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I’m back from a very busy week in London and Copenhagen. I arrived back in the door at home exactly two minutes after Harry and Meghan got hitched, so I missed the whole happy occasion. If only we had some sort of magical way to see photos and videos and relive beautiful experiences like that. Oh well, never mind.

The main reason for my trip was for the kick-off meeting for Hypo-RESOLVE, a new four-year project focusing on better understanding hypoglycaemia. I’m there as part of the Patient Advisory Committee (PAC), which is made up of advocates from across Europe. Obviously, it is now legislated that an Australian also be included in any European diabetes advocate activities. I believe it’s called the Eurovision Law.

The project is made up of eight work packages, each led and staffed by leading European diabetes researchers and clinicians, and after seeing just who was going to be in the room, I suddenly was struck down by the worst case of Imposter Syndrome I have ever experienced. This didn’t get any better when I was told that the presentation I had been asked to give was not only for the PAC. No – it would be in front of all eighty project participants. I looked at the list of who I would be standing up and speaking to, and cursed the meme- and photo-filled presentation I had prepared, wondering if I could pretend to understand statistics and graphs, and add some to my slide deck to at least try to sound smart.

I decided to stick with what I knew (memes, cartoons, photos of weird hypo tales), and left the slide deck as it was, hoping against all hope that I would manage to keep myself nice, and sound as though I understood what I was speaking about.

I was asked to give a talk about the real life experiences of hypoglycaemia. Fortunately I have kept a pretty good record of the literal lows of my diabetes (which, incidentally, was the title of my talk). Thanks to the search function on Diabetogenic, I was able to easily pull together a number of stories about the lows I’ve had. This proved to be more useful than I realised because these days, lows are few and far between. Since I started Looping, I’ve not had the sort of low that has made me want to write about it and try to analyse what it all means in my diabetes life. In fact, I’ve not had any lows that have required anything more than a mouthful of juice or a couple of fruit pastilles to treat.

Reading back through my blog posts was actually really quite confronting, and I found myself getting emotional as I read details of terribly scary lows and how they had impacted on me – in the moment, and in the days following. As I read, I remembered the anxieties I felt about something happening while low that would seriously affect my family.

I’ve not asked them, but I wonder if the fact that I have so few hypos these days makes Aaron and the kidlet feel calmer about my diabetes. They still see me sucking on a juice box every now and then, but it is done without urgency, and without the look in my eyes that betrays the calm I used to try (and fail) to convey.

In my talk, I really tried to express just how significant hypos have been in my life with diabetes. I tried to explain that even once a low is ‘fixed’ there are often residual effects – effects far beyond just trying to work out what my glucose levels would do after playing the how-low-can-you-go-hypo-limbo.

I spoke about how the emotional fallout after a nasty hypo can be crippling, leading me to second guess every diabetes decision I made, wondering what I had done to cause the low in the first place – because that is the ongoing narrative of diabetes….we did something wrong to cause the hypo (or the complication, or the high, or the technology failure). And I really tried to explain how sometimes there are no answers, no matter how hard we look, or how desperate we are to find something to blame.

Of course I spoke about the language of lows and how the words we use impact on the way that hypos are considered. There is no doubt that ‘severe’ hypos are serious and need urgent attention and investigation, but so-called ‘mild’ hypos can be just as burdensome.

Obviously, everyone’s hypo stories will be different and I took great pains to clarify that I was speaking of my own experiences only. In the past, hypos have terrified, paralysed and alarmed me. I was afraid to sleep, I was afraid of lows when awake. I was scared I would have a particularly nasty low around my daughter and scare her. I am fortunate that my deliberate non-compliance has resulted in almost no lows, and feeling safer that I have ever felt before. My fear of hypoglycaemia is manageable these days, yet I don’t take for granted that it will always be like this. I still carry hypo food around with me – there is no point tempting the hypo gods by not being prepared!

I’ll be writing more about Hypo-RESOLVE in coming days. I’m so pleased to be involved in such an exciting and interesting project; I’m honoured to have been selected for the PAC. I’m beyond thrilled that PWD are included in the DNA of the project – right from the kick-off, not brought in at the last minute for comment when all the decisions have been made. And mostly, I am grateful that hypoglycaemia is being given the attention it deserves. I honesty hope that one day no one ever needs to feel the panic and fear that so many of us have come to know.

Kicking off the kick-off meeting (Click for source)

You can read all about Hypo-RESOLVE in the Innovative Medicines Initiative media release from last week announcing the launch of the project. My flights and accommodation to attend the Hypo-RESOLVE kick off meetings were funded from within the project. PAC members are volunteers on this project.

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Look who’s taken over Diabetogenic again! Grumps is back to share some wisdom about how he deals with hypos.

We know that when it comes to diabetes, there is the advice we’re given by HCPs. And then there is real life. I wrote about my ’reality versus what I was told’ when it comes to lows a few years ago, and today, Grumps is sharing his wisdom in the latest instalment of #WWGD.

________________________________________

About ninety mins after lunch today my BG started to drop.

It was a nice slow decline so having checked my insulin on board I decided to do bugger all about it and see what happened.

It kept on its slow decent until at about 6.0 mmol/l the carbs on board stalled and it decided to do an impression of a flying hippo and dropped like a stone.

What’s the advice for treating hypos?….

  • 15g carbs
  • Wait 15 minutes
  • BGL check
  • If “blah, blah, blah”……

Load of bollocks!

Hypo hunger kicks in.

So……

  • 4 Twix bars
  • 2 Twirl bars
  • A pre-emptive bolus and…..
  • Falling asleep on the toilet and waking myself snoring….

I land at 8.6mmol/l just in time for dinner!

Live Long and Bolus

Grumps

Want more from The Grumpy Pumper? Of course you do! Check out his blog here. And follow him on Twitter here

Grumps in Vienna

 

There’s a type of low I have.

It’s usually the middle of the night. I’m alerted to something not being quite right – this time, my iPhone beeped. This time I caught it before it became a complete white out hypo that I’ve no real memory of the next day. I switched into autopilot and started to do what I needed to do. I don’t know how it happens; it’s as though I am watching from above, telling myself what to do.

Renza, sit upright.

Renza, grab your meter.

Renza, there are no strips remaining in the canister.

Renza, get out of bed and walk to the diabetes cabinet and get new box of strips.

Renza, check blood glucose.

Renza, grab juice box from bedside table.

Renza, stab straw into juice box and drink, drink, drink.

Renza, go to kitchen.

Renza, cut slice of bread from sourdough loaf on kitchen counter.

Renza, slather bread with Nutella.

Renza, sit at kitchen table.

Renza, eat.

I was methodical, my movements slow and deliberate, almost robotic, like Hymie from Get Smart. I could almost feel my brain actually engaging with each body part, telling me what to do: walk, reach, drink, eat, chew.

I don’t know how long I sat at the kitchen table. I remember starting to focus on the pale light in the back garden and the shadowy figures the huge tree from over the back lane making. I heard Cherry the cat meow quietly at one point.

Renza, go back to bed.

I climbed back into bed, Aaron stirred. ‘Are you okay?

‘Hypo. One of those that I often don’t remember. You know – where you would be forcing me to drink pineapple juice and I’d have no memory of it…?

I stopped for a minute and realised I was cold but still needed to order my body parts to do what I wanted:

Renza, use your arms to cover your body with the doona.

I started shivering as I realized my hair and t-shirt were damp. I was tired, but couldn’t sleep. My overactive brain that had been busily directing my body, telling it what to do, wasn’t ready to shut down just yet. It was on high alert, and as often happens in that post-hypo murkiness, with the power to shut down the negativity completely deficient, all the scary thoughts started flying around. I thought about what could have happened; I thought about the times that the lows invaded everything and I couldn’t function at all, not remembering the spent juice boxes, empty wrappers, crumbs in the bed. The fear and darkness of hypoglycaemia threatened to overtake me and I knew that sleep that night would be lost forever unless I acted.

Renza…close your eyes.

Renza…don’t have another low…

Renza…get some sleep…

Max and Hymie

I’m reading a fabulous book at the moment. It’s called In Other Words, written by one of my favourite writers, Jhumpa Lahiri. My sister introduced me to her writings a couple of years ago, and I have read most of what she has written now.

The backstory to the book is quite lovely: the writer wanted to learn Italian – really learn Italian – and after years of study, moved her family to Rome. While there, she started writing only in Italian, retraining her brain to speak and think in Italian first.

The book is presented in both Italian and English. When the book is open, the left-hand page is in the original Italian and the right-hand side is in the translated English. As someone with basic Italian, I’ve been enjoying reading the Italian words, saying some of them out loud to feel them roll around on my tongue.

I start by reading the Italian side and work my way through, understanding as much as I can. What I find is that I get the general gist of what is going on, but there are gaps. The detail is completely lost at times, but I am able to piece the story together and understand what is going on. When I read the translation, all the gaps are filled in, the detail is there – adjectives provide description and narrative and help round out the story.

I cover up the English page so that I can only read the Italian, but try as I might – as I rack my brain to remember what a word means – there ends up being a lot missing from the story. But there is the safety net of being able to remove the paper hiding the translation when I simply can’t work out the holes in the story, resulting in a satisfying – and full – understanding of the beautiful story.

Yesterday, I spent the whole day feeling like I was living in the Italian side of my book. I trudged through, with a general idea of what had happened overnight, but there was a lot missing.  I’d had a hypo in the middle of the night – a terrible, terrible low. I can’t really say much more because I don’t know what happened. Parts of it are really clear, but a lot of the particulars are completely missing.

Aaron has filled in some of the gaps – how he knew I was low from the way I was moving around in my sleep; how he managed to get me to drink some juice, and then some more before I was fully able to understand him and the situation; how when he reached out to me I was drenched in sweat.

I’ve filled in the gap of the no sensor alarm – problems with the Dexcom app at the moment meant that when I grabbed my phone, angry that we had both missed the alarms, I was greeted with the message ‘Transmitter not found’. That explained why I’d not been alerted to the impending low, allowing me to treat before things turned nasty.

Because of the app problems, there is no data showing how long I’d been low, or the trajectory of my glucose levels. I know that I was sitting in range when I went to bed, and had been for some time. But that was at 10.30pm and this was three hours later. A lot can happen in three hours.

My bedside table was littered with three empty juice boxes and a couple of other wrappers in the morning, letting me know exactly what was consumed until I felt safe again.

I have a pain in my ribs. When I stood up and felt the painful twinge, I thought perhaps I’d had a seizure during the hypo, but Aaron was able to assure me that didn’t happen. The reason for the pain is a mystery, but I know it wasn’t there when I went to bed, yet was when I stood up to change out of my sweat-soaked t-shirt.

I’ve spent the last couple of days trying to piece together what I do know as I endeavour to search for the missing parts of the story. I close my eyes, desperately searching in my mind for a little hint as to what happened before Aaron realised I was low and sprang into action. Or the way I moved that now means it hurts when I breathe.  I wish I could pull away a curtain – or piece of paper – and that would expose the full story.

But there is no safety net here. All I have is what I can remember and what Aaron has been able to tell me. The gaps cannot be filled in; the detail is completely lost. I feel incredibly unsatisfied, and the uncertainty also means that I am feeling very vulnerable and exposed. If I don’t have the full story, how do I understand it all?

And how can I possibly stop it from happening again?

In the lead up to our daughter being born, I was told that it was most likely that she would need to go to the special care nursery immediately after she was delivered because of low blood sugar. This had been the case for most of the dozens of other women with type 1 I’d spoken to beforehand, and I was resigned to the fact that there would not be many cuddles for a day or two.

The reality was a little different. As soon as she was delivered, her heel was pricked and her blood glucose was checked. ‘She’s good to go straight to your room,’ said the paediatrician charged with making sure our precious baby was all okay. He placed her in my arms so I could drink in the beautiful little munchkin

No; wait. She needs to go to special care. I have diabetes, remember?’ I said, as I lay on the table being stitched up after the C-section, looking in awe at the wriggling, full-cheeked munchkin who had just been lifted from my body.

‘Her blood sugar is fine,’ the paediatrician smiled at me. ‘Aaron can take her to your room and as soon as you are out of recovery you can join them. Lots of cuddles this morning – skin to skin contact is good for you both! We’ll keep an eye on her and do hourly BG checks to make sure she is okay.’

An hour later, I was stitched up, out of recovery and wheeled back into my room where Aaron was sitting holding our new daughter. He stood up and brought her over to me, positioning her on my chest and I pulled away my hospital gown and her swaddling so I could feel her against me.

With the help of a wonderful nurse, we started to learn how to breastfeed. There in my arms was our daughter. I couldn’t stop staring at her and couldn’t believe she was finally with us.

My endo walked into the room to meet her, and see how I was doing at the same moment another nurse walked in to do the first BGL check. As I held our baby, I cringed at the lancet going into her tiny, tiny heel and the tiny, tiny whimper she made.

I looked at the nurse and saw her turn white. “She needs to go to special care. Now. Her BGL is really low.’

My ever-calm endo, looked at the result. ‘I don’t think that is right. Can you check again? Maybe using Renza’s meter?’

‘No!’ said the nurse, starting to panic. ‘She needs to go right now.’ And she snatched the baby from my arms, put her back in her crib and headed quickly out of the room.

Go with her!’ I said to Aaron, but he was already on his feet scurrying after our baby girl.

I was in shock. What had just happened? Our baby had been peacefully snuggling with me, drinking in some of the tiny bits of colostrum she could manage. What was the problem?

In the special care nursery, Aaron watched as the doctors and nurses tried and tried and tried to get an IV line into our tiny newborn baby before they finally decided to just give her some formula.

As it turns out, her BGL was fine. They needn’t have bothered trying with the IV. The meter used on the ward was probably faulty. She could have stayed with me and all would have been okay.

But I wasn’t upset – or surprised – because I understood exactly what I was seeing. This was hypo anxiety from healthcare professionals and I’d seen it before.

When in hospital having my appendix out, a nurse walked in when I was checking my BGL. When she saw the 4.2mmol/l on the meter, she insisted a drink two glasses of juice and eat a sandwich, despite my protestations that I was fine and a few jelly beans would more than do the trick to keep me in the safe zone. She stood there watching me as I forced the juice and food down my throat.

In A&E once, an emergency doctor wanted me to disconnect my pump, because it was sending me low, even though my BGL had been sitting pretty in the 5s for most of the time I was there.

Another time, at work, a diabetes educator jumped up to grab me juice and almost shoved a straw in my mouth when she noticed by CGM trace heading downwards, even though my BGL was still 6 and I had plenty of time to treat before going low.

And it’s not just HCPs. In a meeting once, a senior staffer I’d worked with for over two years asked me if I needed a nurse to ‘help me’ after I excused myself for eating a couple of jelly beans because I was preventing a low. ‘A nurse,’ I said. ‘Why?’ I was confused at what was going on. ‘Because you are hypo. To make sure you are okay.’ And then I was more confused because what possible would have ever suggested that this very easy-to-treat hypo would need the assistance of a nurse?

There is a lot of anxiety around hypoglycaemia. Fear of hypos in people living with diabetes and their loved ones can be paralysing. I know that after a particularly nasty or sticky hypo, I get anxious about lows and I see my loved ones watching me more closely.

But I also work really hard to try to keep some perspective about managing them. And those around me know that keeping calm while I’m low and gently asking if they can do anything is helpful, but panicking is not. Interestingly, no one with diabetes has ever been flustered when they see me going low (nor I when around one of my friends having a hypo).

In each of the situations I described above, I needed to do a lot more to settle and reassure the person panicking than to manage my own low blood sugar. Having to calm down the anxieties of others is not really what I want to do while low.

Unfortunately, low blood sugar is a reality of diabetes for many people. I see it as a short term complication – something I do all I can to minimise, and treat as well as possible – that just needs to be managed. Of course, it can be scary. But doing all I can to keep calm yields far better results: I tend to not over treat and eat the whole kitchen when I am calm.

But what I want to know is why so much anxiety from those around us? If we know that the best way to manage a hypo is calmly, rationally and with measured treatment, why the panic? What are HCPs being told about hypos that send them into a spin so they overreact? And what could be done better to ensure those around us help rather than make things worse when we are low?

Calmly. Quietly.

 

I had a low last week that knocked me for six. It certainly wasn’t the worst hypo I have ever had – far from it actually. But it had been a while since I had one like this. In fact, since I started eating low(er) carb. (I’m still reluctant to call it low carb, because I am really not trying to stick to a certain amount of carbs per day. But to give you an idea, it’s a rare day that I eat more than 80 grams.)

But last week, I did. My usual Japanese food takeaway place was out of sashimi which is my favourite quick lunch. So, I ordered a sushi roll and a cup of miso and off I went.

Now white rice is evil to me. It really is. I love it, but have never managed it! In 18 years of type 1, I have never worked out how to bolus for it. I am better (although not great) with pasta and other carb-heavy foods. But rice? Just hopeless! I would just guess, hope that I was close to right and then kept a close eye on my numbers afterwards, correcting as necessary.

On Friday, I was nowhere near right. No.Where. I watched my CGM line start to rise and rise and rise pretty quickly after I ate, resisting the urge to bolus before I hit the upper limit on my graph. And I am so glad I didn’t because after the spike, came the plummet. Insulin still on board, and two arrows pointing down.

I tried to intervene, but it was too late. Suddenly, my lips starting tingling, I realised I was sweating a lot and my thought process was all over the place. I read the same email five times, started five different responses and had no idea what I was trying to say.

I grabbed a juice box, and drank the lot in one gulp. The desperate low feeling of ‘I.Am.Going.ToDie’ overtook me as I stabbed another straw into another juice box and looked around for what else I could consume that would help, grabbing a handful of jellybeans; spooning honey from the jar and pouring some milk into a bowl with cereal.

And then I stopped. I willed myself to breathe, counting up as I inhaled, down as I exhaled, trying to not get the numbers messed up. I concentrated on my heartrate. I walked away from the food on the kitchen counter and sat at the table, focusing on the artwork above the wood-fire oven that the kidlet and I had done years ago when she was only about 5 years old. I thought about us spreading down a drop sheet on the front veranda of our old house, sitting the large canvas on top of it and emptying tube after tube of paint onto it. ‘It’s like a Jackson Pollock painting,’ she said, signing the finished artwork with her name and then adding ‘and Mummy’ afterwards.

Slowly, my heartbeat returned to normal. I could count my breathing without difficulty. I stopped thinking that I was going to pass out. My clothes were drenched from the sweating, though and now I was shaking because I was cold. I gingerly walked into the bedroom, pulled off my top and put on a thick jumper, wrapping a scarf around my neck for good measure.

I looked at my CGM graph on my iPhone and saw the quick spike and the sudden crash – a sight I’d not seen for some time. I lay down on my bed and closed my eyes for a moment, which became an hour and when I woke, the ‘hit-by-a-bus’ hypo hangover had taken over my body.

All this because of a sushi roll gone wrong. It wasn’t even a delicious doughnut or cupcake, I thought. It took me almost 24 hours to get back on track. The over-treating had to be corrected and I tried to not over correct, but that failed and another low in the middle of the night messed me up a little more.

This was a forgotten low. And I’m not particularly inclined to have another one in the near future to remind me again.

Overdosed on all the carbs!

By the time I walked into the office yesterday, I was ready for the day to be over. Horrendous low on my way in (seriously, I hate the two-hour warm up phase when I put in a new or restart a Dex sensor) and the frenzied, gluttonous consumption of as much glucose as was in my car. (For the record –  two juice boxes and large packet of jelly beans.)

A morning mountain of sugar does not start the day at all well with the overdose of glucose pulsing through my veins turning my muscles to lead and my brain to pulp. And it continued throughout the day, with reminders of the rotten start peppering my day, all the way to bedtime when I found four rogue blood glucose strips stuck to my body. They fluttered like butterflies to the ground when I took off my bra. (That sounds a lot prettier and more delicate than it actually was.)

Hypo mornings are the worst. Especially when they involve the guzzling of the equivalent of my body weight in glucose.

I arrived at work 15 minutes late for a meeting, covered in sweat, hair plastered to my head and my sunglasses skewwhiff on my head. Nothing says ‘I’m-ready-for-the-week-and-to-be-a-smart-sassy-expert-contributor-to-an-important-meeting-with-important-people-and-yes-of-course-I-know-what-I-am-talking-about’ like post-hypo glow.

These days start badly. And don’t end well. I take a ‘begin as I mean to go on, and go on as I began’ approach literally, and figure that if beginning with a carb load suitable for an Olympic marathon runner the day before race day, then I may as well keep it up and compete in my own little Olympic challenge: the carb race.

I mean, why not eat a doughnut or two for breakfast next, right? Or waffles with jam AND syrup AND whipped cream?

And of course, I’ll have morning tea. ‘Biscuits,’ you say? ‘I’ll take six…teen,’ I respond.

Sushi rolls for lunch, because today is not the day to work out how to bolus for white rice and who cares anyway?!

It would be rude to say no to the brownies on the counter of the café next door to the office that I am visiting for the fifth time because caffeine is the only thing that is making me remain upright and remember how to string two words together that actually make sense. (So: ‘Yes, another milky coffee please. And sure, add sugar! All the sugar!’)

Pasta for dinner with more pasta and then add some pasta on the side because carbs, carbs, carbs. And the chocolate chip cookies that the kidlet made over the weekend as treats for her school day lunchbox make excellent treats after dinner for carb-mummy.

And while this is all going on, I am bolusing, bolusing, bolusing; insulin stacking, insulin stacking, insulin stacking. And chasing my tail because of course I end up low and then high and then low.

I know, I know. I didn’t need to keep the high carb day going after my breakfast hypo. But sometimes, when the days starts off going to hell in a handbasket, sometimes, I can’t work out the way (or be bothered) to salvage it. And I wonder what is the point of limiting my carb intake for the rest of the day if the floodgates were jammed open before 9am.

I climbed into bed last night exhausted. Exhausted from the low that started the day, the sluggishness of so much glucose still in my system and a day of peak-and-trough glucose levels that always make me feel listless. I said a silent prayer to the diabetes angels to please, please, please let me sleep through the night and not be up all night weeing out the sugar due to the glucose overdose, or needing to treat a low due to the likely insulin overdose. I pleaded for balance and flat-lines and an absence of alarms.

I woke this morning with the slight hangover the comes from too much sugar and a day on a rollercoaster. Waves of nausea wash lightly over me occasionally, reminding me of the day before. Delicately, I am stepping through the day. Watching my CGM trace, reacting gently, eating cautiously, dosing warily. And cursing diabetes. Completely and utterly inelegantly.

On our last full day in New York, we walked down some stairs to the subway. My phone started vibrating and beeping and I knew that I was heading low.

I hadn’t really managed to get the whole hot-weather-walking-a-lot thing sorted out on this trip. I dealt with insane Conference Hypo Syndrome from literally the second I stepped foot into the conference centre in New Orleans, and just managed by setting a lowered temp basal rate and drinking a lot of juice.

And then, we were on holidays and while I know diabetes is for life, not just for X-mas, I couldn’t be bothered ‘doing diabetes’ and being smart about making some changes and addressing the lows properly.

For the most part, I was right. I responded to the rapid fall warnings on my Dex and avoided any super-nasty lows.

But this day in the New York subway, I was already firmly in ‘deal with me now’ hypo territory. I had a bottle of juice in my bag, but walked into a little kiosk on the platform to see what I could use instead. And there before me I saw these:
And I squealed.

‘Oh my god. Babe. BABE. LOOK!’ I said to Aaron as I grabbed a couple of packs and started to open them before paying. I think he fished out a couple of dollars from his pocket to pay the guy who was watching me carefully. ‘I love these,’ I announced loudly. ‘Green apple Mentos! I LOVE these!’

Aaron corralled me back to the platform and we sat down waiting for our train and I started to munch my way through the pack.

Want one?’ I asked him, pushing the tube into his face. ‘No thanks. I don’t like green apple flavour.

This was a fact I knew well because every time I mention how much I love green apple flavour, he reminds me he doesn’t.

‘What? WHAT? Of course you do!’ I said. ‘It is the best flavour ever. EV-ER! Remember? It is everywhere in France. Remember, babe? Remember? And there was that time that I found green apple Mentos in Melbourne at a servo and got so excited that I bought, like, 40 tubes. Remember? Have one… Have one babe.’

‘No, I’m okay,’ Aaron said. He went back to reading something on his phone.

‘Babe. Do you remember that time at the servo? I told you, right? I was really low and I went in and saw them and got excited and was ranting and raving to the poor attendant about how excited I was and how I’d never seen them in Australia. Do you remember? The guy thought I was really weird because I couldn’t stop talking about how excited I was and how much I love green apple flavoured lollies. Do you remember?’

Aaron shut off his phone and turned to me. ‘I guess I’ll read this later,’ he said smiling.

I ignored him and continued. ‘So I told him how green apple flavour was EVERYWHERE in France, but not here in Australia and how you could get green apple gum and soft drinks and heaps of other stuff and how I love it. LOVE. IT! Remember how it is everywhere in France? Yeah? And then I asked him how many packs of Mentos they had and I dumped them all on the counter and bought them. I spent, like, sixty dollars on lollies. Green apple lollies. I was so excited and speaking really quickly. Like, super quickly. Almost ranting. Like the fast talked in Seinfeld. Remember Jackie the lawyer in Seinfeld? I was talking really, really fast. Like that.’

‘Kind of like now?’ Aaron asked.

‘Am I? Am I? I am… Aren’t I?’ I said. ‘Yeah – I guess. Maybe it’s the green apple. Do you think that’s what it is? Do you, babe? Could it be the green apple? I LOVE green apple flavour! I should have bought more. Will I go back?’

‘I think it could be because you are low. And I think maybe you should eat a few more of those Mentos instead of just speaking about them.’ Aaron said gently.

‘Do you want one? They are great! I love this flavour!’ I asked.

The train pulled into the station and we found a seat. I checked my iPhone and saw that I was no longer dropping. I took a deep breath and looked around the carriage.

‘I really like green apple flavouring,’ I murmured to Aaron. He reached over and took my hand.

‘I know. And you’re really funny sometimes when you are low.’

I rested my head on his shoulder and concentrated on my heart rate, which was slowing down. By the time we got off the train I was feeling fine. And happy. Because tucked away in my bag was a yet to be opened packet of green apple Mentos.

How’d your day start? Mine has been a blur of low blood sugar since the early hours. My head is in a fog, and I am confused at the insulin sensitivity that seems to have moved in and made itself at home. I am also slightly buzzy, (and more than a little bloated!), thanks to the 1750milliliters of juice I have consumed since just after 2am. That’s right: a litre and three quarters of pine-orange juice to keep my BGLs above ridiculously low levels and silence my Dex alarms.

It played out like this:

2.30am – After sleeping through 30 minutes of low alarms, I woke with a start and downed a whole juice box, not even thinking that I’d try for half and then see how I was going – because, really, I just wanted to get back to sleep. But with my alarms still screeching, my Dex still sitting below 3mmol/l and the obvious hypo fog settling it, I downed another box quickly. And, after 60 mins of low alarms, another box.

I spent 90 minutes or so desperately watching the Dex app on my iPhone, waiting for the trace to rise, (and wondering how the hell two adults with perfectly good hearing could sleep through the alarms!), all the while engaging in what this morning appears to be a most bizarre Twitter conversation with some UK friends. (Not sure what’s their excuse for the odd and slightly inappropriate exchange; their glucose levels were apparently fine.)

Eventually fell back asleep around 4.00am with three juice boxes spent on my bedside table and my Dex line sitting comfortably and arrow-less in the mid-fives.

7.00am – Morning alarm coincided with Dex screeching at me with an urgent low alarm, which had been going for about 15 minutes. More juice – this time just one box – before gingerly starting the day, keeping a very close eye on my CGM numbers, which refused to go above 4.7mmol/l. But at least they were staying steady and not dropping. Until…

8.50am – As the kidlet was loading herself into the car and I was speaking to my neighbour from two doors down on the street, another alarm. This time, the fall rate alarm showing a BG that was dropping quickly from 4mmol/l. Kidlet unloaded from my car into neighbours car for school run, neighbour shouting at me to stop talking and go get some sugar, me heading inside for another two juice boxes because one wasn’t cutting it.

Each juice box has 27.5 grams of carbs. I’ve had seven of them this morning. That’s a shedload of sugar and I feel nauseous, foggy and exhausted.

This is not the first time I’ve had a day like this. In fact, I’ve had a few.

And I have done the checklist for what it could be:

Lost weight? – Nope.

Weather warmed up? – No; it’s freezing!

Exercising more? – Don’t be ridiculous.

Other health issues? – No (except a head cold and that would not make me hypo).

CURED? – Well, maybe… although probably not.

There is no rhyme or reason to this at all. There is nothing I can point to change or fix. I just lower my basal rates, under-bolus and have stopped pre-bolusing for meals. I also am very cautious with correction boluses because most of the time, they are just not necessary. This is just a weird period of extreme insulin sensitivity. It’s happened before, lasted a month or so and then things went back to normal.

I expect that will be the same here too, although the complicating factor is that on Thursday I am heading to New Orleans, where the heat, conference hypo syndrome and the fun of travelling WILL be a factor in making me go low a lot.

I’ve made some changes to my low alarm thresholds so I am notified of impending lows sooner. I’ve made a couple of little tweaks to my basal rates. I’m making sure my phone is NEVER out of sight so the chance of a Dex signal loss is almost impossible. And I’ll just wait. Because sometimes that’s all there is to do.

A far too familiar sight at the moment.

 

I am not a micro manager. In fact, with the team I managed in my previous job, I was possibly the furthest thing from a micro-manager, instead working with the team to get them in a position where they were adequately able to manage their own responsibility areas, while I gently stood in the background helping out when I needed. I was there to advocate and champion for the team as a whole, and team members individually and fly the flag of ‘hey-speak-to-people-with-diabetes-before-you-plan-things-for-us’.

However, in the last few weeks, I have become a micro manager. Not of people. Of my diabetes and the results are not good.

In fact, the results look like this photo Aaron took at some point over the long weekend.

Photo credit: Aaron (who captioned it with 'Renza: I don't like Zappa when I'm hypo.' Which is true. I was finding him quite grating at the time.

Photo credit: Aaron (who captioned it with ‘Renza: I don’t like Zappa when I’m hypo.’ Which is true. I was finding him quite grating at the time.)

I had been in hypo city for a while, which is not a nice, fun place to visit. It is awful and it seems that once you get there, the only accommodation is Hotel California-esqu.

I have been over-responding to every impending, suggested or even hinted at high, when I should have simply sat back and waited. Insulin takes time to work – that’s just a sucky fact. I don’t always remember to bolus before I start to eat – or ten minutes before as required at times – and sometimes the delay means that I wind up a whole lot higher than I would like before the insulin can do its thing.

I found myself low about 45 minutes after I had just eaten a huge Easter afternoon tea because I was jumping at ghosts – or rather, rising lines on my CGM – instead of waiting for the bolused insulin to do its trick and cut through the higher fat content food I’d been eating. So, I bolused some more.

Where I should have been sitting tight and being patient, I would second-guess and do something (for the sake of doing something) – and often get it wrong.

This is the other side of CGM. (Disclosures abound about how fortunate I am to have access to this tech. I know all of that. Disclosure also that I love this technology; it is amazing.) The flip side is the over-management and that is where I found myself for most of the long weekend.

Remembering my basic principles of management (whether for people or diabetes), I have spent some of this week stepping back. I’ve not jumped in. I’ve waited more to see what has happened. Watch – Listen – Learn have been the three things I tell myself before leaping in to act. I’ve stopped reacting at any upward trend, thinking about how much insulin is on board yet to do its thing; how long the food I’ve eaten takes to digest and whatever other myriad factors need to be considered before giving myself more insulin.

I hate being high, so I understand why I try to avoid it. But I also hate being low. I’ve yet to find balance in diabetes, and in all honesty, I don’t think I ever will.

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