Beware Diabetic Complacency

Last weekend, my wife and I went camping about three hours north of here. It was the first time I’ve been along on the annual her-side-of-the-family camping excursion, and except for some obnoxious people who were a bit too loud too late into the evening at a campsite across the road, we had a great time.


This was the first time I’ve camped since Type 1 diabetes became a part of my life. Granted, we weren’t roughing it miles from civilization; this was car camping at its best (restrooms and showers nearby, that kind of thing). But, nonetheless, I did give some thought to what I’d need to carry on such a trip, and how the activities and humidity and heat would affect my blood glucose throughout the couple of days we were there.

Yet, to be honest, I did only give it some thought. I didn’t obsess, didn’t overdo supply packing, and didn’t let diabetes and its needs spoil the weekend. I found it comforting, in fact, that as we prepared to leave for the trip (in haste, mind you, because we decided at the last minute to leave on Thursday afternoon instead of early Friday morning), Kathryn wasn’t worried about what diabetes stuff I’d packed; it’s become routine, and she simply knows I know what to gather.

What was great about this trip is that while at the campsite with Kathryn’s parents, as well as with her sisters and their families, no one worried about how I’d be with the food we cooked or concerned themselves about how anything else was affecting my diabetes. In fact, the only mention of diabetes was when our five-year-old nephew asked me what I was doing when he saw me dialing in a bolus before lunch. He thought my insulin pump was a cell phone.

When I told him what I was doing and reminded him that I’d shown this to him before (which he denied), I explained that the tubing put medicine in my body so that my brain could use the fuel from the food I was eating. I said that the medicine helped unlock the sugar in the food so I could be healthy. He asked (repeating and reformulating in that great way kids do) if the medicine was helping the food break into my body, and laughed, and I told him yes.

While the lack of familial to-do over my diabetes may not seem like a big deal, for me it is. The first three or four family events post-diagnosis contained many questions and lots of sidelong concerned glances about what I could eat and how I was doing (all well-intentioned, of course). But last weekend’s acceptance and laissez-faire attitude is quite welcome.

Everything went according to plan, then. No lows, no problems. (I used my temporary basal rate on the pump quite a bit, just to be safe—dialing it to about 75% of my normal.) In fact, the only troubling part of the camping trip, actually, came after we’d returned home early Sunday.

We had decided to leave late Saturday night, around 10:30 PM or so, because of storms, and because we both wanted to wake up in our bed the next morning and have a lazy Sunday at home rather than fight the traffic congestion typical each weekend when us downstaters in Michigan exodus from “up north.”

So…Sunday morning, after about five hours of sleep in my bed, I woke up hungry and poured a bowl of cereal. In my grogginess I didn’t think to check the expiration date on the milk, and I went ahead and bolused for the 70 carbohydrates that would be in the two cups of cereal and one cup of milk. The first bite struck me strange. I was somewhat sniffly, so I thought maybe that was it, that my nose was playing tricks on me. Bite number two: sour. Way moreso.

Still, determined to get my cereal fix, I tried once more, tipping the bowl and taking a sip of the milk. Only then did I realize what I was eating and, without panicking, walked into the kitchen, dumped the cereal down the disposal, and rinsed my mouth out with water from the tap.

However, I was now suffering the immediate trauma of “What did I just do!?!” and felt a bit queasy. I existed at that point in the liminal realm of still somewhat hungry but also repulsed by what had just been in my mouth. So without giving too much thought to anything else, I bailed on breakfast and went outside and told my wife about the horrible sour-milk incident. After 15 minutes outside with her and the dog, we went back into the house to watch “Meet the Press”.

When “Meet the Press” was over, I told Kathryn I was going back to bed. Upstairs, I flopped down in front of the fan, and as I began to enter into sleep, I felt just the slightest—only the tiniest—clammy surge of warmth in my legs that often means my blood glucose is going low. (I don’t know exactly how to describe it; I could probably spend pages elaborating on the nuances of how a low blood glucose feels to me.)

In my exhaustion, I simply wanted to avoid the feeling, ignore it, and hope it would pass. I told myself I’d deal with my blood glucose when I woke up. My mind wandered to the carbs I’d taken in while driving home (to ensure I wasn’t dipping beneath 100 mg/dl), and I thought, yeah, those carbohydrates are still doing their thing (remember, I was tired and not thinking too clearly).

Then something told me to give that clammy leg-warmth feeling a bit more attention.

I went back over my morning, and, yep, bingo, I realized that about 90 minutes earlier I’d bolused for a meal but never had any carbohydrates. I looked at my insulin pump, and there was the evidence: 5.85 units of insulin on board.

I went downstairs and drank a glass of orange juice, poured a different kind of cereal and opened a new carton of milk, then went into the living room to watch the closing ceremonies of the Olympics with Kathryn (the Canadian broadcast was airing it live). I said to her, “Guess what stupid thing I did this morning.” When she didn’t guess (apparently I can do a lot of stupid things in the course of a morning), I told her. We both wondered: Would I have woken up feeling that low as it came on stronger? What would have happened?

Anyway, yeah, close to scary. I guess the moral of the story is to watch out for the wicked ways of spoilt milk. There could be consequences.

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  • 21308diabetiesdiagdate

    im type 2 diabetic and i get so hungry in the morning(i work overnights) and my sugar level is in a good range not too high or too low this is before taking my pill in the morning.and i ate this morning(around 2:20am) crackers with sliced turkey and cheese and i also ate an ice cream sandwich.and i got off at 6am and by 7:30 and i fixed me something to eat because i felt like i was starving like i havent eaten anything,i wasnt feeling shaky or anything just very hungry its now 10am and im hungry again,i took med at 9am.does anyone else get that way and what causes this constant hunger?

  • Eric


    Thanks for the comment. The bolus I refer to is the infusion, over a one- to three-minute period, of fast-acting insulin to cover the meal I’m about to eat. I don’t know if other people have a great way of describing it, but has a pretty decent definition:


  • Lorraine

    Hi Eric, read your blog all the time and love it. Since I am type2 oral meds could you please tell me what is a bolus. I am constantly reading about it but have no idea what it is. Thanks And Regards

  • Mary

    Loraine if you look up thru the letter you will see a word “basal rate” highlighted in blue. If you read the second paragraph it helps with what bolus means.

    “Many people use an insulin pump because it closely mimics what a healthy pancreas does: It provides a steady flow of insulin all the time to help the body utilize the glucose that is always in the bloodstream, providing energy for thinking, breathing, and other automatic functions. In addition, a pump allows users to give themselves larger insulin doses (“boluses”) at mealtimes to cover the amount of carbohydrate ingested. This combination of basal and bolus doses helps keep blood glucose levels close to normal at all times, which in the long run can help prevent diabetic complications. (For people who inject insulin, the intermediate- or long-acting insulin serves as the basal insulin, and short- or rapid-acting insulin injections are used to cover meals. The long-acting insulin analog glargine [brand name Lantus] provides “peakless” basal coverage for up to 24 hours.)”

  • millie

    re 21308… I used to feel this way also, Bg reading not low but I was starving.I noted what you ate, and I will advise you to eat foods with more fiber, as they will travel slower through your system and help with feeling full. Try a sliced pear with slices of cheese and hi fiber bread with p-nut butter, for breakfast eat a high fiber cereal, oatmeal, whole fruit, make a frittata with veggies ,Fiber helps in more ways than one! Peace.

  • Lorraine

    Hi Just want to thank Eric for the very understandable explanation of a bolus and also Mary for her great explanation of the process of a pump. I have never before known who I could ask.
    Much Appreciated, Regard

  • Rick

    I made my lunch before work, I work second shift, and tested and bolused with my pump when it ran very low of insulin. Without thinking since I was in a hurry to get to work and had the pump in front of me I removed the infusion set an proceded to refill the pump, after having a full dose and no food. Of course there was a problem with the first setup and I had to redo it. Soon after I passed out and was found by my family an hour and a half later, and ended up at the emergency room. Lesson learned eat first, even if you may be late.