I haven’t had an encounter with The Fear in a while. I actually can’t recall the last time I had it or what might have triggered it. I do get pretty spooked before my bi-annual nephrologist appointments, but not to the extent that I used to get freaked, expecting to be told I’d slid a little closer to dialysis and the transplant list, nothing the gracious donation of an organ couldn’t fix. However, she’s assured me things are stable, and that based on her experience, she expects my kidneys to stay stable. While that hasn’t completely alleviated my pre-appointment anxiety, it’s made a big difference.

Monster Under My Bed (from: Cedric Hohnstadt Illustration)

The Fear, of course, is the shadow lurking in the corner, the monster under the bed, the boogeyman waiting to lunge out of the closet just when I’m feeling safe and secure in the bed of diabetes life, which is hardly the most comfy, pillowy mattress ever, but I’ve come to tolerate it enough to catch a decent night’s sleep on occasion. The Fear is what I feel when I think some complication of horrific magnitude has come to snatch me from safety and tote me off into scary uncertainty.

I used to live with The Fear because I didn’t understand that I had a choice. How much to teach kids about complications is fodder for another post, but I had learned about them as a kid at camp initially. I don’t know if the caveat that I could avoid them if I took care of myself was ever offered or not, but I, with my infinite child logic (see yesterday’s post…), took away the message that blindness, amputations, kidney failure, and premature death were essentially as much a part of diabetes as taking insulin and exchange diets. I was wrong about everything except the insulin, but for years, as certain as I know insulin stinks to high heaven, I was certain that I would be dead by age 30. That prophecy didn’t come to pass though. There was a point maybe in my mid-20’s, when I updated the prophecy to age 40, but as I stared down the barrel of my 30th birthday with my sexy new boyfriend, Jason, on my arm, it occurred to me that maybe I’d been mistaken to think such an early death was inevitable.

That’s about the time I got serious about getting myself together and figuring out how to manage my diabetes the way it was meant to be done. Of course, I’d been screwing with it – and dragging my poor body along for the ride – for so long, that it took me a couple more years to slay the demons who eventually had to concede that I was leaving them for good. Living without those demons has been an awesome experience thus far, but The Fear still stops in for a visit on occasion.

I like to have a treat at night, so around midnight last night, I broke open the cellophane wrapper of a 37g carb pastry. My BG was sitting at 105mg/dL, so I did a combo bolus to account for the fat and keep my BG from dropping before the sugar hit my bloodstream. At about 1AM, Jason went to brush his teeth, and I would’ve done the same, except I started to feel a low coming over me. The pastry carbs were MIA. I thought about a cup of milk, but opted for a sugar-free pudding instead because that’s the same number of carbs. In retrospect, maybe that wasn’t the best choice, but I knew I had pastry sugar waiting to charge through my system, so I didn’t feel the same sense of urgency that would have steered me towards the juice carton otherwise.

I ate my pudding and waited. At some point, I started to not feel so good, like kind of nauseous, an odd symptom I get with lows sometimes, so I checked my sugar. 61mg/dL. I really wanted to go to bed, but I needed my BG to not be low. It had been about two hours since I’d eaten the pastry, and maybe an hour since I’d eaten the pudding. Why the heck wasn’t my BG coming up? I was getting frustrated, especially since the nausea wasn’t lifting, so I got some cookies out of the cabinet. I didn’t measure or weigh or count. I wanted my BG to rise enough so I could go to sleep, so I just ate until all that remained were crumbs. I checked my BG. 55mg/dL.

Just Crumbs

That’s when The Fear arrived. I’d eaten all this carby food, and my BG had been hovering too low for almost two hours. I had bolused for the pastry, but never bolused for the pudding or the cookies, which had to have totaled at least 70g carbs. The only logical explanation was that my food wasn’t digesting. Gastroparesis ?? Could it be? There are times when I suspect I have some delayed digestion. Before meals, if my BG is low or within target range, I bolus after I eat more often than not, and I don’t typically get dramatic post-prandial spikes. I also use the combo bolus feature with almost every meal. If I took my entire bolus before I ate, I’m pretty sure I’d end up with a lot of post-meal lows. If I have slowed digestion, that doesn’t even really upset or worry me. What worries me is if it progresses to full-blown gastroparesis with the nausea, vomiting, weight and appetite issues – and the unpredictability of how to bolus for food if you don’t know if or when it’s going to be digested.

Although this one instance of carbs that aren’t kicking in is flimsy evidence, I do already have autonomic neuropathy. It’s affected my heart. I’ve had some unfortunate incidences of diabetic diarrhea. One of these days, I might cover that topic if I can figure out how to write about it without embarrassing myself or completely grossing you out. I’ve also had some sexual function/lady parts issues that I can only attribute to diabetes, yet another sensitive topic I’ve skirted. And these are issues that started close to 15 years ago, so would it be a surprise if my stomach also wasn’t functioning optimally, especially in light of having been bulimic for 18 years? Honestly, if last night was a sign of gastroparesis, it’s a wonder it hasn’t developed sooner.

By the time I went to bed, about 3AM, I wasn’t feeling low anymore, but I wasn’t sure how to bolus for the food I’d eaten over the course of the previous three hours. I told myself that perhaps I was just having one of those fluky nights when no matter what I do, I’m low. Even people without gastroparesis get days like that because sometimes diabetes just does it’s own inexplicable thing. If that were the case though, and I fully bolused for the carbs I had consumed, I might be facing some fierce early morning lows. I erred on the conservative side, assuming that at least some of the carbs were going to hit me eventually, and I took a small bolus of 1.5u. Then, I brushed my teeth, crossed my fingers, and got into bed.

The Next Morning

Naturally, I spent most of the morning being awoken by the CGM siren, periodically silencing it, and hoping it wasn’t bothering Jason too much. At 6:30AM I bolused 3.5u, hoping that would bring me down. Jason got up, got ready and left for work, and the siren was still blaring, kindly alerting me to the RISE RATE and the HIGH SG. I checked my CGM, and my BG was maxed out. Not good. Not good at all. I bolused 4u, and hoped that would do the trick and I could sleep in peace for just a little bit longer.

A few minutes before 10AM, the siren was still ringing out from under the covers. I looked at my CGM monitor, I looked at the clock, and decided that even if I tried to salvage any more sleep, it wouldn’t be peaceful. I felt like crap, I had a headache, and I felt like I’d licked the lint filter in the clothes dryer, so I trudged downstairs to see what my BG was, and take yet another bolus. 245mg/dL. Not horrific, but obviously not good. I tried not to think about what my BG had been 7.5u of insulin ago, while I programmed another 2.9u.

The Fear is gone, but I’m concerned. As I ate lunch a short time ago, I panicked for a moment, wondering if my food was going to digest. Was I over-reacting last night to assume this was a sign of gastroparesis? Do I wait and see if I have more incidents like this? Do I assume it’s just diabetes being diabetes, or do I follow-up and make sure it isn’t anything more foreboding? Maybe I was jumping to conclusions. Maybe I was being irrational because my BG was low. Having had diabetes for 31 years, and having already experienced problems as a consequence of not managing it well in the past, it’s hard to not let The Fear get the best of me sometimes. The Fear doesn’t need a reason to intrude though. If I listened to it every time it crawled out of the woodwork, I’d spend my life in and out of doctors’ offices and medical testing facilities, chasing every little hiccup and twitch like they were signs I was dying. I know I need to be cautious and proactive when it’s justified, but I also know I can’t let The Fear order me around. The problem is distinguishing when I should pay attention to it, and when I should know that The Fear is only trying to scare me.