I’m unable to predict when I’m going to have a hypoglycemic episode. They don’t happen often, and when they do, after I’ve gotten my blood glucose back up and after I’ve fought off the desire to eat half of what’s in the kitchen, I try to think back and reconstruct events leading up to the low blood sugar so I can figure out what to do in order to prevent it the next time.
Short of an obvious (and unintentional) overbolus — a rare instance indeed — putting my blood-dotted, lancet-pricked finger on a specific cause for a low is an exercise in maybes and what-ifs. There are just too many factors contributing to each hypoglycemic episode. Too, too many. In hindsight, of course, I try to and am often able to think I know what it may have been. “Oh, that’s what it was!” Because the desire for a eureka moment is strong in me. I want to know. And I’ll think I’ve figured it out, the one or two reasons I sank into that miserable, sweaty, shaky, foggy-brained fifteen minutes of 45 to 60 mg/dl.
How do I avoid, for instance, Tuesday’s low in the checkout line at the grocery store, during which the clerk’s ringing my purchases and I’m pacing back and forth trying to figure out how to treat the low that’s arrived. In my brain the connections aren’t happening. Yes, a sugary soda right there in the checkout cooler. Root beer! Oh, but there’s an entire rack of sweets. Twix! Not good for me. Not a good way to treat.
But something, I need something. Fruit. I don’t want fruit. Milk. Blech. What should I choose? And oh, but good god am I hot. I’m sweaty. Can they see I’m sweaty? Should I take off my jacket? Do people know what I’m going through? Of course they don’t. Are they staring? I can’t think straight. Should I tell the cashier, the bagger? I’m an adult, dammit, figure this out. Fix it. You know how to fix it. Get that soda. But do I need to pay for it first? No, no I don’t. Open up the root beer and take a swig, a few sips, that’s all. You want those carbs in your mouth. Those carbs on your tongue begin the trip back to good.
Then I can walk to the car, sit in the car, check my glucose in the car, wait out its rise in the car, in the parking lot, in the car, in the cold, snowy afternoon (oh sweet, sweet cold! I’m so hot right now, so sweaty, wiping my forehead and hyperaware of my shirt clinging to my back). Then I’ll drive home. Then I’ll think about this incident. I’m sure that if I change the things I did that led to this I won’t let it happen again. I’ll avoid another low. At least one like this. A low that sucked.
Except they all suck. And it will happen again. Seeking that one thing that led to the low — be it bolusing too much for an afternoon snack, changing up my exercise routine, taking cold medication or cough syrup, enduring a stressful meeting or worrying about something I have no control over — what it may have been caused the hypo is no doubt a confluence of any number of things, each of which is weighted differently in its contribution, but each of which is important, each an arm on a very sensitive and difficult-to-balance mobile of good blood glucose control.