I love Live on Patrol

Get to be out in my city…virtually tonight. So fun.
The city came to see me tonight and did a drive by to tell me I’m going to be some poor kids crazy Aunt in April or May! I’m not leaving here, though, until vaccination.

An awful lot is happening out there in the city while I’m stuck in here.

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I wondered who was shining that bright light in my car in that parking lot. Hey a couple needs some privacy here.

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I believe, Phil, that I have the riots to thank for this unexpected development in 2020.

Congratulations :slight_smile:

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Worst low BG of my entire life last night.
I peed my pants. I barley made it. Harrowing. Absolutely harrowing.

This covid has gotta give. I don’t know why, but my ability to do BG control during covid has just tanked. There must be something fundamentally wrong with my risk analysis or my perception of system control. I keep dropping the basals, but I am clearly not doing it fast enough.

As I ‘came to,’ I covered head to toe in juice and apple sauce (which at one point fell into my lap from the sky). I couldn’t use the straw, so I tore the juice box open with my teeth. Broken glass, wet blankets, brain fog today, but no serious harm or damage. I think it took me an hour to crawl to the juice boxes. I had already consumed all emergency juice boxes next to my bed throughout the night.

As me and my Egyptian friend with chronic illness say (when we speak in code), “Last night, Anubis cometh.” Anubis is the code word reserved for things & events that were undeniably death defying.

image

Anubis is the Egyptian god of mummification and the afterlife as well as the patron god of lost souls and the helpless.

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I hesitate to heart this, but can relate strongly to the content. You experienced my worst nightmare of nightmares, and one I am all too familiar with.

@mohe0001 I hope you are ok, please let me know if I can help\lend support\or anything else.

My friend is asking me simple questions that force me to think through my own thinking.

This is my theory.
I’m certain I hit 20 last night.
There was a 12 hour drop. Once I fell into a deep sleep, I stopped getting up to correct with a juice box and that was bad.

I think that I look at this overnight data on the Dexcom app (small screen) and I think to myself, “That’s nice flatline data, just a little low,” so I keep bumping back the basal, but then the next night I still always go persistently low.

I think that data is actually WAY too low and I need to bump back the basal a ton. I think that I am maxing out what the sensor can read, so it appears to be kinda decent. But, its not decent at all - I’m fight like hell with it to keep it at BG = 20 (many overnight juice boxes).

I just cut the overnight basal in my low dose setting and my high dose setting from 1.20 down to 0.70. That should prevent this from happening again. 1.2 was perfect some months ago, but it is not ok now. It is the opposite of ok.

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In my experience, Dexcom registers anything 20 or lower as LOW and 400+as HIGH. You might have been nights out low last night -super super scary stuff

@mohe0001:

Very, very, very scary event!!!

As you are always the first to jump in to try to help others facing challenging situations, in that same spirit, I’d like to offer a list of suggestions that may help you unravel this odd and dangerous pattern. Some of these suggestions may seem silly or you may be well further along than this in figuring out what is going on. I apologize in advance if any of these suggestions annoy you … but they are offered in the hope that they may be of help to you.

For starters, do you have, or can you get, any of the newer shelf stable glucagon? On two occasions a number of years ago when I had a “scary low”, I was able to self-administer the old dry-mix glucagon. I realize that may not always be possible, but it is a useful option in those situations when juice doesn’t seem to work.

Have you carefully checked ALL of your pump settings to make sure that you don’t have an error or typo? While I don’t know anything about an OmniPod, it seems as if it is easy to enter an incorrect number for basal rate or carb ratio and yet not trivial to see or find that error.

Have you gone through all of your pump and Dexcom logs and reviewed what you ate for the past 24 hours to see if you have any hidden clues? I know that I am prone to errors … particularly when I am trending low. For example, for a pre-meal bolus I’ve entered 85 grams of carbs instead of 55 … and not noticed it until many hours later after trying to unravel a crashing low. I have also entered a finger stick BG level in the grams of carb field which is almost always a bad move.

I certainly don’t want to insult you by suggesting that you look for errors, but on more than one occasion I have learned the hard way that I, at least, am perfectly capable of making jaw-dropping errors. While it is certainly likely that you may be experiencing a physiological shift on basal needs, I also think that it is worthwhile to check for possible errors or other explanations.

I sincerely hope that you are having an uneventful night tonight …

Please stay safe!

John

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No, I don’t. I haven’t owned glucagon in years. You self-administered, huh? Its possible that I could self administer. Shel stable certainly sounds better than refrigerated because I could keep in next to me.

I was looking for errors last night. Unfortunately, I was doing it with a BG = 40. So, I will need to double check today. While I don’t expect to find any errors, I do believe that there has been a dramatic shift in my settings because there was a dramatic shift up into wildly high insulin requirements some months ago. I think I am on the downside of that and need to work quickly to drop the dosages.

I’m uploading the Omnipod data into Tidepool now to take a closer look. I am suspicious about user error because I have been alternating between a low dose
basal setting during the night and a high dose basal setting during the day. I might have left the high dose running overnight, or accidentally selected it when my BG was low.

No insult taken, John. Thanks for the brainstorming. I’ll take a deeper look at the Tidepool and Omnipod data today. Sometimes I’m just stumped and you guys always help take a different perspective on looking at the problem.

@mohe0001

Although my insurance doesn’t yet cover either, there is gvoke that, I think, doesn’t require refrigeration and even comes in an “epipen” style auto injector:

https://www.gvokeglucagon.com/what-is-gvoke

Then there is Basqimi that is an nasal spray:

https://www.baqsimi.com/

More and more insurance is beginning to cover these because old-style glucagon was so tricky to use.

I wish you luck as you go through Tidepool looking for clues.

Stay safe!!!

John

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That looks really useful. I will call about that after the holidays.

Until then I have built a mountain of juiceboxes and granola bars and a giant bag of 350 pieces of Halloween candy from 2 years ago. The slightest nudge causes it to collapse and rain down sugar.

Tidepool uploader fails for some reason, but I’m very close to finding the overnight basal, now. Danger has passed.

@mohe0001. Baqsimi works very quickly, but does not allow you to microdose like Gvoke or the mix it yourself style Glucagon does. On the other hand, when I’m super low I’m not sure it really mattees - I’ll take Mr Toads wild ride and deal with the rebound high later. Far preferable to seizures

@mohe0001

I had an experience like that a few months ago. It’s been at least 20 years since I had a truly terrifying hypo I couldn’t handle myself, but I was fighting a fever that just decimated me.

Dexcom told me I was dropping, but was of little use after it just started reading “low”. I had drank several boxes of juice, to the point where I felt like I couldn’t fit anymore in me. Had moved onto straight dextrose dissolved in just a tiny bit of water and held under the tongue. And that’s the last I remember…

Woke up puking and soaked in sweat (I hope! Never considered I might have wet myself), because my husband gave me the glucogon after I started convulsing. First time he ever injected anyone with anything, and apparently the whole thing was more harrowing for him even than me.

I know a lot of old-timers have long since stopped filling glucagon prescriptions, but this was a big wake-up call for me. You can’t ever start believing you’re above a hypo emergency.

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Holy crap, @Robyn_H. Its really hard to give someone a shot when they are convulsing. Tell your husband that I am impressed. I believe that he has achieved the rank of honorary street medic. That’s good skill on his part.

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@Robyn_H you might talk to your Endo about Baqsimi. On of the few forms of glucagon you can easily give someone having seizures, and no needles or mixing. Pop the cap, give it a shake, shove the nozzle into a nostril and deploy. For me at least, it works faster than the mix it yourself type.

@mohe0001 I’ve been training him up for a while now! LOL He’s definitely a keeper. I never really thought about how hard it would be while convulsing, though. I always just told him to stab my thigh. It’s too big to miss, and I won’t care if it hurts when I’m unconscious. I had to ask him about that. He said he sat on me! (He’s got a foot on me and nearly a hundred pounds!!!)
Basicallyy sat on my hips, pinned my knee to the ground with one hand, and jabbed my thigh with the other.

@El_Ver Probably a great idea, but it’s not covered by insurance. They did just add the gvoke one, though. Unfortunately, not till after I filled my yearly quota on the old-school syringe, vial, and pellet variety. I never considered that setup difficult, though.

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@Robyn_H my spouse is scared to death of needles, much less injecting someone else (who’s convulsing). Personally I tend to get very physical when I’m that low and I know I would feel absolutely horrendous if I struck her even if I didn’t know I was doing it.

I had a low once that took 6 firefighters to hold me down as I convulsed, 2 ended up with a black eye. Not proud of that, and I had no idea at the time, and I still feel terrible. They had several very nice guilt induced dinners shortly after they saved me.

My spouse far prefers the Baqsimi got ease of use. I used a copay card that have me 2 for $25. Maybe the Baqsimi website still has the card listed?

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I also got Baqsimi this year,$0 cost since new pump and dexcom maxed my oop, and my insurance covers it.
But haven’t needed to use it yet. Glad to hear it worked well.

(Just watched episode of Nurses who Kill, often with insulin. Will surely take baqsimi with me if hospitalized!!)

OMG, @MM1.
We had someone post on the site about an experience like that.
I’ve read academic papers about murder with insulin and I wrote a paper for my computer forensics class on if you can do forensic analysis of diabetes devices (because my professor was a cop at the St Paul crime lab). He didn’t like my paper, but I think that it was pretty original and asked some practical questions about forensic analysis of medical devices.

They have caught people delivering fatal insulin dosages through the pump. It was sparked by nurse comments that just sorta stuck in my head over the years - offhand (maybe joking comments) that insulin would be the best way to kill someone because it would be virtually undetectable. I don’t even like writing about it here in case it gives anyone any ideas. I’ll prob delete this comment soon.

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