Taking care of the first middle of the night hypo

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Back when I was first diagnosed with type 1 diabetes, I was taking 10 units of Lantus (long-acting basal insulin) in the morning, and another 10 at night, with each dose 12 hours apart. After I'd been doing that for a bit, my endocrinologist suggested that I do the 20 units of Lantus all at once, so I began to take just one injection of Lantus, before bed, with double the dose.

It was great to have one less shot to take, but that small joy did not come without issue. It did not take long for me to realize that I needed to come up with a system to make sure I didn't make any mistakes. My type A personality, combined with the newness of diagnosis, had put me off my game. I ritualized separating the gray Lantus pen from the blue Humalog pen, for a while even asking someone else to look at the pen, clicked all the way to 20, to verify that I was taking the correct insulin at the correct dosage, as a double safety measure.

I didn't have access to my Dexcom CGM (continuous glucose monitor) yet, so I was not sleeping well at night. I was frightened of having a dangerous low blood sugar event while sleeping, so my quality of rest was very low. Combined with a high-pressure, 40+ hour/week job, I was truly burning the candle at both ends.

It would come as no surprise that after a while, I would experience two of the scariest mindgame situations a tired diabetic on injections can encounter: 1) being unable to verify if I had just injected 20 units of Lantus, as desired, or if I had mistakenly injected 20 units of fast-acting Humalog (I never actually made this error, but it didn't stop me from spending the half hour after dosing imagining the terrifying situation coming true, until I realized my blood glucose was steady and I was imagining a problem that didn't exist) and 2) not being able to remember if I had taken my Lantus dose, which could potentially mean either not taking it at all (causing dangerous high blood sugars) or taking it twice, which would mean dealing with constant quick carb consumption for 24 hours until the Lantus ran through the cycle.

The night I couldn't remember if I'd taken the injection twice on accident (I had only taken it once), I remember girding myself with the infinite wisdom of anonymous advice online (before I had discovered the helpful and friendly DOC [diabetes online community] and was reading through some pretty scary and uninformed chat boards) and full-sugar content sodas in my nightstand. I set my alarm for every two hours to check my blood sugar. When I got through the night without incident, I realized I had not double-dosed, but I left the soda in the drawer as a safety blanket. I've been doing some straightening up in my room recently and debated getting rid of the sodas, but my sharp and nearly infallible instinct won out, and so there in the drawer they remained, waiting for the day/night that I hoped would never come, when they would earn their keep in the top bedside drawer.

With nearly two years post-diagnosis under my belt, I've become so much wiser and savvier than I was in those first few months. I have a CGM and a pump; I've figured out how to practice high-intensity exercise without danger, and sleep much easier knowing I have my technology safety net and superb mind-body connection. Despite all of that - this morning, that stale can of Dr. Pepper had the hero moment for which it had been waiting.

I awakened to excruciating pain in my left foot, which is currently enveloped by a walking boot (tendonitis, old dance injury). Knowing that I had an early wake up call, I tried to ignore and keep sleeping. Once I was semi-conscious from the pain, I heard the beep-beep-beep-beep of the Omnipod letting me know my three days are nearly up, but I tried to sleep through that as well. Then my CGM receiver buzzed, letting me know it was time to calibrate the re-started sensor. Exhaustion (and knowing my alarm was set to go off in a few short hours) kept me from waking, but the pain in my foot increased in intensity, and no position I tried would relieve it, so I sat up slightly with the intent of taking some ibuprofen and hitting the pillow again. The symphony of my diabetes technology was begging to be addressed, so I popped a fresh test strip into the meter to provide the CGM with the first calibration point.

THE NUMBER ON THE SCREEN WAS 34.

"Treat your low blood sugar!" the meter flashed. I'd never been so low. I stared at the number for a moment/an eternity, then in a smooth movement, slid up into a straight-backed seated position, rolled over to turn on the lamp, opened the bedside drawer, and produced that can of Dr. Pepper that's been waiting for a chance to serve since those first few months after diagnosis. My brain screamed at me with the intensity of a drill instructor: "This is not a drill! You've trained for this! You know what to do, now do it!"

YO, LOW BLOOD SUGAR:

I popped the top and drank, drank, drank. I took stock of how my body was feeling...which was fine. That's almost scarier than an extreme hypoglycemic experience itself, knowing logically that you are so low, but feeling "fine". I kept pinching my fingers to see if they were numb and tingly, or feeling my forehead to seek a band of sweat, but the symptoms simply weren't present.

Once my meter confirmed I was out of the woods, first at 77, and then firing straight past my target zone (oops - overtreating almost seems warranted in a situation such as this), I breathed calm and mindful, expressing gratitude for the ability to wake and treat without complication, physical or mental, and also that my newly-diagnosed self left that can of soda in a place where confident, future me could reach for it in a moment of what could easily have been a very serious crisis (but was not).

I will be tired when my alarm goes off in a couple brief hours, but I will also be alive. I'll gladly indulge in a cup of coffee and wear under-eye bags with pride. I think I deserve, at the very least, a high five, to be honest. This early morning, I dealt with a diabetes situation I've feared since the frightening hospital endocrinologist told me I would encounter it one day (that, folks, is a story for another time)...and I prevailed.

When we (or our loved ones) experience frightening health situations, preparation, training, and a calm heart will allow us to move through confidently, and with any luck, unscathed.

Remember, knowledge is power. We can't train for every scenario that could pop up in life with diabetes, but we will learn what we can, and keep the supplies on-hand that will enable us to deftly maneuver around every curveball diabetes throws, morning, noon, or night. The unknown is scary, but when the moment comes that requires swift action, you'll be shocked and proud of how well you can handle it. Even more rewarding are the peace and joy that come along with knowing that anything headed your way that is less unpleasant than the D-situation you've just dealt with, is a moment for rest and thankfulness.

Now checked off and moving along! I probably won't feel so great in a few hours, between the "roller coaster" and lack of sleep, but it's going to be a great day, because I choose to make it so.

I'll carry on with the day's commitments. It will be my secret what monster I conquered in the mask of darkness this morning, and I will smile and speak gratefully from a place of humility, and life will go on, as time stops for no one and nothing, not even diabetes. Check in with me in a few hours when this optimism and gratitude is likely to fade to a bit of grouchiness, but after experiencing as disconcerting a sight as a meter reading of 34, how could anything else not be simply wonderful?

Do you have a plan in place to deal with inopportune low blood sugar situations? Don’t wait to strategize and plan for the unexpected! We can help support you and your healthcare team with the process.