Sneaky low underlines vulnerability

Mental and Emotional Wellness
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Since I started a more aggressive and intelligent insulin, eating, and exercise regime four and one half years ago, my time low and number of threatening hypos markedly diminished. I can usually keep my time low, as measured by my CGM, to < 5%. And the number of debilitating lows I’ve been able to limit to about once per year.

Yesterday was one of those once per year lows. I just returned from a two-week vacation and my routines were upset by a restless overnight redeye flight and jet-lag. I decided to eat dinner early yesterday at one of my favorite burger restaurants. I like to order my barbeque burger lettuce wrapped with bacon and an onion ring. I have my insulin routine well-dialed in for this meal and I find it tasty and satisfying.

This meal requires a brisk 20-minute walk to get to the restaurant, something I’ve done many times. I pre-bolused about 30 minutes before my expected meal and then walked to the burger joint. I did notice that my gait was slowed and I had an odd sensation in my knees that I’ve felt before when dropping low. I had just swapped out my CGM and I was in my two-hour blackout period.

When I got to the restaurant and ordered my burger and wine, I received the glass of red wine and sat down. This is when things started to go wrong. My pump alarmed about needing an immediate battery change. I was warned earlier about this and I was hoping to postpone it until that evening when I would need to refill the pump reservoir, too.

So I sat there and swapped out the battery but that meant a complete screw rewind and reprime. I did all that and then my CGM alarmed that it needed two calibration readings. Out with the fingerstick meter, got two readings, a 50 and a 52, put them into the CGM. I realized I was symptomatically hypo but I’ve successfully treated many lows in this range.

But then I lost awareness of my situation and started an adrenaline sweat. I never thought once about claiming my burger at the counter. I knew enough to eat a couple of glucose tabs and thought about the mini-mart across the street that had candy bars. I finished my wine and packed up my backpack and left the restaurant completely forgetting about the hamburger.

I crossed a busy street waiting for the walk signal and went into the store and bought a large European style candy bar and ate the whole thing. As I walked home and my blood sugar ascended into the high 60’s and low 70’s. It was then that I wondered if I had eaten my hamburger. I concluded that I didn’t since eating a barbeque burger in a lettuce wrap means sticky hands. My hands were not sticky and I didn’t wash them during this episode.

This was a strange low. I was aware enough to treat my low with some glucose tabs but totally forgot about my ordered meal. I wonder why the counter help didn’t wonder why no one answered their call for order number 292?

I hate when this happens! Although I have really upped my BG game in the last several years, diabetes proves again that it can render me helpless. I’m telling this story here because I know you understand.

9 Likes
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Makes a strong case for faster insulin taken after eating instead of slower insulins pumped into body well in advance of eating… doesnt it?

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Ugh. I’m glad you got through that low OK. Those types of lows don’t happen all that often anymore, thankfully, but they are still scary when they do occur.

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Thanks, Jen. What startles me about this incident is the clarity of thought and action to take care of resetting my pump and calibrating the CGM but missing the crucial response to eat the meal I ordered.

@Sam19 - As you know, I gave Afrezza a thorough trial for prandial use and decided that pump-administered fast acting insulin is overall the best answer for me, even given this incident.

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Terry, glad to hear you made it through the low okay. I experienced my first severe low about a month ago but luckily for me I was at my doctor’s office and they helped me through it pretty quickly. Give yourself a pat on the back for managing as well as you did!

Honestly they should have conditioning classes like the Navy Seals do so that we PWDs can mindlessly do what we need to in these situations :wink:

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Glad you are OK, Terry. CGM can sometimes give us a false confidence and for me it has been many years since I’ve had a horrible low like you experienced.

Where was Norm? I bet he’s the one who picked up Order #292…

Your experience is one reason that I can’t/won’t prebolus in certain situations. When I worked I only had 30 minutes for lunch. Because I had to drive to a restaurant, I wouldn’t pre-bolus unless I was high. Accidents, breakdowns, and traffic jams were a small risk, but a definite danger. I ate at Wendy’s almost every day and a small chili, side salad, and Diet Coke worked well without prebolusing.

Take care and yes, I understand.

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Thanks for your support, @Christina16. It appears that you’re new to this. Glad that you were able to get through that severe low at your doctor’s office.

I have had a lot of practice responding to lows of various seriousness. You do need to make sure you always have your emergency glucose nearby and when in doubt, check your BG level.

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Thanks, Laddie. Norm was with me but he didn’t catch this low. Isn’t that like Murphy’s law for hypos? My CGM was in its blackout period, the pump was going through its dysfunction, and Norm missed this one. What’s weird is I don’t consider a 50-52 mg/dL as a severe low. But it did affect my cognitive function. I’m a big fan of multiple redundant safety systems but even then you can’t control fate.

I still like to pre-bolus and I know that it can be risky. I rarely go out without my emergency glucose in tow. If my brain isn’t 100%, however, all bets are off.

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Pre-bolusing is the only way to go with liquid insulin-- and I know you’re generally a chess master of the game-- but that whole evolution you just described is just beyond my comfort level. I’d make sure I was at least in the restaurant before I prebolused. There are just so many variables out of my control for me to consider pre-bolus before I leave my house for a 20m walk to restaurant…

What if I got hit by a car? What if someone had a heart attack in front of me and I had to do CPR? What if i got to the restaurant and to my surprise it was closed bc the cook didn’t feel good? There’s a million possible ways pre bolusing outside controlled circumstances can lead to trouble. That’s why I only do it in controlled circumstances. In that situation I’d get to the restaurant and prebolus and enjoy the wine before ordering the food-- or order the food and tell them you don’t want it delivered for 20min if that’s feasible. I know it’s not a real option to sit there with the food in front of me without eating it…

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How’d the wrapper taste ?

Glad you can tell the story… ; )

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We all choose the level of risk that we’re comfortable with. I always carry a day pack with me when I’m out. Inside is a large container of glucose tablets, 50 when full. That’s the answer for all those contingencies you mention.

There is no right or wrong answer to this question. It’s a subjective evaluation we all must make. In the end, safety is never absolute, but simply shades of more or less safe.

One thing I will do differently in the future is to not volunteer for exercise when my CGM is in its two-hour weekly blackout period.

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Well, I did go to that restaurant again and order the Cowboy Joe burger wrapped in lettuce. It’s a burger with barbeque sauce, crisp bacon and an onion ring or two. Delicious.

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I’m glad you made it through okay and I definitely relate to you on how baffling a reaction can be to a low blood sugar. I had one years ago where I pretty much lost control of my motor functions, yet it felt like I had complete clarity of thought. The whole thing was such a bizarre and helpless experience that it still periodically pops into my thoughts.

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Thanks for the comment. The thing that I find interesting is the contrast between symptoms that debilitate while at the same time experience clear thinking.

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I think the reason for this is that insulin is not needed to get glucose into the brain – also the typical brain glucose concentration is about half of what it is in the rest of the body. So your muscles may literally not have enough sugar to move, but your brain has enough to think. These harrowing descriptions really make my heart hurt for my son, who will likely have many hypos to face in the years to come.

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I am so very glad you made it through safe and sound! So very scary. And I feel the frustration because I know it doesn’t happen often for you. And I feel the same. The frustration sometimes can be a killer.
And did almost the same thing myself the other day. I do try to pre-bolus for most meals but have a hard time at work. Only have 30 minutes and while it needs to happen before the 5th hour of my shift, it can happen anytime from 3-5 hours. So the other day, I thought let’s try it and pre-bolus to see if it would help some of that post meal rise. So I dosed off my dexcom, which I don’t normally do as it is not as accurate as I need it but I thought a lot do so let’s try it.
And than you know the rest. Break was delayed and the dexcom is alarming and I’m not thinking clearly. I know I’m in trouble, I know I need glucose, I know I need to just go but do I? Nope. By the time I get to the break room, I test 42 but do I just eat? No, I try and figure out if I’ve taken insulin (which I had,duh!) it was one of those lows that was sneaky and hit every symptom in the book but did I pay attention, nope! It was very sad and a little scary and mainly because I pre-bolused and was late in the meal. All very preventable which is the kinda low I hate, when it is all due to mistakes on my part.
I unfortunately do this more times than I care to admit. At home I set a timer in the kitchen to remind myself to eat. And wow the number of times as a Mom trying to put meals together for the family and not eating in a timely fashion.
I am so very sorry it happened to you and so sorry it was one of those perfect diabetes storms, where everything that could go wrong, did. So thankful you made it across the street safely and also so glad you finally got your burger, finally. Enjoy each and everyone of them. And know we all feel for you and most of us can say, been there done that. And somehow we find a way to carry on!

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Thank you for your kind response, @Sally7. I’m glad you negotiated your close call safely. There’s something in the value system of my brain that lacks wisdom when I’m low. I’ve actually stood for minutes and minutes in front of an open refrigerator deciding which food I should use to treat my plummeting low.

I don’t know your work situation but perhaps you could talk to your management and coworkers to find an acceptable way to duck out of the work flow when you’re going low. Some people suggest to give up the pre-bolus but I won’t do that. To me it’s just one of the things that sub-q insulin demands if good control is sought.

Maybe using a countdown timer on your phone 100% of the time could be part of the solution. In any case, your needs as a T1D, deserve a relatively high priority when competing with other demands. Good luck. I know it’s not easy.