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There is one word – actually an abbreviation of a word – that strikes particular fear through every fibre of my body: ‘Gastro.’ I hate even talking about it. Just typing the word sent a shudder down my spine. (I am nothing if not dramatic…)

A work friend and colleague was telling me about how she had been struck down with gastro a couple of weeks ago – a lovely gift from her kinder-aged daughter. Just the mention of the nausea and vomiting was enough to have me sweating and getting nervous. For the record – and so you understand my irrational fear of the topic – we weren’t sitting next to each other in an office while she was telling me. She was on the other end of the phone. Two states away in Queensland. I was in Melbourne. And yet I was still looking around me wondering what I should disinfect.

A couple of weeks ago, on a Tuesday night I went to bed with my plans for the next couple of days clearly organised and sorted in my head. I had a most-civilised mid-morning flight the next day, and then a couple of days of meetings in Adelaide. I’d booked a cab, checked in online for my flight, half-packed my overnight case and mentally gone through the check list of what needed doing in the morning before I needed to head to the airport.

And then, a couple of hours later I woke up startled, with a very unsettled feeling in my stomach. ‘That doesn’t feel good,’ I said to myself. I lay there for about thirty seconds trying to convince myself that it was all in my head and I was fine and that it would be best to close my eyes and go back to sleep. Before I jumped up and ran to the bathroom, making it there just in time before vomiting. For the first time.

I spent the next few hours alternating between throwing up and being flaked out on the sofa willing myself to not throw up. I was cold and sweaty and hot and clammy all at the same time. My heart rate was racing, and every time I stood up I was dizzy. I gripped onto the walls as I stumbled down the corridor to the bathroom, tripping over nothing but my own two feet.

At about 6am, I sent an email out saying I wouldn’t be getting to Adelaide and cancelled my flight. I crawled back into bed, still nauseous, thinking the worst was behind me. For the most part, it was. I threw up a couple more times before my official alarm went off at 7am.

I feel like death,’ I told Aaron. ‘And I bet I wind up in A&E.’ I used some choice words, mostly words beginning with ‘f’ and ending in ‘uck’, and started to work out how much time I’d lose in an emergency bed having to deal with HCPs wanting to remove my devices from me and ‘look after’ me.

‘Should I stay home?’ asked Aaron. ‘I can take you in that way.’ I told him it wasn’t necessary and that if I really needed to get to hospital my dad could take me. He got ready for work and the kid got ready for school and the two of them left, leaving me in bed, switching between dozing, holding my tender stomach and glaring at my iPhone and my Dex trace. I was hoping if I stared daggers at the trace hard enough it would stay in range.

My Loop was working overtime. I spent most of the morning between 3.5 and 4mmol/l thanks to my Loop cutting off all basal insulin. By about 11am, I could see my CGM trace starting to inch up closer to 5 and then 6, and Loop was making tiny micro adjustments to my basal rates.

I was able to keep water and some dry ginger down, and chewed on small blocks of ice. I didn’t feel dehydrated; I wasn’t going high. I didn’t have ketones. Things were looking good!

By 1pm, I was feeling comfortable enough to call into the meeting I should have been at in Adelaide. My nausea was less pronounced. I felt washed out, achy and tired, but I hoped I was out of woods, and needing to go to A&E was becoming less and less likely. Thankfully.

I have generally been pretty lousy at managing gastro and diabetes. I usually do end up in A&E, needing to be rehydrated and given some anti-nausea meds though an IV as I’m unable to keep them down after taking them orally.

But of course, it ends up being far more of an ordeal than simply lying on a bed with fluids being pumped into me. There is the inevitable request for my insulin pump to be removed so that insulin can be administered via IV – even if it’s clear my pump is working just fine.

Nurses insist on checking my glucose levels, refusing to pay any attention to the CGM spitting out readings every five minutes. My requests (demands?) to self-manage my own glucose levels – and diabetes generally – are ignored. I’ve no idea what would happen if I tried to explain the DIY APS thing I have going on these days, but suspect that wouldn’t go too well.

Usually, it takes me making an emergency call to my endo for things to go the way I really want them to – fluids, dark room, anti-nausea meds and home in about 4 hours (at the most).

By the time I leave I often feel worse for wear – and certainly more battle scarred – than I did when I first walked in there, doubled over and trying to not throw up on anyone.

But I avoided all that the other week. I managed to spend the day in the comfort of my own home, breathing in fresh air from the open windows and generally feeling comfortable and content. The only gastro hangover I had was a little exhaustion and abdomen discomfort. All in all, it was a good outcome. (But I’m still terrified of the word ‘gastro’…)

A much preferred view to a cubicle in A&E!

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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.

 

Fade in to bedroom in middle of the night…

Diabetes: Helllloooooo! It’s me; Diabetes!

Me: Piss off!

Diabetes: Rude! You don’t like me very much, do you?

Me: Um…no…It is 3am and you have just woken me up. I guess you’re okay. I mean…I guess.

Diabetes: Pfft. You’re a lousy liar. I hear the words you use when talking about me. We should discuss your language. You swear like a trucker a lot of the time.

Me: My language? You want to talk about my language? It’s 3am. I’ll tell you what you can do with my fucking lang….

Diabetes: Yeah – that’s what I’m talking about…

Me: Well this has been fun. I might go back to sleep now.

Diabetes: Oh – I’m not done yet. We have so much to catch up on. Let’s talk.

Me: About what…?

Diabetes: I was wondering… Do you think there is any way that you could like me? Any way at all? What would I have to do?

Me: Is leaving me alone and finding a way for my beta cells to start working again an option? Could you do that for me?

Diabetes: Not so much.

Me: Okay. Is just being in the background and not bothering me and responding the same way to the same things each time an option?

Diabetes: No. Not really.

Me: Um…is never again waking me in the middle of the night a possibility?

Diabetes: Again, no – I get lonely and it’s fun to have you around when it is dark outside.

Me: Okay. Then to answer your question: no. I don’t believe there is any possible way that I could like you. In fact, I think that I will pretty much dislike you for the rest of my life. Which I hope to be a very long one. We have nothing in common and you have no redeeming qualities. So…

Diabetes: I’m sad to hear that, my friend…

Me: I am not your friend.

Diabetes: Whatevs.

Me: That is not a word.

Diabetes: Totes is.

Me: It is not. And neither is ‘totes’ unless you are referring to a bag.

Diabetes: You know; you’re actually kind of annoying.

Me: Pot. Kettle. Black.

Diabetes: Use verbs!

Me: I had no idea that my diabetes was so into grammar and language.

Diabetes: Yeah – I love it. And punctuation.

Me: You do?

Diabetes: Yep. I do.

Me: Wow. That’s kind of interesting…

Diabetes: It is, isn’t it?

Me: I love punctuation, too.

Diabetes: I know. I can’t decide if my favourite punctuation symbol is the interrobang or acclamation point.

Me: Oh – they are two of my favourites as well! … So, what else do you want to say to me?

Diabetes: Oh – just this…You’re low and probably should do something about it.

Me: What the fuck‽

Diabetes: Renza! Language! Drink some juice. (But excellent use of an interrobang!) … Also, if you find yourself talking weird punctuation marks with your chronic autoimmune health condition – I’d suggest that you think about what could be going on with your glucose level. And then do something about it.  

Renza: Do you know what this punctuation mark is:

sarcmark

Diabetes: No. What is it?

Renza: It’s a sarc mark. And this one? This one is a snarc mark.

snark-markRenza: You should consider pretty much everything I ever say to you to conclude with one of those – take your pick.

Diabetes: That’s not very nice.

Renza: Neither are you.

Diabetes: Drink some juice, you moron.

Renza: Don’t tell me what to do! Great; now I’m wide awake.

Diabetes: And it would appear my work here is done. See ya…

Fade out to sound of expletives, all  punctuated with a certitude point.

certitude-point

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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