The Juice Box Diet

From Wikipedia – Hypoglycemia or hypoglycaemia is the medical term for a state produced by a lower than normal level of blood glucose.[1] The term literally means “under-sweet blood” (Gr. hypo-, glykys, haima).

Hypoglycemia can occur for a few reasons, but typically it is because too much insulin was delivered – whether it was because the carbs were overestimated, not enough food was eaten, your basal or bolus rates are off, or because your system changed and you now don’t need as much insulin.

Now that you know the definition, let me explain how it feels.

For the years before I was diagnosed there were times when I felt shaky – I’d have something to eat and I’d feel better. Everyone at some point in their lives have felt it – this doesn’t only affect diabetics. Like many people, I didn’t think much of it. After my diagnosis however, I quickly learned the term, how to conquer it, and that is was one of the side effects of too much insulin in my system. I still remember lying in the ER, my first post-diagnosis “low”, my heart started pounding, I got clammy, shaky, I yelled out and the nurse ran over with a dixie cup of OJ. Five minutes later I was fine. Like nothing had happened. On the positive side of going low is the ability to “come up” quickly – as long as you catch it before you pass out.

I carry a glucagon emergency needle with me at all times. This is similar to an epi pen but holds a quick shot of glucose to be delivered in extreme cases. It comes in a bright red case that screams emergency BUT when you open it there are about 5 steps to take before it is ready.  http://www.childrenwithdiabetes.com/d_0n_022.htm

First… push the liquid into the little vial…mix it with the sugar tablet… then draw the liquid into the needle… then jab it into the unconcious diabetic – anywhere, through the clothes. Hmmm, that sounds like it could take a few minutes?

Knock on wood that I haven’t use it yet – but I did come close – when I was alone – on a bus – commuting home from New York City.

I’d gone low twice at work that day and drank the 2 juices I typically carry with me. One of them was right before leaving the office so I assumed I would be ok to get home. My commute is about 90 minutes – walk 15 minutes, bus 60 minutes, and drive 15 minutes.  After 15 minutes on the bus I started to feel a bit shaky.

“You’ve got to be kidding me” I mumble to myself.

I pull out my meter, take my numbers – 41. “Sh*t!”. I know I don’t have any juice on me so I rummage through my giant purse to see what other goodies I have in there. The guy sitting next to me looks over and gives me the stink eye – apparently I was rummaging loudly and he couldn’t hear his iPod stream.

Hmmm…granola bar (the fiber kind, not so fast-acting, 25 grams), 1 laffy taffy (about 4 grams), and a fruit roll-up (about 10 grams).  Now keep in mind that the medical experts tell you to have 15 grams of sugar, wait 10 minutes, and if necessary have another 5 grams until you feel better. This thought doesn’t even cross my mind as I try to quickly chew the laffy taffy. Not so easy. Next i shove the full fruit rollup in my mouth and continue chewing, quietly. Still shaky, and feeling worse by the second. I wolf down the granola bar. About 5 minutes go by and I’m still shaky, and getting clammy. I test my numbers again. 42.

Ok… I just have to give it some time. Stay calm. Breathe. I don’t feel so good. Don’t think about it. You’ll be fine. You just have to let the magic laffy taffy do the work. Test my numbers again. 40. Ugh. (Laymen, remember, Zero = VERY BAD!)

I look through my purse and locate my magical glucagon kit. Now, how do I ask stink eye to jab me with this needle if I pass out? I’ve never had to recruit help before. And this is kind of a bit involved. I tap him on his shoulder.

“Umm, excuse me sir, I know this is kind of weird, but, um, I’m a diabetic, and I may go into diabetic shock, and if I do pass out…do you think…um, do you think you can…” I launch into the 12 step program explanation of how the glucagon works.

“Yeah, so, can you stab me with this if you happen to notice me unconcious?”

I get a blank stare from him. “Sure, but I can’t make you any promises.”

Ok, wow. I am so happy stink eye is the one next to me today.

I’m still feeling shaky, praying that my numbers start to go up so stink eye doesn’t have to save my life, and all of a sudden… the bus pulls off the turnpike and looses power. That’s right. LOOSES POWER. We are broken down, 25 minutes into the trip home from hell.

I test my numbers again. 50. Ok, at least I’m going up and most likely won’t need stink eye to stab me.

Now I just have to hope that I don’t go low again while we wait for a new bus (30 minutes) or on the rest of the commute home (30 minutes). It dawns on me at this point to turn my pump off to stop the insulin delivery and buy some more time.

Luckily I made it the rest of the way home without going low.

Lesson 1: Always have sugar on you, especially when you’re alone and unable to quickly access.

Lesson 2: Overcome your fear of asking a stranger for help.

Lesson 3: Tattoo “I’m a diabetic” on your forehead.

So what is it like to go low? From what I gather it varies for many. When I was younger, one of my favorite movies was Steel Magnolias (go figure right?). The scene where Julia Roberts is getting her hair done, her blood sugar drops and everyone rushes to get her orange juice – her mom needing to force feed it as she knocks it away and is a real biatch. Well , that’s not how it goes for me.

I have yet (knock on wood) to be force fed juice and I know when I don’t feel right, I test my numbers, see I’m below 70, grab a CapriSun, drink it in about 2 seconds and wait for the magic.

Not long ago I was going low 5 to 8 times a day. When started to get the shaky feeling, each time I tested my numbers and each time I was already in the 30s. Juice became a main staple in my diet- in the middle of paying bills, on the phone, cleaning the house, watching tv, walking to the office, working, sleeping, cooking, swimming, commuting, showering, sitting… What I was experiencing was hypoglycemia unawareness.

Hypoglycemia unawareness is basically a term used to say I had no idea I was so low. http://www.medterms.com/script/main/art.asp?articlekey=22381

Usually you start to feel shaky in the 60 range and are able to treat it before it gets lower. I, on the other hand, would test my numbers just because and get a 34 reading. Shoot. 29 – wow, didn’t even feel it. 46. I am so sick of this….

I started testing my numbers 10 to 12 times a day in hopes of catching it earlier and that helped, but I still don’t feel the lows very quickly. (I am happy to say I fixed those lows, turns out my internal system changed and the insulin regiment I was on – all of a sudden – was too much insulin for my body to handle.)

 That’s the real deal with diabetes, one sugar cube at a time.