“Nicole was talking to her mother and suddenly collapsed.”
This is what my wife’s father told me at 1pm, last Friday. Nicole, and our son Jonah, had been visiting her mother at a surgical ward in our city’s medium-sized hospital. (Her mother had been admitted two days earlier for an emergency.) Now Nicole, apparently, lay unconscious in the emergency room.
I had no other information other than what Jonah told me a few minutes later while we drove back to Stratford General: “First Mamma started laughing. Then she started crying. Then she…”
Well, that sounded promising. Laughter. Tears.
“Smells like a low blood sugar,” I said with a vague feeling of relief.
In truth, we’ve been married 16 years and I’ve only seen her lose consciousness once due to a low blood sugar. Therefore, I wasn’t too convinced that her current ER adventure had such a simple cause.
With all the other issues Nicole has, it could be something worse than an insulin overdose. Last November she was paralyzed from the neck down due to a complication of renal failure. Her blood pressure also drops expectantly, once landing her face in a dinner of vegetable stew. Plus, she’s been suffering heavy menstrual bleeding and low red blood cell count.
Jonah and I arrived in ER 15 minutes later.
Last time I met Nicole in the ER it was a frenzy of nurses, doctors and paramedics. This episode, however, had all the drama of a bus stop. The nurse showed Jonah and I into Nicole’s room.
There she sat in gown and bed, eating a sandwich.
“Hi,” she said, sounding a little surprised.
“What’s going on?” I asked feeling relief that she seemed relatively fine, confused as to why she was relatively fine and annoyed at having to drop work for a non-emergency.
She had an IV in her arm, an oxygen tube in her nose, an oximeter on her finger and about 12 ECG pads stuck to her torso.
“Didn’t they tell you?” she said.
“No,” I said.
“It was a low blood sugar.”
I reached into my backpack and pulled out the glocumeter (which she had left at home much to my angst). Snap! She pricked her finger. Beep! The readout gave the final verdict: 10.5mmol/L (189mg/dL).
“Well, you’re not low anymore.”
“They’re making me eat this disgusting sandwich,” she said. She handed me two slices of snow-white bread with yellowish goop oozing out between them. “Throw it away! We’ll tell the nurse I finished it.”
She explained that her blood sugar had been a bit low after breakfast. She had popped a glucose tab, which brought it back up to normal before she left to visit her mom. Nonetheless a half-hour later, while in her mom’s room, she suddenly realized she was going low… real fast.
Well, no need to dial 911 when you drop to the floor in a hospital. In-house “paramedics” had her on a dextrose drip, stretcher and speeding to the ER (a two-minute walk away).
Only two ways I know of to raise blood sugar (quickly) when the person has gone unconscious and is unable to drink or eat: IV or glucagon. We have glucogan at home (as I’m lousey at needling arteries).
I prefer the IV treatment, however. In theory, it offers better glucose control. In practice, I’ve heard from many sourecs, most emergency rooms over compensate. Case in point, even with my wife’s blood sugar at 10.5mmol/L they still wanted to see it higher (plus monitor her for the next six hours).
We’re grateful and applaud the staff’s ability to reverse such an emergency quickly. But emergency’s over.
“Let’s get out of here,” I said. Nicole began peeling gooey ECG pads off her body as the nurse protested and got the doctor. The doctor, however, had no issues with her leaving.
“You ate the sandwich?” asked the doc. Nicole nodded.
Why did the glucose in her blood drop below 1mmol/L (according to the nurse). Nicole’s been so stressed lately dealing with her mother’s medical emergency. She’s been so stressed that she said she didn’t even feel stressed. That’s when I know she’s really stressed. Yet, by the fateful Friday morning, her mother was now stable. That allowed Nicole to relax. Going from stress to relaxation can result in a sudden drop in insulin needs.
The next day, our neighbour, a retired nursing professor, heard about the incident. She told Nicole something to the effect of: “Let me guess, they shot your blood sugar as high as the CN Tower? They always do that in ER.”
In the end,Nicole’s blood quintupled in sweetness reaching 25mmol/L (450mg/dL).
Good thing she got out of there when we did.
But, also, good they got to her when they did.
Thinking outside the T1D Matrix,
– John C. A. Manley
P.S. It really doesn’t take much sugar to correct even a very low blood sugar. The rebound effect is an avoidable myth. See what I mean by reading this “classic” Diabetic Dharma post from 2015: How to Fix Low Blood Sugars Without Going High (Part 1 of 2)