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Archive for April, 2012

The ‘Highs’ and the ‘Lows’

Rainie - one of the stabilizing factors in my life!

Sometimes Rainie’s nose amazes me! I was driving past the kids’ playground to get to the part of the park we hike in every morning when Rainie uncurled from the floorboards, and frantically began smelling the wind coming through the open window. She was obviously in some distress, so I pulled into the parking lot, leashed her, and let her out. She immediately led me to the play area, and began alerting on a little girl who was running up the slide with a pink pump clipped to the back of her pants. Little pink-sweatered arms soon encircled Rainie, as I talked to “Emma’s” mom. Yes, her blood sugar was low (65), after having refused to eat breakfast. As Emma’s mom and I talked, she mused, “I wonder what it feels like for her when she goes high and low?”

This is a question I’m often asked, “What does it feel like?” It’s taken me a long time to figure out the answer to that. I’ll try to describe how it feels to me. (Please remember that I’m describing this as an adult diabetic. When I was young, I had the same feelings, but no words to describe them with.) And as I describe the differences between ‘low’ and ‘high’ blood sugar, please realize that a diabetic often fluctuates between the two states many times a day due to the nature of diabetes.

Low blood sugar, or hypoglycemia, might be fun if it weren’t so scary and disorienting. Hypoglycemia is potentially life threatening because the brain’s only fuel-source is sugar, and with too little sugar, the brain cannot function properly. Therefore, most of the sensations of low blood sugar are brain-based.

If my blood sugar (BS) is dropping slowly, the symptoms may be unnoticeable at first and slowly become stronger; if my BS is falling rapidly, I catch the symptoms as soon as I can. The first symptoms tend to be a general ‘fuzziness or blurriness’ in my thinking and perception. It is very easy to not even realize anything is wrong, and slowly become agitated and frustrated because ‘things just aren’t right’. I may also get very cranky or whiny.

As my BS continues to drop, my thoughts and reflexes get slower and slower, and it becomes more difficult to understand conversations and new ideas. I may also make relatively impulsive decisions. These are the times I’m glad I have my low blood sugar alert dog, Rainie. Her alerts keep me from doing things (like driving) when I’m still feeling ok, but could easily put myself, or others, in danger. (I am not drunk – although I may look that way.)

As the blood sugar continues dropping, I become physically unstable, emotionally fragile, and easily overwhelmed. I become dizzy, clumsy, disoriented, teary, easily confused, and unable to make up my mind (which is really bad because it means I can’t even decide what I want to eat in order to correct the situation). Even though my lips and fingertips may be numb and my vision may be blurry from the low BS, I get angry when people begin to question me and offer help. And I need help! And at the same time, I’m somehow unable to take care of myself. And I’m scared!

If things were to continue, there is a good possibility I would become unconscious, go into ‘shock’, and, in the worst-case scenario, die.

The symptoms of high blood sugar, or hyperglycemia, are much more physical than low BS’s are. The first thing I notice is a deep headache. Then I get thirsty and agitated – very ‘squirmy’ and unable to concentrate and be still. I crave water to try to dilute my sugary/syrupy blood. I’ve noticed my tongue feels like it’s a dry cotton-ball sometimes. Then, my body begins to ache. Every part of me feels toxic, as if I’ve got the achiness of the flu. I don’t want to move because it feels ‘too hard’ – like walking through mud. And my brain feels that way too. Sometimes I just want to curl up in a dark, cool room and not move. If my BS gets high enough that I begin to ‘spill ketones’, I can get very nauseated and vomit. High ketones are poison to the brain. I’m also very sensitive to the fact that a few hours after high BS begins, my vision gets blurry because the sugar in the blood makes the lenses of the eyes swell.

High blood sugars can be very stubborn and not respond to extra insulin the way low blood sugars respond quickly to sugar. Often, with high BS, the body is resistant to the insulin because of adrenaline released as a protective mechanism by the liver. This can happen as a response to low blood sugar, exercise, excitement and all sorts of emotions like fright/fear, crying and laughter. And at other times, I am extremely sensitive to my insulin and am ‘low’ for hours on end and have a hard time bringing my BS up. Frustratingly, sometimes blood sugar control seems impossible, as if it’s influenced by the weather or color of socks I’m wearing – there seems to be no rhyme-nor-reason to it.

Unfortunately, even though it may only take a few hours for the blood sugar to ‘get back under control’ with either insulin (for ‘highs’), or sugar (for ‘lows’), it takes many hours for the cells in the body (and the emotions) to get back into balance.

It's easy to get wrapped up with the severity of diabetes. But it's a part of life, just like joy, laughter and friends.

Life with diabetes is a true seesaw. High and low blood sugars happen. It’s part of living with diabetes. If you have diabetes, or know someone with diabetes, please be patient, and be present. We all have ‘one of those days’ occasionally; unfortunately, for someone living with diabetes, ‘those days’ happen almost every day.

Please see my next entry, “An Addendum”. I go on to explain a few characteristics of low blood sugar that I forgot to mention here.

It isn’t about the dog

I’d like to share this blog, written by a friend who also has a diabetic alert service dog. I was at the DMV today, and was bombarded by many of these same, frustrating issues. It is hard (and questionably worthwhile) trying to explain to people that service dogs are not ‘pets’ in fancy jackets.
Thanks for writing this, Amelia.

It isn’t about the dog.

Yes, She Has Saved My Life!

Rainie and Molly at the Beach

The other night my husband and I, and Rainie too, went out for dinner at our favorite local restaurant, which is also frequented by the firefighters who’s station is just down the street. I wish I’d had a camera to take a picture of the three firefighters, still in their work gear, bending down around Rainie for some impromptu Rainie-love. Although I’ve talked to a couple of firefighters before, I guess I’d never talked to this crew. They were full of questions since they’d never heard of a “Diabetic Alert Dog” before. They were incredulous that she can smell my blood sugar changing. One said he was surprised that she hadn’t been trained to ‘ring a buzzer’ that would call for emergency help, but, instead, has been trained to alert me so I can take care of myself long before I need help from anyone else. They asked for some business cards so they can find out more (and possibly have me come and lecture). I found out that one of the most frequent emergency calls they get is to take care of someone who has become combative or lost consciousness due to low blood sugar.

One firefighter asked, “Has she ever saved your life?” I think she may have, at least once. The most incredible alert she ever gave me happened when she and I were walking on the beach with Rainie’s friend, Molly, and my friend, Sally. We had been walking for about 40 minutes when Rainie came and started dancing around me. Usually she alerts by nudging my hand first, then does her dance later. I was feeling fine, but did my blood sugar anyway. The reading was 135 – perfectly normal, so we kept walking. But Rainie wouldn’t stop her dancing and jumping. We had only gone about 5 minutes further when Sally said that I’d better test again since Rainie was trying to tell me something. Still, I was feeling fine, but Rainie was going crazy! We stopped, and I tested. The meter read 84. Usually his number would be all right if I weren’t walking; and I was dropping way too fast – 41 points in about 5 minutes! Way too fast! I reached into my pocket for some glucose or some sort of candy, but all of my pockets were empty. I asked Sally if she had anything to eat, but she didn’t. I told her we needed to turn around and get back to the car. I was still feeling ok, but I knew this was not a good situation. On the way to the car, I asked every person we met if they had some candy, but no one did. When we got to the car (where we couldn’t find my glucose bottle either), my blood sugar tested at 31. This is dangerously low! Now I was feeling shaky and was wet with perspiration. Sally quickly drove to the nearest store while I kept talking the whole time. When we got there, my meter read “low”, (too low to read). I don’t even remember what she bought me to drink; but I do remember that Rainie stayed in my lap, licking my face, and possibly keeping me from going unconscious.

Decisions, decisions….

As I sit here at my computer, I am shrouded from the outside world by sheeting rain. Rick, my husband, and I and Rainie, of course, had planned to go to a ‘spring gala’ at an incredible estate about an hour from here. It was going to be an outside affair among the sculptured gardens and manicured beds of blooming bulbs and camellias. There were going to be Guide Dog puppies with their trainers on display, as well as ponies and rabbits for the kids to play with. We decided not to go. Even if the event had not been cancelled, we would not have gone. Everyone would have been in their Easter finest; and the mansion would have been polished to its utmost glory with flowers in vases placed “just-so”. And I would have had a wet dog.

One of the rights of having a service dog is that I may legally bring her anywhere that is open to the public. About the only places that a service dog cannot go are operating rooms, into the kitchens of public restaurants, ICUs, and CCUs. Rainie, and dogs like her, have no legal rights to enter a private home or church without permission, either.

However, there are times when I’ve found that even though I can bring Rainie with me, it may be best if I didn’t. In other words, I need to use my best judgment. I think I did this today. I guess I could have left her at home, but we would have been gone too long for me to be comfortable with that. Also, I’ve never left her home alone since I’ve had her. Once I have left her with my daughter to dog-sit when I went to a movie about a zoo. I’d heard there would be lots of roaring lions, and this would probably upset her. And since Rainie isn’t the best at movies to begin with, I decided to go by myself. Another issue is that in the theater there is really no easy way to distract her (although the stuff spilled on the floor does a pretty good job by itself). I couldn’t bring a chew bone because it would roll down to the next tier. So I left her with my daughter.

There was one particular situation I found that a ‘distracter’ didn’t work, and bringing Rainie did not work for me: this was when I took water aerobics classes. Rainie is welcome in the gym. She stays with me in the locker room, and sits outside the stall while I shower. The gym even installed a special hook for me to leash Rainie to right next to the pool and behind where I stood while in the pool. The problem is that when I exercise strenuously, my blood sugar falls rapidly, so Rainie is alerting all the time. She’d sit next to the pool, and paw toward me, or whimper for my attention. All of these are good, except that I was prepared for the changes, and knew it was part of my exercise routine. I decided to try to distract her. It was suggested that I fill a ‘kong’ (a hard, roundish, hollow, rubber toy) with peanut-butter, freeze it, and give it to her while I was exercising. I tried it and it worked really well – once. The second time I tried the trick, it did not go so well. I had settled Rainie and given her the kong. We were in the middle of class when another class member cried out, “Agh! What’s that in the pool?!” I looked to see a large, black, peanut-butter filled blob (the kong) bobbing on the bottom of the pool; and Rainie, leashed behind me, pulling as tight as she could against her tether, with her toes gripping the side of the pool, trying to jump in and retrieve it. Needless to say, I never did that again. In fact, I don’t practice water-aerobics anymore.

The moral of the story is: Despite what the law states, it is always best to use your best judgment.