Several months ago I had a salad, some fruit, and cheese for lunch. That morning I had been too busy to pack my usual lunch, so picked up some food on the way to work. I had been running high all morning and set an increased basal rate on my pump. Despite this, I remained high. At lunch, as I sat talking with colleagues, I bolused for the food. I didn't even think that I was eating something different than usual. I plugged in my lunch of 40 grams of carbohydrates and continued eating and chatting.
An hour after lunch I was wrapping up a conference call with a client when I began feeling a bit low. I tested at 2.9 mmol/L and thought that was a little odd, so cancelled the temporary basal rate on my pump and ate a few glucose tablets.
Fifteen minutes later I felt no better; maybe even a little worse. I tested again and found myself at 3.1 mmol/L. I ate some more glucose tablets and took a few minutes out from work. I rarely get shaky with lows, but I felt shaky with this one, like my body was fighting with all its might to bring my blood sugar up.
Fifteen minutes later I'm still feeling low. I check again and find I'm at 3.3 mmol/L. By this point I knew something wasn't right. I check my pump and see that I have over four units of insulin on board. It was at this point that I realized I had bolused for 40 grams when I had eaten only 15 grams.
I felt no real panic at the time, although I did debate telling an office mate that I was having a bad low, which I don't typically do. I ate the remainder of the glucose tablets and brought out my backup supply. I suspended my pump's insulin delivery. I went to the fridge and brought out a small tub of fruit and ate the entire thing.
I left my pump off for two hours. I was sure I was overdoing it. But two hours later I was 4.7 mmol/L. And three hours after that, a full five hours after eating an entire tube of glucose tablets, a half a tub of fruit, and going without insulin for two hours, I was 7.0 mmol/L.
That evening, as I lay in bed drifting towards sleep, I had the stark realization that I had almost died that day. Not literally, of course. But it was the kind of low that was not a disaster because I had supplies, and backup supplies. And because I tested often and knew what to do. It's the kind of low that easily could have turned out frighteningly differently.
Flash forward a few months.
The night before last I woke up in the middle of the night with a blood sugar of 2.8 mmol/L. I ate several glucose tablets, a granola bar, and a glass of almond milk. I didn't bolus for any of it, and I woke up in the morning at 5.5 mmol/L. It should have been a warning, but I made no changes to my pump basal rates. I did, however, set my alarm for 2:00 AM last night so that I could wake up and check, just in case.
At 2:00 last night, I have no memory of the alarm going off. I do have a vague memory of removing the wrist brace I've started wearing at night for carpel tunnel syndrome. Perhaps at this point I got up and turned the alarm off. At any rate, there is no record in my glucose meter that I tested.
At 4:00 AM, I woke up with my right hand tingling like crazy. I climbed out of bed and retrieved the wrist brace from the spot across the room where it had landed when I flung it away. Since I was up, I decided to test. I was 3.4 mmol/L and ate a glucose tablet. After thinking a moment, I ate another one as well. Just in case.
Coughing woke me up in the morning. I tossed and turned for a while before reluctantly climbing out of bed. Then I looked at the time.
I'm supposed to be at work at 8:30 AM. My alarm usually goes off at 6:00 AM.
The first thing I did was grab the phone to call my colleague and let her know there was no way I would be there in time for my 9:00 appointment. It was all I could think about. I dialled and pressed the phone to my ear, hearing no dial tone. I hung up and tried again, and for a few moments couldn't even figure out if the phone was on or off. Finally, I managed to punch in the right digits and got through. My colleague was available and had no appointments, so said she would cover me for the appointment.
It wasn't until I hung up that I thought to test.
I was surprised when I saw the reading. I didn't feel low at all. As I scrambled to get ready for work, I crunched through four glucose tablets. As I was heading out the door, I popped one more in my mouth. I called a cab to take me to the nearest train station, since I didn't know how long I'd have to wait for a bus.
It wasn't until my mind cleared that I realized how foggy it had been when I first woke up.
When I got to the station, half an hour after my initial test, I still felt odd and shaky. I tested at 4.3 mmol/L and, even though I wasn't truly low, ate another glucose tablet. I found myself wondering if I had any stash of low supplies in my office, in case I burned through the tube of tablets I had with me.
It was when I was riding the train, sitting quietly staring out the window, that I began to really process what had happened. Before leaving I had checked my alarm. Both alarms had been set correctly and turned on.
Was I really low all night? Was that why I didn't wake up for two alarms?
And then the thought crept into my mind, the thought that has haunted every adult with Type 1 diabetes who lives alone, and every parent of a child with Type 1 diabetes.
What if I hadn't woken up at all this morning?
I arrived at my office still feeling off. It was now an hour after initially waking up. The first thing I did after walking into my office was test. 3.8 mmol/L. My colleague came in to say hello and ask how I was. I ignored her momentarily, instead popping another two glucose tablets and pulling out my pump. I lowered all my basal rates across the board.
I thought about my childhood, dream-like memories of mornings waking up with my entire body tingling to find my mom pressing the straw of a juice box between my lips, telling me that I was low and had to drink some juice. And—worse—a few memories missing completely, filled in only by my parents' retelling of events. Battles with glucose tablets and juice boxes, me resisting and screaming, or laughing, or spitting out the glucose gel that was squeezed into my cheek. The shape of someone standing in the doorway holding a phone, asking if they should call 911.
For the most part, I forget. Most of the time, I think it's a bit dramatic to call Type 1 diabetes a life-threatening disease. People live with this disease for years. Most of the time, we deal with it and move on with life living, working, and participating in any and all activities we choose.
Then there are times like today, when I sit at work, barely hearing the meeting proceedings. Thinking back to this morning. What if I hadn't taken off the wrist brace, and my hand hadn't tingled and woken me up, and I hadn't eaten some glucose tablets? What if allergies hadn't woken me up this morning? What if I hadn't woken up at all?
What if, what if ...
On some occasions, I feel threatened. I feel like I flirted with death, getting too close to the line for comfort, and still make it in the end by pure luck. These are the scary lows, the dangerous highs, the close calls exchanged among the diabetes community. These are the forum posts made at 2:30 AM as someone, somewhere, is up treating a dangerously out of range blood sugar while the world around them sleeps. This is the fear of a mother who still worries about her adult Type 1 daughter if she doesn't hear from her at least once a day. This is the realization that of the dozens of diabetes-related decisions we make daily, it takes only one wrong decision for things to get perilous.
Sometimes, I feel like life-threatening is a completely appropriate label for this disease.