An Epic Low

Hindsight is 20/20.
INVISIBLE ILLNESS WEEK 2010

Lows happen.

If you rely on insulin for survival, low blood sugars are part of the journey.

Sugar has a history of terrible horrible no good very BAD lows.  She would pass out and hit her head pretty regularly in her pre-pump days.  The days when she was too little to tell me what was happening....too little to even understand what she was feeling, for that matter....the days of quarter units that I couldn't ever draw up accurately in a half unit syringe....the days when I had to settle for giving more insulin than necessary because my brain couldn't figure out the most precise dose, and I wouldn't have been able to draw it up in a syringe even if I could have.  She was just a baby -- only 2 -- when she started to deal with this disastrous consequence of being a child with Type 1 Diabetes.   

Until I started to connect on line a few years ago, I thought these lows were normal.  But they weren't.  They were "bad lows", and, while all people with Type 1 Diabetes risk dealing with them, not everyone has them.   Off the top of my head, I remember this post from Lee Ann over at The Butter Compartment.  Recently Michael's wife had to call 911 for a low blood sugar at The Diabetic's Corner Booth.  Here Kerri describes the experience of wanting so badly to pick up her crying baby, but having to deal with a lingering blood sugar in the 40's first...and HERE you can watch her dealing with the brain fog that accompanies low blood sugar.  A few years ago, Shamae posted about Sydney's seizure.

As a mother, it's hard for me to put into words the emotions of watching your precious child succumb to these "bad" low blood sugars.  I grasp for adjectives to describe the feelings of desperation, fear, and helplessness....but there just aren't words to adequately explain what it's like.  In the back of your mind, you know that the end result could be death.  Yes.  She could DIE.  What if nothing works?  What if the juice doesn't kick in fast enough?  What if, what if, what if....the term "PANIC" seems appropriate, but it's still a far cry from accurately describing the actual experience of going through it.

Last night we faced this beast again.

There were a few things that contributed to this drama....

1. She woke up at 55 -- already beginning the day with a liver low on it's glucose reserves.
2. She swam for a bit in the early part of the day, and dropped to 55 again with the activity.
3. After the second low, she spent the rest of the day in the 300's, despite multiple corrections.
4. She didn't eat all of her dinner.
5. She ran around playing hard on the lawn at church following service last night.

Keeping all of that in mind, allow me to set the scene for you....

One of our family's favorite activities is to hang around for lunch or dinner
(depending on which service we attend) after church.
Inevitably we run into friends, and it's always nice to catch up!
Our church campus has an outdoor grill and a cafe,
along with big lush lawns and a bunch of play equipment scattered about for the kids.


Here in the desert, we've just started to have tolerable temperatures in the evenings.
The kids have been patiently waiting to get outdoors and run around
after months of being stuck inside.

As previously mentioned, Sugar spent a large part of her day in the 300's.
The opportunity for free range exercise was welcome,
especially since it seemed like nothing else was working
to bring  down those stubborn highs.

Here's how things looked when we got home last night.

 She had a banana and I bolused her for it.

She didn't get a full dose, because the pump adjusted for both the
insulin on board still circulating from dinner,

plus a blood sugar that was under her evening target of 150.

 Of the full unit she would have gotten, the pump only advised a dose of 0.25 units.

And then....20 minutes later....

24 fast acting carbs and 8 minutes later, she was significantly more symptomatic.

Moaning.

Whining.
Crying.

Restless.

Heavy eyes.

Head bobbing.
Refusing to drink.
Confrontational.
Poor color.
Unable to put words together to describe what she was feeling.

Apparently the juice box and fruit roll up from earlier weren't working.

I poured out roughly 4 oz orange juice and stirred in some sugar.

(This is what I learned to do in nursing school!)

She drank about half of it and then refused to drink more.

She did take some sugar straight from the spoon.

Then refused more of that.

I tried to get her to suck on a 15c lollipop....but she didn't want that either.

After a few minutes, it seemed that she was getting worse.

We just weren't making any progress.

We were just about 15 minutes into this low, and she had taken plenty of fast acting carbs.

Things should have been turning around.

But they weren't.

 It was at this point that I decided to stop caring what the meter said.

Those dang things are only required to be 20% within an actual reading anyway.

I needed to step back and treat MY DAUGHTER.

SHE WAS WORSE.

I don't care that the number was 40 instead of 30.

45 isn't an acceptable number under any circumstance.

Her symptoms dictated that the situation was worsening right before my eyes.

I remember learning in the beginning that Glucagon should only be reserved for
instances of seizures or unresponsiveness.

Well, I wasn't willing to wait for that.

I believed that, if something drastic was not done,

 SHE COULD DIE.

In 5 years, I've never done it.  

Looking back now, I believe there were times that I probably should have.

Hindsight is 20/20.

 I didn't have anymore time to waste.

The fast acting carbs we had given weren't working and time was of the essence.

So I gave her 7 units of Glucagon as a rescue measure.

In my mind, she was 7 years old, so I chose to give 1 unit per year of age.

Don't ask me how my brain came to that conclusion.

It's what my God given maternal instinct felt was the right thing to do.

Had she been unconscious or seizing, 

I would have given half the vial in her thigh just as we were instructed to do

way back when all of this diabetes stuff was brand new.

I opened the red box and had to remind myself what to do next.

Inject the fluid into the powder.

Swirl to mix -- DO NOT shake.

I grabbed an insulin syringe, and my heart was racing as I pulled up the dose.

With that, I injected it into her arm.

I continued to rub honey into her gums and cheeks.

I was waiting and praying for any sign that things were turning around.

 Just a minute or two after that reading, she began to complain of nausea.

Hearing this was music to my ears, because I knew the Glucagon was working.  

(Nausea and vomiting are common side effects of Glucagon).

I took a deep breath and allowed the tears to come.

I was one very scared D Mama.

That red box goes with us everywhere.

It's always stuffed at the bottom of her bag.

Last night I was reminded of why it's a vital part of our life with Type 1 Diabetes.

To a bystander who may not know better,
Sugar probably appears like any other happy go-lucky child.
One would never guess that we raged this battle for her life last night.
Just because you cannot see it, doesn't mean it isn't there.
Constantly.

**One thing I'd like to edit this post to include is the suggestion to keep an insulin syringe taped to the red box.  When Sugar was first dx, the CDE gave us that advice.  You see, when you open the box, all you have is the big needle that comes with it.  Also, you'll see that I was measuring Sugar's dose according to UNITS (u).  
The syringe in the box uses MILLILITERS (ml).  
There's a big difference between 7 UNITS and 7 MILLILITERS.**