no other reason than the fact that it motivates you to shoot for better-not perfection. Often, we feel like other people (doctors, family, friends, etc.) expect perfection from us when it comes to managing our disease...or if you're like me, that pressure can also come from yourself. When we try to hold ourselves to such an impossible standard and inevitably end up falling short, it's hard to stay motivated to keep trying...and often, we end up throwing in the towel completely after trying so hard (and failing) to be perfect. If instead we just try to better ourselves-by any amount-we can benefit from a sense of accomplishment that leads us to keep striving for better. It's hard to see how anything bad could come from this approach, especially because it's one that sets you up for sure success instead of the inevitable failure of expecting perfection from yourself!

Bottom line, I love the message of this book. I can see it being extremely helpful for anyone who is in a D-rut, lacking motivation to manage their disease effectively. As the marketing person who sent me the book said, there's something in it for everyone-T1, T2; young, old; newly diagnosed or someone who has lived with the disease for decades. I'd recommend it to anyone as a quick, easy read that's entertaining in spite of being about a disease that's not funny in the least!