Diabetes Self-Management Blog

This is it, folks! The last in a three-part series reflecting on a severe low blood glucose episode I went through four years ago. Last week, I talked about how the experience highlighted some of the remarkable gifts I have developed through my years of living with diabetes. It was, if I do say so myself, an interesting little piece of philosophical prose.

Today, however, I’m going for practical. I want to share some of the straightforward, how-to-get-through-your-day-with-diabetes lessons I learned. Since we’re going for practical here, I’m going to break it down lesson-by-lesson. I’ve even included a few “homework” assignments for those of you who feel so inclined. So everyone take a seat, spit out your gum, stop talking to your neighbor, and let’s begin.

Lesson Number 1: Take back your lunch (and other things)!

If you recall, at the time of the incident I was working as a therapist at a residential treatment center. Days were almost always 10-plus hours, and there was still never enough time to get everything done that needed to get done. It’s the kind of situation many of us find ourselves in at work — too much work, not enough time. And what’s the first thing to go when time gets tight? Lunch.

For me, it started by moving from a half-hour lunch break to a 20-minute “working lunch.” Soon, it became a 10-minute working lunch, then 5. On the day I passed out, there simply was no lunch. Little by little, I had allowed the hectic pace of the work environment to completely take over. Most of my coworkers did the same. And to be sure, it wasn’t exactly healthy for any of us. But diabetes takes that choice from kind of unhealthy to extremely dangerous.

After I came home from the hospital, I simply decided that I would never give up my half-hour lunch. With each new job since (and I’ve had a few, being a part-time social worker, teacher, musician, and writer), I have been explicitly clear that lunch is nonnegotiable. Ten-hour days? Sure, those happen. Come in on a Saturday sometimes? All right, I can do that. Skip lunch? Never. I have made it a condition of my employment.

If you are living with diabetes, you have a right to take the time you need to care for your condition. You have a right to ask for the things you need, to set the limits you need to set, and to say “no” when those limits are not respected.

Homework: Write down the basic things you need in your daily routine to take care of your condition the way you feel you should. Once you have that list, take a look at your work schedule and see if those needs have been “trimmed back a little,” severely limited, or dropped altogether. Then, talk to your boss. Tell him about any reasonable accommodations you need in order to effectively manage your diabetes. If he refuses to hear you, remember that diabetes is protected under the Americans with Disabilities Act, and no employer can legally deny you reasonable accommodations.

Lesson Number 2: HAVE SUGAR ON YOU AT ALL TIMES!

There’s nothing else to say about this one, really. Have sugar on you. Do it! Now!! There’s no reason not to. If I had bothered to take that incredibly simple step that day, none of this would have happened.

Homework: Got sugar? If yes, great. If not…. GO GET SOME GLUCOSE TABLETS!!

Lesson Number 3: Breathe…

The final (and central) lesson here is time. We need to take the time to care for ourselves without compromising; without letting our health management needs be over-run by our environment. If you had asked me then why I had given up my lunch altogether, or why I didn’t ask my client to wait for three minutes while I ran back to my office for more glucose tablets or some M&M’s from the vending machine, I would have said it was because I “didn’t have the time.” I would have told you that I simply had “too much to do,” and that it couldn’t wait. The truth is that I had given away that time without thinking about it, simply because it seemed to be what “everyone else was doing”.

But in recounting the events and lessons of that day, I’ve come to realize something more fundamental about living with diabetes, and perhaps about life altogether: time is something created, not something absolute. Humans are unique in dividing the natural world into segmented measurements like time. And while our habit of measuring the world has led to some truly inspiring discoveries (the discovery of insulin among them!), it is not without its drawbacks.

Measuring time the way we do leads us away from the present moment. We spend our lives focused on tomorrow’s errands, this deadline or that deadline, or creating next week’s schedule down to the minute. But while it is important to plan for the future, it is equally important to do our best to live in the moment, especially living with diabetes. As I wrote last week, diabetes requires us to be always attuned, and that requires us to be in the present moment.

Homework: Find your way to be present. Meditation, yoga, exercise, art, writing — all of these are great ways to return to the present moment. Once you find what works, stick to it. Living mindfully is one of the most invaluable tools available for those of us living with diabetes.

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Comments
  1. This is a great story and valuable advice, Scott. What you say about time is so true — I do a relaxation exercise based on different ways to see time, which you can read at http://davidsperorn.com/blog/?p=157

    Posted by David Spero RN |
  2. The situations we let ourselves get into are incredible sometime. And, we do it to ourself.
    As a frequent traveler I can’t tell you the number of times I let myself get into situations when food is not easily obtainable.

    Your advice to always have sugar or tablets on hand is what has always prevented me from having a situation like yours where you had to be hospitalized.

    I always have hard candy in my backpack, pockets, luggage,everywhere.

    It’s save me many times.

    Posted by Craig L |
  3. Scott: An excellent piece of advice! I hope everyone will follow your suggestions. I discovered you method when working from 1957 [when diagnosed] to 1980. It is just good ole common sense which can carry us a long way; just celebrated my 55th year as a T1D.

    Today the Americans Disability Act can/may help. However, I suspect that some employers still use legalese to “dump” a person with diabetes for the slightest reasons.

    By the way, plain old sugar cubes cost less and melt quickly so we can respond verbally when necessary while doing our job; [no chewing]. When really pushed at work I just popped a sugar cube in my mouth about every 1.5 hours; tested whenever using the Ladies; they were clean in those days. A sugar cube is 5 grams of carbs.

    Thanks for a great piece. Happy Holidays!!!

    Posted by joan |
  4. People who are not diabetic do not understand these problems - even most of the doctors. Thank you, thank you, thank you, I don’t feel so alone now.

    Posted by Beaux |
  5. Also, whenever you change your diet or to a different food but not your insulin you have to check what that new food or diet does to your blood sugar.

    After that, like you I learned to keep some quick carbohydrates handy at ALL TIMES.

    Instead of hard candy may I recommend a more food like treat.

    Something like Ensure, or better yet go to your health food store and get the equivalent.

    I do not recommend Ensure and therefore this comment may not get printed. I only recommend it as either an cheap EMERGENCY low sugar episode tool or as an occasional meal replacement or treat on days you crave sugar. BUT NO OTHER TIME.

    As it is highly processed with isolates, has white sugar and GMO oils in it.

    Posted by Bimbam |
  6. I find I get busy and don’t drink enough liquids.This happened Sunday and I found myself in er after I blacked out right after church. So not only watch your diabetes but also your intake of fluids, especialy water!!

    Posted by Louise Walsworth |
  7. i find it amazing sometimes when my dog wakes me that if i can get the meter together it is down around 23..that’s the lowest i can function..i have been known in the sleepiness to eat half a bottle (of 50) in glucose tabs before passing out with the still open bottle in my hands..remeber at bedside to have the liner off the bottle of glucose tabs as it is sometimes impossible to get it moved..at that point in time i can’t move and being deaf i have no access to a tty which is clear across the room..it takes generally 32 to 48 hours to recover even partially from those that are that low and i sleep most of the time..having no one around to do anything about care except of course the dog..when one is already on a limited income with very little budget for food (45.00 a month) how do you cope with that??? and i have autonomic neuropathy and it has taken from me all signs of the drop in sugar so i am lucky that my dog just took over from there

    Posted by marylittle |
  8. Does anyone else have the problem of going low while eating? Sometimes when I start eating, my BG drops 10 - 15 points. This is no big deal if my pre-meal BG is 100 or higher, but if my pre-meal BG is 80 or lower, then the drop can be very unpleasent. And, I don’t know what to do besides wait it out. I’m already eating, and I mean really eating, hamburger and fries, chicken breast with rice, sandwich. My doctors and Diabetic Educators don’t believe me, so I don’t know quite how to cope with this. (Good news, I’ve never passed out, but I’ve sure been miserable).

    Posted by MEL |
  9. Because of hypoglycemic insensitivity - I have had Type 1 diabetes for 54 years - I take my blood sugar almost 20 times per day as a matter of survival. Insurance has not balked at this, perhaps because I live alone.

    When my blood sugar drops into the 30s,I tend to go away from the juice/sugar that is near to me and head elsewhere to find some. It does not make sense, but it is what I do.

    Do others do odd things like that when low?

    Posted by Donna |
  10. When I had an episode -first and only one- some months ago, I learned that while in the episode, you don´t think clearly, far from it. I got confused if I had it high or low because the readings were oscillating. Forgot if I had my meals and if I had the medicines. Also, found out that you dont get it all of a sudden, you get it as an accumulation of different issues until you fill the bucket. It´s not that you were well day before and today in a crisis. Maybe you have several days not sleeping well, at the same time get a cold, or are missing lunch frequently, you are eating not healthy, etc. I think as accumulation and then saturation.
    That´s why is so important not to never miss reading your glucose even if you feel well. If you get a bad reading, try to remember what you ate that could cause that reading. If you get several highs or lows in a row, watch out and try to correct. But if you dont measure every day or several times a day, the warnings slip without notice and then get the episode.

    Posted by Hector Rios |
  11. I am a Nurse Practitioner and diabetic on insulin. I have been low enough to functional very poorly.

    I also have been low enough that I had rolling lows. I would eat feel a little better and go low again. It is because I am on Victoza which slows food absorption from the GI tract. The food I ate to bring up my blood sugar wasn’t being absorbed. Solution - liquid or gel glucose under the tongue. I was also dehydrated and my blood sugar did not come up and stay stable until I drank several small bottle of water.

    The other thing I recognize is that the body reacts to sugar levels that are significantly lower than a personn’s “usual blood sugar”. Therefore if you usually have higher blood sugars, you might be having low blood sugar symptoms but when you check, your blood sugar may be in normal range. Its just low for you. Another good reason to get your body used to consistently low normal blood sugars

    Posted by Nancy |
  12. Sound advice from all. I work at a front desk in a high school. When I was placed here I made it very clear that I needed to step away to check my levels, to shoot insulin, and that I would be eating several times a day. Fortunately, my current employer is very understanding. I have been let go before because of some trumped reason that was hiding the fact that the boss was ’squicked’ because I had to draw blood. Seriously, that was the word she used.
    Anyway, I use fruit snacks as my go-to low fix when away from home. They are all about 15 grams of carbs a serving, so perfectly fit the bill. At home, we keep a large supply of ‘Juicy Juice’ in the small containers, 60 calories, 15 carb grams. It is the quickest fix I have found, and I am a frequent sufferer of lows, perhaps due to the Victoza, Lantus and regular insulin mix I need.

    Posted by Pat Weiser |

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