Scary low blood sugar story – what would you have done..?

1

Pride goes before a fall as they say. After a few weeks of wonderful BG control, I just had the most frightening experience since being diagnosed with Type 1 diabetes 10 months ago.
It all started with my lunch, for which it seemed I had underbolused. 1.5 hours after eating I measured 195 mg/dl. I had bolused 3 units Apidra for approx. 35g of carbs, usually that works fine for me. Not today. So I corrected 1 unit Apidra, since I knew I was going to walk for 15 minutes shortly, but I also took my basal (2 units of Levemir) at the same time.
I packed my bag and went out. As I reached the bus station, I was just ready to get on the bus, when I suddenly realised I somehow had taken the wrong backpack with me!! Instead of the backpack with all my diabetes gear in it, plus my wallet, keys and cellphone, I noticed i was wearing my CAMERA BACKPACK!! At home I had been in a hurry, the two bags look very alike, and I just grabbed the wrong bag in the dark hallway of my flat. My camera bag had NOTHING diabetes related in it, not one little glucose tab. What an idiot!
So I was standing on a bus stop, 15 mins from home, no diabetes gear and I started to feel funny. I turned around and started to march back home as fast as I could.
Only 20 minutes earlier, I had measured 195 mg/dl, so I thought I cant be in any danger. I was wrong. I made it home and rang the doorbell like a crazy person, fortunately my partner was still home and opened the door.WTF would I have done if he hadnt been home? Or if I had gone on the bus before realising I had the wrong bag with me??
I sprinted up the stairs, the weird thing was I felt no real hypo symptoms, (why? scary!) all I felt was this incredible rage. I stormed into the flat, got my metre out and measured 58. I had dropped well over 100 points within 25 minutes!! I ate 16 g of glucose tabs and 10 minutes later I was back up at 104. I was crying and all I kept saying was "I had the wrong bag, I took the wrong bag with me!!"

What an unfortunate combination of events. The forgotten bag, the fast BG drop... It felt like I really got myself close to a potentially dangerous situation.
I cant really figure out what caused the fast drop, maybe I shouldnt have corrected the 195 since I still had some bolus on board, and/or the Levemir was absorbed faster than it should have been because I inject my basal into my thigh and went right into fast walking after?

I think what scared me the most here was that if I had dropped any lower, because I made a mistake with my backpacks, I couldnt have treated myself. So here is my question – what would you have done to ensure you wouldnt have passed out on the street? Go up to a stranger and ask for help? Walk into a shop and demand food? What would I have done if I had already boarded the bus??
Was it wrong to inject both basal and correct the high just before going out walking? (Well, obviously)–
Man this is overwhelming! But at least I think I will NEVER take the wrong bag with me again, and I will always carry additional glucose in the pockets of my jacket and will place diabetes gear in ALL my bags...

How close I came to real danger I will probably never know, but even realising the potential of if scared the ■■■■ out of me and was kind of a rude awakening. I am sort of surprised that I dont see more incidents of pwds just dropping in the middle of the street more often. After my experience today, it feels it could happen SO fast?!?

2

Sounds like a perfect storm, as they say, Julez. Sorry this happened and that it scared you so badly. I frankly can't respond to the combination of events because it includes walking and I have found exercise very unpredictable. Which is a really good excuse for me not to exercise (I've used other ones throughout my life, so mostly I'm kidding, but not entirely.) I do know when I used to walk to the market that was 20 minutes away and then walk all around this huge market I would often go lowish and have to check while shopping/take a couple glucose tabs.

The only thing in your narrative I'm wondering about is if you took into account the Insulin on board when you bolused the correction? That's something you want to be sure and do. (I wouldn't worry about the basal as it has a much longer slower onset time and I doubt it had anything to do with this; some people seem to disagree with this but I'll be honest I think it's their imagination).

What would I have done? Definitely approached a store or candy stand and explained my situation, showing them the camera bag and asking them for a small "donation" of lifesavers or juice or something. It's embarrassing of course, but they should be sympathetic and it's a small thing and you can volunteer to return and pay. This might be one situation where all the talk about (type 2) diabetes in the media might do you good!If a pharmacy was nearby I would of course choose that first. If I'd boarded the bus and it wasn't one you could hop off of easily in front of a pharmacy I would have embarrassed myself further by making an announcement to the bus and asking for candy. Someone would have some and be sympathetic I'm sure.

3

Wow Julez what an experience. Sorry you had to learn all the stuff you did the hard way. But look what you learned. Never leave the house without D stuff, never leave the house without glucose tablets, skittles, jelly beans or some other form of fast acting carbs, check you bag before you leave the house. But in the absense of all that stuff, I personally would have gone in to a store, explained my situation, and asked if they could give me a coke or some juice which I would be happy to pay for later on. The reality is most people want to help and you weren't incoherent, just raging, so they probably would. Or at the very least called 911 for you.
The other thing is don't just trust that your meter was right. It only has to be within 20% of actual, so the reality is your blood sugar could have been 195 or 156 or 234 and it would still fall within the acceptable limits for blood glucose meters. And no I would not correct a high in my thigh and then go briskly walking. But you already answered that question for yourself. The levemir probably didn't impact your blood glucose that dramatically but the Apidra most definitely would.

4

We've all had scary lows. They certainly aren't fun. And yes, very, very scary.

I had one that involved nearly fainting into the train tracks--and still refusing to test because I was in public. (And, in my screwed-up low mind, you don't treat unless you test first, right?) I walked nearly 3/4 of a mile while low, despite the candy and snacks in my bag.

When I came back up, I realized how scary the whole situation had been. It's one of the big reasons why I got a medical alert bracelet. Though it happened three years ago, I still think back to that day and shudder.

I carry low treatments in all of my bags, and I also have a single small bag that carries extra strips and candy and juice (and EpiPens) that I transfer to whatever bag I'm going to leave the house with.

As far as having no low treatments goes, I was on the school bus on the way home one day, and I'd been serially low all day and didn't have any more low treatments with me. I also had NO food with me (which never happens) for the same reason. I called out to my fellow bus-mates (we were a close group), asking for low treatments. No one answered me.

I waited five minutes and tested again. I'd dropped a bit more. Then I called out, "If you guys have candy and aren't giving it to me because you want it for yourself, please know that I WILL faint on this bus, and then you'll all be late going home because you'll have to wait for the ambulance to come." Suddenly everyone had something to give me!

So yeah, if I'd been on the bus and I had no low treatments, I'd make an announcement that I have diabetes and NEED candy or juice. If you don't think anyone will listen to you, ask the bus driver to make an announcement. But I'd have preferred to treat before the bus if there was a shop nearby or something.

I'm terrily sorry you had this experience. I hope you feel better soon!

5

Yes, that sounds scary Julez... not sure i can help much, i have approached strangers and asked for candy before... i got some shame (shoulds) from the one time i did, but i'd do it again. yes definitely some candy or sugar packs in your camera bag too. And i dont think you'll make that mistake again. i also saw you breaking into your apartment if your partner wasn't home... can you put in a hide-a-key?
58 isn't a scare for me as i've been 43 or 46 before and still have my wits about me...
i also want to mention that some of my worst lows were when i was taking two different types of insulin close to each other too.
i hope this is your worst episode ever... all the best...

6

Every time I hear a story about a “unbelievably” fast drop I ask the same question— did you wash your hands right before you tested and got the 195? My suspicion is that your bg wasn’t actually 195 after lunch but for some reason read falsely high (in my life usually from contaminated fingers) but also could have been a defective strip. So maybe you corrected a false high? Wouldn’t that explain everything?

7

Hi Julez. We've all had these moments, and they're terrifying. I lead a crazy, busy life and quickly learned that the only way to mitigate this is to distribute glucose tabs everywhere: in the glove compartments of each of our cars, in my jackets, in my briefcase (where I also carry a glucagon emergency kit that I've explained all my friends, family and colleagues how to use), in the desk drawer of my office, my wife's purse, etc. However, even with the best laid plans I've found myself in the same situation with no tabs available. I was in NYC a couple weeks ago going low in a part of town with no convenience stores or drugstores. What are the odds of that in New York??? Nevertheless, I found a street vendor selling big doughy pretzels. A quarter of one of those shot me up 100points in 15 mins.

I also do quite a bit of international travel, so I have developed a repertoire of alternatives that I know will work in a pinch depending in which country I might find myself if I run out of my own glucose tablets: Haribo, Skittles, Lindt Thins, M&M's, etc. I once stabilized a slow drop due to too much Levemir on a 4 hour flight with a steady consumption of peanuts. On a recent trip to Africa I found a brand of vitamin C tablets sold at grocery checkouts that have 10g of glucose in each tab. As a last resort, there's always Coke. One can has 39g of fast acting carbs. If there's one thing you can say for that company, they probably have the best distribution in the world.

I learned the hard way to avoid Apidra. I found it's onset for me to be less predictable to Novolog (Novorapid in Europe), and when it did hit, it hit hard and fast. In fact, while in my honeymoon phase I preferred regular human insulin. It had a very slow and predictable onset, giving plenty of time to correct an overdose.

The biggest difference to avoiding nasty surprises has been my CGM. I started using it 6 months ago and it's been a godsend. Now I have plenty of warning if my BG goes in either direction and and quickly correct it accordingly. I also wear a medic-alert bracelet, just in case the worst occurs. Then people can hopefully understand what went wrong if I pass out and treat me accordingly.

In short - what would I have done in your situation? I would have been just as panicked and frustrated as you. I would have popped into a store to buy glucose tabs or the alternatives I mentioned. In the absence of that, or if I would have been without money, I would have sucked up my pride in the interest of my immediate survival and asked the people around me for sweets/soda/anything that would raise my BG.

These are the challenges we face as diabetics. Nothing is foolproof, but fortunately there things we can do to mitigate the risks.

8

Hey Julez -

I know that I will fall very fast if I walk right after a bolus. In fact, if I were at 195 and wanted to knock the blood sugar down quickly I would correct to 120 and then walk for 40 minutes to an hour and even giving myself the extra margin there would be a chance that I would end up in the 50s or 60s. Did you double check the 195? If I'm shocked by a number, I always retest even if I can't wash my hands first. Even if your hands weren't dirty, that 195 might have been closer to 160 and only a second (and sometimes a third) test would help you know how much to correct.

Take heart that you don't see pwds dropping in the middle of the street. We all make mistakes but thankfully there is some margin for error.

Hope you feel better soon,

Maurie

9

When I used to have a OneTouch UltraSmart meter, I recorded #s as low as like 7, 12, etc. at various times nd would always be totally astounded I wasn't passed out/ dead (since, of course, paramedics always say funny things like "woah, your blood sugar was 50..." when you wake up...). I passed out a few times too, which is never fun but fast BG drops happened more frequently when I had shots. About the only time I see them now is if, for some reason, I bolus, get distracted and then realize "eek, my BG is crashing..."

I have very few situations where I don't have carbs up my sleeve. My current "running" solution is the little bags and they are also handy for socializing, errands and other situations where I can run into trouble. I like being what I refer to as "naked" (not lugging a bag of diabetes supplies along...) so I always stick a bag in my pocket.


I like both of those snacks but, in my head, they are *really* only for lows and I just keep a tub of the mix and reload the bags and always have a couple ready for action. In your situation, if you have two bags, toss a snack in each one and you'll always be safe. Or keep one in your pocket. The main hazard is when I leave them in my pocket as MrsAcidRock is not usually too happy when they go through the laundry.

10

Too funny acidrock - I do the same thing. I use Dex 4 tabs with 4g of glucose in tiny zip lock bags (purchased on Amazon.com) and drop them in the pockets of my various items of clothes. And yes, every so often they make it into the washing machine, but hey, I just figure I'm sweetening up the laundry... :-)

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11

I had an almost identical situation happen to me years ago (link to my D365 post about it).

I would hope that if you passed out on the bus or anywhere around people that someone would call 911. In fact, I believe bus drivers are required to call 911 if they see someone having a medical emergency even if they are not a passenger on their bus. My fear isn't so much of passing out, but of passing out when no one is around.

My most nerve-wracking experience recently was when I was using the exercise room in our apartment building. I had glucose tablets with me but had no meter. I suddenly felt super dizzy and took the elevator upstairs to my apartment to test, where I found I was 37. In hindsight, I thought taking the elevator was not the smartest move (but was probably smarter than taking the stairs, which I had considered), and—like guitarnut says—the next time I should just assume I'm low if I feel dizzy!

Yesterday I had sort of the opposite situation. My pump ran out of insulin around 4:30 and I had no backup supplies except for an insulin pen. I was at work and had to stay late to help with a youth event where there was only one other staff member, so I really couldn't leave. I tried covering with injections, but without being able to track insulin on board I felt lost. By the time I got home at 10:30 I was feeling terrible and my blood sugar was 457! No ketones, but I felt like I definitely could have run into an emergency situation like DKA if anything had gone wrong.

I think these types of situations happen to all of us, and the best you can do is make sure you're bringing the right bag next time. I have a checklist I go through in my head before I leave, that includes meter and glucose tablets, to make sure I don't forget anything. I still occasionally find myself without fast acting sugar, and if I do I stop into a store the first chance I get to buy something.

12

A quick look at the amount of time that Apidra is active would definitely lead me to suggest that you should have waited before taking the correction, especially considering that you were about to go walking.

After 1.5 hrs, there is still considerable IOB. the "tailing" period appears to be @ 3+ hours.

Your description of what you plan to do in the future is really sound - I have stashes of glucose tabs all over, plus always have the tube of ten in my pocket. Sorry, let me re-phrase that in a bolder voice - "TUBE OF TEN!!" ahhh, much better.

13

My usual rapid falls are due to incorrectly adjusting for the glycemic index of the food, and due to it causing either the insulin to kick in too early or too later and not hitting the raise at the right moment. Or the bolus to soon to exercise causing it to hit the system before the food has had a chance to get into effect.

You mention about injection sites can also mess things up a bit as the different parts of your body do alter absorption rates. I know my right abdomen is no where near as good performing as my left, but I believe the majority of changes like that are all due to long term injection in areas and the changes to the tissue not so much for those newly diagnosed.

As for supplies you have the right idea about depositing things everywhere. I've deposited glucose tabs in pretty much ever coat I own. I've also got a packet inside my meter case I've converted into a bare essentials pack which never leaves my person. I know my diabetic nurse goes on about making sure I always carry a backup pen, spare needles, spare vile, spare cannula, glucogon injections, spare this and that. But over the years I've slimmed everything down to being very light, very compact, and never having it not on me even in a full lycra race kit, I can fit in the essentials to get me somewhere that anything I may not carrying I can deal with later.

I've never actually had to beg for food, but it has been in the back of my mind before now as to what would I do. I honestly don't know how I would handle that situation other than trying to talk a store into giving me a snack and calling a family member to bring my wallet over.

Over the years I've had some epic hypo's. I know some fear hypos immensely, but I guess after so many (record being scraped up three times in a week by paramedics) I now just treat them as they are, something to learn off. But every hypo has been a learning experience and something that I have adapted from. Nothing to fear.