Insulin Reactions are Not for Sissies

I thought he was part of my dream. Then I felt him bump into my end of the bed and double over. “What are you doing?”
I can’t remember his response. He turned around and walked smack into the antique dressing table, his head making contact with the wall.
“Steve, what are you doing?”
“Trying to find the bathroom.”
I switched on the lamp at my night stand. The clock read 12:37 am. We’d been in bed close to two hours. He saw the bathroom door and walked through it. I could hear him in there, standing, nothing happening. I still wasn’t sure. This one was starting differently, and I needed to wake up. He came back to bed, and when his answers to all my questions were, “I don’t know, I’m sorry,” I got up and got the glucose tabs from his bathroom sink. The dilated, glassy, vacant look in the eyes is also an important sign.

Thank goodness I didn’t have to use the glucagon pen this time. Since he wasn’t convulsing and was propped up on pillows at the headboard, he was able to chew the large tablets without difficulty. With the third or fourth tab, I think, the convulsions started.

This is where quick judgment is necessary. He’s already got glucose in his system, and you don’t know how much more he needs if any; you don’t take the time to test his blood sugar, and anyway you know with this violent a reaction it’s probably in the teens. Most important is to administer glucose in some form and keep him contained until the convulsions subside and he regains full consciousness.

Once convulsions have begun, juice is not an option. He may try his best, but as much will end up on clothes and sheets as will inside him. If the reaction begins with convulsions (or you’ve not detected it until the convulsions begin), you’ve got to grab the glucagon emergency kit. This is dicey in the wee hours of the morning. It involves a syringe full of fluid and a vial with powdered glucagon in it. You must shoot the fluid into the vial, shake the vial to mix the solution, then draw the solution back out of the vial with the syringe and inject the convulsing human with it. And the human does not cease the convulsing for you while all this must be done.

The hardest thing for me is the point when I know everything’s been done that’s to be done, and the symptoms haven’t subsided yet. In 2009, because he was learning to trust the technology on his new insulin pump and kept mismanaging it, we went through this at least a half dozen times in a six month period.  Once when we were in New York City, it happened twice in one night, and I was up walking the streets of the city that never sleeps at 2:30 a.m. to buy him some food to make sure his body’s glucose stores would be replenished.

The first time he woke up convulsing I called my parents in a panic, kept Mom on speaker phone while Dad drove over and I called 911. The paramedics gave me a crash course in dealing with this kind of reaction. I had tried the glucagon pen in the interim and had done it wrong. It was the first time I’d ever stuck anyone with a needle. Now, I’m just, bam. Done.

But this one was different. And we hadn’t dealt with one in a while. The convulsions started later, and I could tell things were going to get a lot worse before they got better.

Then he decided to take a walk. Not much I can do about it from my side of the bed. Five-foot-eight, 190 lbs packed with muscle hops up and starts walking, the only things in the room that are going to stop him are gravity and furniture. Mercifully, he stumbled into the rocker only a few feet away, hit the wall and folded down to a sit, knees bent, feet off to one side, still convulsing while his forearm repeatedly banged against one of the legs of the rocker. I sat with him, tried to deal with the arm, fed him one more glucose and talked to him to see if I could wake him up.

What he’s going through at this point is horrific: He has the same dream almost every time, that the surface beneath him is breaking into pieces and falling away, revealing a fathomless pit into which he is starting to fall. There is no convincing him otherwise, and it is the reason for his desire to move from wherever he is.

After another minute of him banging his arm on the chair, staring into space and grabbing hold of electrical cables, I got up on my knees and pinned him against the end of the bed with my torso. He would intermittently hold me tightly for a few seconds, and then the convulsions would take over again. I knew he was coming back, just not quickly enough for either of us.

The front of my pajamas was getting drenched with his sweat. During this period he successfully chewed one more glucose tab. I ordered him to keep chewing, afraid some might still be in his mouth, and he answered, “I am. There’s nothing more to chew.”  And then I knew he was returning.

“I’m sorry. I’m so sorry to put you through this again.” Ninety percent back. Five minutes later he was in the shower washing off the sweat, putting on clean, dry clothes and crawling back into bed. Now he sleeps, exhausted, and I write it all down as my heart slows back to its resting rate.

Steve has been a Type 1 Diabetic since age 13. It is an auto-immune disease with no known cure. Type 2 Diabetes is genetic, has the same symptoms as Type 1 but can be prevented or controlled with lifestyle changes. Steve has been meticulous in his self-care over the years except for one period in his adulthood, and for that brief period of negligence he paid with heart surgery in 1997; still he has fared far better than most Type Ones of his generation. If you are borderline Type 2 and have the privilege of making choices to improve your health before you become insulin dependent, do it before there’s no going back.