Your pancreas makes insulin which controls the quantity of sugar in your blood. It's sort of like a thermostat: when you eat, or otherwise do things to raise your blood sugar level, the pancreas makes insulin which helps the cells process the sugars to bring the level back down; at the opposite end, when your blood sugar drops the pancreas stops making insulin so the sugar absorption stops and your blood sugar level rises. For most non-diabetics, blood sugar will range from about 80-120 depending on what they've eaten (and how long ago) and what they're doing.
Then there's the Type I diabetic -- e.g., me. My pancreas does not function at all. Instead, that thermostat function is managed by lots of blood sugar monitoring and taking injections of insulin: lantus which is a slow acting insulin that keeps the blood sugar down over a 24-36 hour period, and humalog which has about a 2-4 hour effectiveness curve. I'm constantly balancing my latest blood sugar levels against what I'm eating and how much insulin I need to take.
Sounds fun, huh?
Oh yeah, a Type 1 diabetic's blood sugar levels can range anywhere from nearly zero (in which case they're likely in a coma) to upwards of 800, in which case they'll likely wind up in a coma if it stays there for an extended length of time. High blood sugars are more of a chronic, long-term problem while low blood sugars come on fast and are generally much more emergent.
I've been a diabetic for, god help me, twenty-nine years. In that time I've had three low blood sugar events that would qualify as emergencies.
The first happened when the XS and I had bought our house in Seattle together and so were getting my house ready for sale. I'd spent the day doing some last minute repairs getting ready for the open house (i.e., finally installing the kitchen baseboards), and was meeting the XS and some friends for a movie. After the movie, I had to go back to the house to do one last thing before the open house the next day. Sometime during the movie my blood sugar dropped precipitously, but since I like movies and didn't want to miss anything, I ignored it. The problem with ignoring it is that eventually your blood sugar drops so low that your brain stops functioning and you no longer recognize that your blood sugar is low. So the movie ended, and I jumped in my truck to go back to the house to finish my project.
I somehow managed to get the final piece of trim in, but then I jumped in the truck and left to drive to the new house. That turned out to be something of a problem in that I had no idea where I was, where I was supposed to be going, or what path to take to get there. So basically I just drove randomly through the neighborhoods surrounding the house. After about three hours, the XS started wondering where I was so she called me on the cell phone. Apparently, it was pretty clear something was wrong, since I couldn't really engage in an actual conversation. So while she alternatively called me and the police, I kept happily driving in circles unaware that anything was amiss. Eventually she managed to connect me and the police outside a convenience store where they mandated that I check my blood sugar. As I recall, it was something like 24, so bought and drank a bunch of orange juice, waited around with the police until they were convinced I was functional, and then I drove home.
The good news is that I didn't kill anyone. The bad news is that I still have no idea what happened in The Lincoln Lawyer after about the first twenty minutes.
Which reminds me to share one more point about blood sugar. When your blood sugar drops low enough, your brain stops doing much more than trying to keep you alive. Thinking becomes secondary, and so is doing things like forming memories. If you sleep through a bout of low blood sugar, you're brain won't bother converting the day's events into long term memory, and so when you wake up you and an amnesiac will have a lot in common.
This has happened to me twice.
The first time was about five years after the pointless driving event, during the period when the XS was doing everything in her power to avoid me. It was a Saturday, and she'd woken up early to go hang out with her family. When I woke up, I woke up into one of those movies where the person is all by themselves wondering what's a dream and what's real. I wandered all over the house wondering why it was empty. At some point, I decided to call the XS who, having been through this before, called the EMTs.* The funniest thing about this one is that I actually argued with them about checking my blood sugar levels. I was convinced I was fine -- despite the fact that I was wandering around wondering what was real.
The second time happened when I was living alone. It was a workday and I woke up at about 11:00 to the sound of my alarm (which had been playing since 6:20) and my phone going nuts with people at work trying to figure out where I was. The thing I remember most about this is that I knew it had been low blood sugar, but I literally had no idea what day it was. But again, you suck down some orange juice and you're fine, even if you never get those memories of the prior day back (which is actually really weird).
I bring all this up, 'cause it is time to raise my insulin dosage. After the last of my emergent lows, I worked with my doctor to drop the dosage of my lantus. The fact that my blood sugar dropped over night was a good indication that I was taking way too much lantus. But nearly a month of blood sugar values in the four and five hundreds is telling me that I'm not taking enough.
So back up I go, with the hope that I don't go so far that I wind up waking up five hours late wondering what day it is.
As I think about, I'm actually not sure which is worse, cancer or diabetes. Not that it really matters. It's not like I'm getting rid of either of them anytime soon.
* Nothing like wandering around in your underwear when four EMTs and your in-laws show up at the house. And by the way, the EMTs that showed up at my house did not look like the two in the picture.
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