Sometimes diabetes throws me for a loop when I do everything right, but sometimes I make mistakes when I should know better. This happened last Friday night. I did several things wrong, and I feel several things, including embarrassed and scared. But lucky.
First, I went out to lunch after noon, and I rarely take a late lunch, so I went off my normal schedule. I had to guess on the carbs and apparently underbolused, I was at about 195 (according to the CGM) and climbing. I took a minor correction bolus at about 3:00 pm. I knew that I would ride my bike home at 5-ish and I would need to be careful because it can drop rapidly after I begin riding, especially when it peaks in 2-3 hours. But it's only 7 miles away or about 25 minutes give or take. I am so sensitive to that 1 pm bolus that I probably didn't need to correct at 3 pm, but I figured it was going to continue to rise and I didn’t want to feel crappy for the next 2 hours until I got on the bike. I planned to check my bg before leaving for the day and could snack if I needed.
At 4:30 I got a message from my friend, who was at a happy hour at a pub a few blocks from work, so I walked over and joined him and some other co-workers at about 4:45. My bg was reasonable, dropping from the correction and at about 165 when I sat down, but I had two beers and bolused for them, and for the food I planned to order because I was going to stick around for another hour. Anyway, no buzz - just 2 beers and a few bites of some happy hours snacks. I felt fine. There’s usually no reason for me to bolus for a beer, but I did.
I called my wife at around 6:15 and told her I was late but going to get some work done when I got back to the office, and she told me the kids were looking forward to seeing me. Uh oh, better get home. So I skipped ordering food (despite having taken insulin), said goodbye to friends and walked back to the office, changed into bike clothes, and got on my bike. (I could go back now in my pump memory and see just how much insulin I had on board at that point, but it would just make me cringe. I had the 3 pm correction bolus peaking, plus 3 or 4 more units. I could also go back and check the graph on the CGM but I'm sure I know what it looks like.) I was in a hurry and did not check my CGM at the office, test my blood, or anything and by then I hadn't looked at my CGM for maybe 45 minutes to an hour. Big mistake. I planned to pick up a book being held at the library, which was only a few blocks away, so I figured I would test or snack there. So maybe the 2 beers did affect me enough to make me a little reckless about my diabetes. I put the CGM in my messenger bag before starting out. I know I can't hear the CGM in my bag - so there was another mistake. I wouldn’t hear any low alarms. Still, I am used to riding home and hearing the "anticipated low bg" alarms ringing as I reach home, and I ignore them because I am so close to home.
I felt good and changed my mind, deciding to skip the library. (Another mistake - so I had no idea what my bg level was at.) I rode hard, but at some point about 5 miles into the ride on the bike trail I recall feeling very hungry and thinking the beer must have really hit me all of a sudden. I was dizzy and had trouble staying on the bike, and I was very sweaty. For some reason I thought I was drunk! Under other circumstances I might have realized that this was a severe and sudden low, but because I had 2 beers 2 hours before I must have blamed the very strange feeling on that. Which is ridiculous. It's not like exercise has ever made me sensitive to alcohol. It makes me sensitive to insulin, and dammit I know that. So by this point I was not thinking rationally at all. In my bag I had a test kit, Gu packets, granola bars, a cell phone, a bus pass - everything - but I just kept riding home and didn't consider stopping. The low hit me suddenly, because I couldn't have been out riding for more than 20 minutes. Either I didn't realize I was low, or else I figured I was going to be able to tough it out. I wanted to get home and eat dinner.
Passing a familiar landmark at the 5-mile mark was the last thing I remember. I don't remember getting up the final mile-long hill to my house, and I don't remember traveling the next 8-9 blocks. I rode myself into the ground, literally. I am told I was found lying unconscious in the grass in someone's yard about 2 blocks from home with my bike on top of me. I awoke to my wife standing over me with paramedics hovering around while I was hooked up to an IV. Ann told me that the paramedics tested me at 19 mg/dl. Whoever found me saw my diabetes alert and my contact info and called 911. It was a friendly neighbor whom my wife thanked, but I am too embarrassed to go down that street again.
My legs are cut up from the cranks, I have a cut on my nose, a gash on my left shoulder, and a scrape on my right knee. My front rim is bent, and I smashed the blinkie light hanging from the back of my messenger bag. I have no idea how I did all of that, but it sounds like I fell more than once. Not sure how I avoided getting hit by a car if I couldn't ride in a straight line. I still feel angry at myself, ashamed, embarrassed, scared, vulnerable, etc. I have so many emotions as I think back on this event. I know better.
I can try to spin this positively and say that I had some determination and strength that enabled me to ride up a hill (at 19 mg/dl!!!) but on the other hand I was not fast enough to race 7 miles home before the insulin caught me. I made a lot of mistakes and I know better. Stupid. I like to think that I have this thing under control after 30+ years, so I don't like making dumb mistakes and making a spectacle of myself. I feel guilty for being a bad example of persons with diabetes; I am sure the whole neighborhood saw the ambulance lights flashing and got the scoop on how some guy with diabetes passed out. I have been cycling with diabetes for years and began to feel like the White Star Line with that "unsinkable" ship - Friday was the Titanic.
I am commuting by bicycle again this week, and I am more careful about managing my bg. This was an uncommon event but I learned that I can't outrace insulin, and I can't forget that I have to pay attention to diabetes.