hypoglcemia - Carol
HI,
I wanted to tell you that I asked him about the insulin, and lows
tonite. He said that the problem is: he snacks too much and then
takes too much insulin. He said in the past, it seemed to work, but
in the last couple years, he may snack, check his blood and it might
be 173, then take insulin and a couple hours later his BS might
still be 142– so, guess what? Yep, he takes more and then it
doesn’t drop until during the night. I wonder what causes it to
take so long to drop down???
I checked out that Sentry watch web site and I’m going to see if our
insurance will cover it– it looks like that could help. Have you
seen it?
Randy
April 27th, 2004 at 5:37 pm
I have never seen the watch. But….that’s funny because a little while ago I told my husband that I bet he was eating more than what you knew and that was why he was injecting more.
Carol
April 28th, 2004 at 11:47 am
Compare the lows time to the last time he injected the Nova Pen. I believe it’s at 3 - hour duration. During that two hour window with the onset of the Lantus which is 6 hours, he is probably hitting the lows. Probably cutting back his injections or dropping a couple units of Lantus at night comparing to the wine amount may help stop the lows.
He needs to remember that the wine initially makes insulin work harder but the end result is higher sugar hours later.
I drink wine at times, it’s really not worth the price you pay but, hey, we all have to have some vice in life.
Take care,
Carol
April 29th, 2004 at 10:37 pm
One of the most dangerous things about running low all the time like
that and having frequent hypos is that eventually he will loose his
warning signs. This means he will go from awake and fine to passed
out with no time to treat hypos.
I never inject when I drink wine - although i sometimes do for cider.
You should never test your blood within 2 hours of eating - it will
always be a bit higher than you want it to be!
I was told that you should never inject without eating - infact - not
to even test between meals unless I thought i was hypo or about to
drive or exercuse. I’m in the UK so we use different units, but the
DVLA (the people who issue driving licenses) say type 1 diabetics
SHOULD NEVER DRIVE if we are below 5 mmol/l and that we should check
our blood at least every 2 hours while on teh road. Also your brain
takes about an hour to fully recover from a hypo - you might *feel*
OK but your responses will not be up to scratch.
With regard to exercising that someone mentioned - I go to teh gym in
the mornings. I used to get very frustrated with having to eat -
whats the point in exercise if you have to stuff yourself with food
first?! Now I count carbs I’ve pretty mcuh cracked it. I lower my
background insulin (insulatard) by 2 units for my morning injection,
and instead of doing 1.5 units of novorapid for every 10g carbs I do
1unit for my breakfast (this takes my usual breakfast novorapid dose
from 5 units to 3). Then I go to the gym, and don’t need to eat! In
teh 3 months that I’ve been doing this I think I’ve needed an
emergency OJ about twice! I do have to keeo an eye on my sugars for
the rest of teh day - sometimes I can hypo at about 4pm even if I
have had the usual for lunch, but mostly I’m fine.
Jessxxx
May 2nd, 2004 at 8:07 am
Randy–Your husband sounds like SO much of a carbon-copy of me up until a
few years ago, it is spooky. I have, on several occasions, counseled couples
dealing with situations just like ours. So, I will do a bit of cut-and-past
down
below, rather than re-inventing the wheel, of advide I have given in the past.
Just be very aware– It’s not a Watch that will help, or your vigilance, or
keeping food by the bed, or nagging, or anything. This all has to do with HIS
behaviors. sigh–I know how difficult this is, BUT–just to inspire–there is a
way out of this, back to a fairly normal life. I’ve been married for 30 years,
and been diabetic for 39 years, so trust me–I know…
Several things contributed to saving both my life and my marriage. I’d been
diabetic for 9 years when my wife and I were married in 1974. Until the early
1990s, things went along pretty much on track, until I too lost my early
warning signs for hypos. It seemed that I also began to have more hypos,
plus I couldn’t feel them coming on far enough in advance to do anything
about them. I had always had the occasional low, but I’d feel shaky and eat
something. Or I’d wake up at night drenched in sweat, but at least I’d wake
up.
Then, I began to pass out at random times, almost had several car crashes,
wandered away from work one day and was found unconscious by the side of
the road by paramedics and ended up in the ER, and I woke up with
paramedics and ambulances in the driveway on a dozen occasions
throughout the ’90s. During these 10 years, things went from bad to worse in
our relationship–my wife had a hard time trusting me and felt like I must be
doing something wrong. I felt like a ticking time bomb waiting to detonate. We
became very alienated. We were also raising 2 children then, so I understand
the entire range of issues. When my daughter came home from school one
day toward the end of her senior year in HS and found me passed out, had to
call 911, and my wife came home to emergency vehicles in the driveway, she
insisted that it had to “be fixed medically”, or she would no longer tolerate
it.
The doctor insisted I test before I get behind the wheel to drive, and that I
run
my sugars between 150-200. I found that range unacceptable, and began to
research hypoglycemic unawareness. I found out that it is commonly
associated with 3 things: chronic low numbers, 20+ years duration of
diabetes, and switching from beef/pork insulin to human rDNA insulin.
The frustrations and difficulties of dealing with a diabetic husband in denial
of
the difficulties family member also face are enormous. I was that kind of
diabetic for quite a while, and it does put a lot of stress on the individuals,
not
to mention the relationship. From the point of view of the diabetic, let me
attempt to explain something, which does not in any way excuse the
behavior, but may help to understand it. We’re scared of high readings. We’re
scared sh!tless of them–they represent the bogeyman of complications,
unseen, wrecking our internal origins. If high readings are our enemy, it must
follow that low readings are our friend. Faulty logic, we realize, but
nonetheless, the more time we spend low, the faultier our logic becomes and
the less we can feel our lows, until this sort of twilight edgy state of
consciousness becomes accepted as nearly normal. It makes us edgy,
nervous, paranoid, stubborn and, unfortunately, enormously resistant to
seeing how “off” we are and trying to change it. It makes us resistant to
suggestions that we need to change anything. And it’s a vicious cycle–Afraid
of highs, we drive our sugars progressively lower and lower. the lower we get,
the less we “feel” low–in other words, when we live at 90 and seldon venture
lower than 75, 65 feels pretty bad. But if we live at 70 and often venture down
to 55, we barely notice 50.
That’s a VERY small range, when you think of it– between 75 being just
below fine, and 55 being just above whacky–only 20 points. There’s no
clinical difference between the 20 points separating 85 and 105, but a HUGE
difference between 55 and 75. The more time we spend in the 70’s and
lower, the less we feel it affects us, and the less we feel it at all. A
diabetic
can dull their sense of alarm and danger by spending too much time in this
neighborhood. There IS one fairly certain way out of this–it requires a lot of
dedication and hard work. One needs to scrupulously avoid a reading below
80 for two weeks. If he can manage that (and he can–IF a coalition of
friends, family, doctor, employer, whoever can be enlisted for support
tightens the screws) than he will recover his own internal sense that these low
readings are bad. It’s a form of intervention that took me from a twilight of
nearly 10 lost years of my life into a fully functioning person. I remember
doing many stupid things–being outside working in the yard, or shoveling
snow, lost track of time and eating, went too low to know or care, figuring,
“Whatever…”, then wondering why, when my wife finally pulled me in to eat
when I was way too low to stop and figure it out myself, why someone hadn’t
taken better care of me sooner… And her being really mad at me for letting
myself get like that, and me being mad at her for letting me get like that…
and
around and around.
It’s HIS fault, and it’s NOT his fault–after a certain point one’s thinking
processes are probably slightly impaired on an on-going basis, and if one
spends a lot of time low, one likely has never sufficient glucose in the system
to built up one’s counter-regulatory store of glycogen in the liver to allow one
to fight off lows internally. He requires a time-out, as we say in Special
Education, both for his mind and the body. He needs to repair thought
process and liver response to hypoglycemia. He need to back off a
dangerously tight degree of control. His readings and his mis-use of insulin
are out of control, and he is courting permanent brain damage, which will
scar memory, judgement, reaction time and mental acuity.
I lost the entire 1990’s to the fog of hypoglycemia. I dragged myself back
through fear, guilt over the hurt I’d inflicted on my wife and children, a
couple
of near-misses in the car and one wake-up fender-bender, two 911 calls at
work and several more at home, and a desire to stop being a ticking time
bomb. I wanted control, not just over the diabetes, but over myself. It takes
incredible patience, determination, strength and willpower to do it. Read him
the riot act. Call the doctor and insist that the doctor read the riot act as
well.
Your husband may think he’s protecting loved ones from a tomorrow of
blindness, kidney dialysis, and amputations, but you get a today of anger,
frustration, danger, hurt, emotional torment and confusion. Look into his
eyes and ask, “What are we going to do about this problem?”
My hypo awareness has fully returned, my life is a normal productive one,
and my fears of accidents, unconsciousness and worse are gone–this ticking
time bomb finally feels defused, and my life has been returned to me. My
sugars are stable for the first time ever, my moods are level and my life is
predictable. My relationship with my wife, although damaged and strained by
those years, is healing and growing back together. I lost 10 years of my life,
and caused 10 years damage to my marriage. My children had a dad who
functioned like a binge alcoholic for much of their childhoods. I still have
lows,
but I feel and treat them, they are never my wife’s problem. I test often, at
least 5 or more times a day, and always before driving. I treat highs with
extreme caution, and give correction bolus shots for them VERY carefully. I
also treat lows with extreme caution, because OVERTREATING the lows is as
dangerous as overtreating the highs–both mistakes put you on that yo-yo
roller-coaster of up, over-correct, down, overeat, and on and on… Your
hubby’s snacking is NOT a good thing, and neither is his drinking–both make
it increasingly difficult for him to maintain the kind of control you both
desire.
Your description of his behavior was chilling, and tells it all to me: “If he
nibbles on some sweets or carbos, boom–time for a unit, and on it goes like
that. If his BS readings rise above 110–boom- another unit.” This is a
behavioral/Lifestyle change you MUST INSIST he change. A correction bolus
can NOT be take for a reading below 175-200 without risking a low EVERY
SINGLE TIME! Shooting continuously for “nibbles on sweets or carbos” also
insures overlapping bolus doses, as Novolog stays active in the system for 3
hours. He has GOT to accept a more controlled, regulated and moderate
lifestyle, there is nothing tosay about it.
My thinking processes today are clearer, and my emotions more stable today
than I can EVER remember. I feel cheated to have been put through it, but
blessed to have finally escaped. You CAN help. HE can do this.
good luck,
Michael
May 10th, 2004 at 3:53 pm
Judith–I agree with most everything you said in your last posting, but I think
you did lose sight of one important point I was trying to make to Randy about
her husband. (and, ok, i have a few less year of diabetes under my belt than
you do, but more years as an adult, so we even out there…!) My point is
this–
under the circumstance described (which mirror my own–and MANY others’–
in remarkable fashion), the very things which should and would allow the
diabetic to take responsibility, to judge, evaluate, accept OR deny
consequences, etc.–these mental, emotional and psychological facilities
have been compromised by the diabetes at that point. Chronic hypoglycemia
and chronic roller-coaster up and down of blood sugars messes with your
abilities to judge, evaluate, interact and, in fact, conduct your own affairs
with
a degree of normal functioning. It is like a form of subtle Mental Illness (and
I
work with the mentally ill, so it’s my professional observation, not just a
casual
guess…). I’m not saying the diabetic under such type of “control” is always
out
of their mind–far from it, and that’s the difficulty. They THINK they’re okay
all
the time, because they mostly manage to keep their lives together–but just
barely. They CAN hold down a job, do the work, keep track of most things
and appear to be responsible and functional. But they are, in truth,
functioning in a twilight awareness, where mental processes are always
somewhat compromised. I’m not speaking here about the condition caused
by the occasional bad hypo–that it bad, but fades quickly. It’s CHRONIC low
and yoyo sugars over many months and years which finally add up to this
condition. It is not well-understood, but may have something to do with how
the brain conserves its unreliable and meager rations–but it can be reversed
before memory and function are permanently lost. At the point Randy
describes (and which I was at as well), leaving it to the diabetic himself to
sink
or swim on what resources he has left is not all that great a piece of advice.
Yes, good–DO take care of yourself and your children. But–and here’s the
rub–DO also help that damaged husband, even if he seems to refuse help. If
a drowning man pushes away the life preserver because he wants to drown,
okay, you could say that was the decision. BUT–what if that drowning man
pushes away the life preserver because he’s breathed in so much water that
his brain is short of oxygen and he’s not able to think straight and make a
decision? If a person is judged unable to think straight, I feel it is proper
for a
loved one to take matters into one’s own hands and lend help–even insist on
it.
Michael
May 12th, 2004 at 4:12 am
Judith–I’m never disquieted, and no apology is necessary. I understood that
you were ” talking aggregately” (nice phraseology!), so no need to be sorry.
An intelligent, informed (and opinionated…) discussion is always a good thing
as long as no one is too attached to the rightness of their own opinions/
experiences to the exclusion of those of others. I’m certain neither of us fits
into that “Addicted to Dogma” category. I was interested in your point which
compared the uncontrolled diabetic to ” the bi-polar who refuses medication.”
Yeah, been there–or the post heart-attack patient who wolfs down pizza, or
the lung-cancer patient who continues to smoke… I visit some of these issues
all the time, with friends and family mambers. I don’t have an answer, the the
questions keep bugging me. Perhaps if I WAS more dogmatic, I would be
able to issue either a blanket condemnation or excuse to these types–but, it’s
seldom so black and white–as we say in Taoism, in the larger part of yin is the
smaller part of yan. In truth there is always falsehood, so in certainty there
should always be doubt! Maybe that’s why my hair is turning grey!! No black
or whites allowed…
smiles,
Michael
ps–Jeff–good point, about the “Less talk, more action” advice–you for sure
cannot debate a hypoglycemic diabetic!