The Bad Low

Kate has Type 1 Diabetes. Before getting to know her, the only “info” I had about this disease came from my extensive childhood reading of Babysitters Club books. Either diabetes has changed significantly since the early nineties, or Ann M. Martin didn’t have all her facts straight. Maybe it’s a little bit of both.

My mother has had Type 2 Diabetes since I was a teenager. At first, she managed it with pills and diet and regular visits to a diabetic clinic. Some time after I left home, she was switched to an insulin regime. These days, she injects herself twice daily, with the same prescribed dose each time. Before Mom was put on this treatment plan, I hadn’t been aware that people with Type 2 could need insulin injections. It’s not exactly common knowledge. And as little as I had known about Type 2, I knew even less about Type 1.

Kate wears her Type 1 status on her sleeve. It’s all over her Facebook feed, in the form of funny memes, scientific articles, and statuses describing various diabetic suckiness. Back when we were just friends, I’d noticed that she carried a small kit with her, almost like a glorified pencil case, with a pricking device to check her blood, and pens to inject insulin. I’d never asked her about the process, since I figured it was none of my business. I would look away when she would pull up the bottom of her shirt to inject.

I learned a lot about Kate’s diabetes in the first few months of dating her. I learned that she has to note the number of carbs in each food item she eats, sometimes by reading the nutritional info on the package, sometimes by Googling on her phone. Some foods she knows by memory. A slice of bread has 15 g of carbohydrate. A cup of milk has 12 g. Any grams of fibre get subtracted from the carb total.

Calculating an insulin dosage requires a certain element of guesswork. There are just too many factors in play to get it right every time. Time of day matters – Kate needs more fast-acting insulin per grams of carb in the mornings and less in the evenings. (She also takes a slow-acting insulin once per day, but that amount stays the same regardless of what she eats.) Moderate exercise brings Kate’s blood sugar down, but extended high intensity exercise can make it spike. A bike ride to work might drive her down, but it could also drive her up, depending on how hard she goes. Stress tends to elevate her blood sugar. Sex tends to lower it.

As such, Kate never gets a break from thinking about her diabetes. She can’t mindlessly graze without paying attention to what she’s putting in her mouth, but she also can’t skip a meal. She applies as much of her experience and knowledge as she can to every diabetic decision, but it’s such a complex matrix of choices that some of it has to be conjecture by default. This means that she is prone to highs and lows.

A non-diabetic’s blood sugar typically falls between 4.0 and 8.0 mmol/L. This is the safe range that diabetics aim for. Because a diabetic’s blood sugar can deviate significantly from the norm, most meters will show values between 1.1 and 33.3. Both extremes can be life-threatening.

When Kate’s blood sugar rises above 13.0 or so, she feels sick. That’s her body’s way of telling her not to eat any more things. She gets thirsty and has to pee frequently, as her kidneys struggle to filter the excess sugar out of her bloodstream. Extended highs put a strain on her organ function. This is a long-term danger.

When her sugar drops below 5.0, Kate starts to feel exhausted and impaired. Her speech becomes slurred, her jaw becomes slack, and her ability to keep her voice at a normal volume is non-existent. Every action is an effort; keeping her mouth closed and her eyes open is a real challenge. Sometimes Kate is giggly in these states, like a funny but harmless drunk. Other times, she gets very emotional, overwhelmed by her physical and mental exhaustion and utter vulnerability.

Lows are the immediate danger. A lack of sugar in the blood means a lack of sugar in the brain. If Kate’s blood sugar drops low enough, she’ll lose consciousness. Left untreated, she’ll go into a coma next, and after that, she’ll become brain dead. She goes to bed each night knowing that a miscalculation with her insulin could mean she doesn’t wake up the next morning.

The first time Kate had a low blood sugar in front of me, we were at Marble Slab, having ice cream cones. Her loud, slurring voice was jarring. I didn’t know her very well yet, and in the moment, I felt like she must be exaggerating. I held up my end of the conversation, observing the odd behavior with an eyebrow raised. Fifteen minutes later, Kate’s demeanor had returned to normal and she was ready to drive me home.

We talked about lows after that, and how they feel. Kate explained that she can tone down the ‘drunk’ appearance when the situation calls for it (like at work or around strangers) but she said the effort it requires is absolutely exhausting.

I witnessed a couple more of Kate’s lows over the next few weeks. Even in her impaired state, she was always able to think clearly enough to self-treat. She would take some fast-acting sugar (like juice), wait a bit, and retest her blood. She would repeat this process as needed until she got a safe number, and then she would eat real food (something with carbs, fat, and fibre).

It seemed pretty straightforward, and more to the point, Kate always seemed to have the matter under control. I was comfortable with my assigned role: passive moral support and a buddy to wait things out with. One random Saturday night in January, my role changed.

It was late. We were in bed together, and Kate told me that she felt weird. Indeed, she didn’t quite seem like herself. It was almost like she was fading in and out. She decided it would be prudent to test her blood, so she did.

2.5.

I’d never seen such a low number on the meter before. I rushed to the fridge and brought back a juice box, poking the straw in and handing it to Kate. She always jokes that you should never challenge a diabetic to a juice drinking race. I could see why. For someone with very little energy, she was still sucking that thing back like nobody’s business. She was handing the empty box back to me before I could blink.

We had to wait for the juice to do its magic. So I sat with her, trying to keep her engaged in conversation while simultaneously feeling guilty that I couldn’t just let my exhausted girlfriend sleep if she wanted to. When we decided to test again a few minutes later, Kate was pretty much unable to move, so the task fell to me. My hands shook as I followed the steps, Kate watching me with lidded eyes to offer any corrections I might need. I pulled a test strip out of the plastic bottle and put the cap back on right away (since extended exposure to the air spoils the strips). I slid one end of the strip into its slot in the meter and I pushed until I felt it click and the screen came on. Then came my least favourite part: harvesting the blood!

blood
“Blood Harvest” is totally the name of my new band.

I primed the pricking device and took Kate’s hand in mine, feeling her finger tips to find a spot that wasn’t calloused. Once I had settled on one, I pressed the pricker against her finger and pushed the button, bristling at the telltale ‘thuck’ sound of the lancet piercing her skin. She didn’t wince.

I squeezed her finger until a sufficient quantity of blood oozed out, and I held the meter up until the blood absorbed across the strip. The meter blinked its countdown (3…2…1…) and then:

2.3.

SHIT.

Kate had downed a whole box of juice but somehow her blood sugar was still dropping. I raced to the kitchen for another box of juice, stabbing the straw into it sloppily and racing back to the bed. This time I held the juice box up for her, easing the straw into her mouth and asking her to drink. She was still conscious, but completely sapped of energy. She polished off that juice box, as she had the last. It just took a little longer this time.

With one eye on the clock, I did whatever I could to keep Kate awake. I told her she didn’t have to talk if it was too exhausting, but that I would feel better if she could find a way to indicate she was still conscious every minute or two. I fought to give the appearance of calm, stroking her hair, trying to make her smile. On the inside, I was frantically working to remember everything she had told me previously about how to deal with a dangerous low that lasted too long. I had no earthly idea what I was going to do if she was still dropping the next time I tested. I was terrified.

“If you have to call an ambulance,” Kate slurred quietly from under the covers, “can you put some clothes on me first?”

I nodded, trying to smile. A few minutes later, I tested again.

I don’t remember what this number was. But it was in the right direction. Maybe a four? Still low, but significantly higher than the last test. I gave Kate a third juice box, to be safe, and then I brought her a buttered roll. By that point, she was shivering. This was a relief since feeling cold is one of her symptoms of recovering. I bundled her into the bed as tightly as I could. Only her face poked out the blankets. She started chomping on her roll with no hands. I started breathing normally again.

Experience would teach me that I had made some mistakes that night. We had waited maybe five minutes between the first box of juice and the first retest. We were supposed to wait at least fifteen minutes, to give the sugar a chance to hit the bloodstream. When Kate had tested at 2.3, that was only because the juice hadn’t yet reached her blood.

Time has made me much better equipped for these situations. Now, I’m her time-keeper between tests. I’m her gopher, running to the kitchen for food or drink when she’s too exhausted to move. I’m her decision-maker, choosing what kinds of carbs to treat with when she’s too cloudy to think. Sometimes I giggle with her, observing with amusement as she finds the world hilarious. Other times, I hold her as she cries at the frustration of feeling so weak and helpless. Whatever type of low it is, I wait it out with her and remind her that she’s not alone.

Caring for someone in a medical emergency is a thing I always thought I was incapable of doing. Deliberately piercing another person’s skin and then squeezing until I’m satisfied with the amount of blood that wells up is something else I thought I was incapable of doing. Being with Kate has sparked plenty of significant changes in me, but that night I became someone I didn’t know I could be. A caregiver. A nurse, even. People who know me find this fairly hilarious.

It can be hard. It can be lonely. Kate was with me in body, that night. She was even awake. But her mind was operating at the lowest function I had ever seen it, and her lack of energy suggested to me that she could pass out at any moment. Kate is an excellent person to have around in a crisis, but that night she WAS the crisis. I had to act on my own, without my coach there to help. Without my buddy and lover there to reassure me that things were going to be all right.

Even in less severe cases, like when we’re waiting out a ‘funny’ low, I still feel alone. She can be right beside me, holding my hand, but I rarely feel like she’s the one I’m talking to. It’s more like talking to a very drunk person, or a small child. This – Low Kate – is still a person I love, but she lacks the sharp wit and intelligent sensitivity of my woman. I look into her eyes and she’s not quite in there. So I sit with her, laugh with her, cuddle her, and wait for my lady to come back to me.

She always does.


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