Sometimes your need for basal insulin, the long-acting variant that counteracts the liver’s constant release of glucose into your blood, changes. It can happen because you’re more active, or, as is often the case with diabetes, it happens just because. I take Tresiba, which is ultra-long-acting, so any changes you make take several days to show up. I’d dialled down my dose after waking up hypoglycemic every morning for almost a week but I was still struggling with hypos. Tresiba keeps very stable blood sugars when the dose is set right, but it has the disadvantage that it’s not very flexible in day-to-day life.
While waiting for the lower dose to take effect, I took less mealtime insulin, following the principle that high is better than low. After all, high blood sugar can take your foot or your vision away, but it happens over time, while low blood sugar can leave you dead on the spot. That is what almost happened to me the other day. I had lunch at work, chicken and salad, and when the salad was caked in balsamic vinegar I got a bit too trigger-happy with my insulin pen.
Half an hour after eating I started to feel hypoglycemic and drank a bit of apple juice. You should always sit down when your blood sugar is low, but the pub was busy and I figured the juice would do the trick. I was wrong. The last thing I remember thinking was that the room was swinging, and then reality slipped. Everything went black and I fell down with a loud bang. I only lost consciousness for a couple of seconds, probably thanks to the apple juice, because I remember hitting the floor. My manager also heard the bang and came running. He helped me sit up and got me another glass of juice. Within fifteen minutes I’d recovered and was back to work. Hypoglycemia is a strange beast. One moment you’re flat out on the floor and the next you’re going about your day as normal. Physically, I was fine.
Mentally, it changed me. I’ve been diabetic for almost four years and never had a serious incident from overdosing on insulin. My hypos have always been resolved with small amounts of carbohydrates and as a result of following a low-carb diet, I’ve managed to stay off the rollercoaster that so many diabetics struggle with. The fall left me with a pulled muscle in my neck and a bruise the size of a grapefruit on my left bottom cheek. The bruise on my soul is far greater. I thought I’d nailed my diabetes and had it under complete control. If passing out from hypoglycemia taught me anything, it’s that the beast still lurks under the surface and sometimes comes up to show its ugly face. It’s humbling, but also terrifying.