In part two of resident diabetic Henry Stewart’s ongoing series, Insulin is Not a Cure, he explained the best-case scenario when taking insulin (exhaustion), the worst (death), and the normal (really bad).
Insulin therapy is all guesswork. As Sam Whiting wrote in the San Francisco Gate, the idea that diabetics can control their blood-sugar levels is a myth: the best for which they can hope is to influence them. A diabetic, essentially, is trying to be his pancreas, which is about as feasible as him trying to do the work of his heart or lungs. A properly functioning body knows its blood glucose levels and administers small amounts of insulin whenever necessary. A diabetic can only prick his finger to check his blood so many times a day, take so many injections, make so many guesses as to how whatever he’s planned to do and eat that day will affect his condition. (Some diabetics now have “insulin pumps,” a continuously worn needle connected to a small gizmo that allows many small insulin infusions throughout the day, more accurately mimicking a pancreas.) He can overdose by accident. And once the insulin has entered the bloodstream, there’s no way to get it out, like an egg in a cake. All you can do is eat. The insulin isn’t just feeding you; you’re feeding it.
But food isn’t the only factor to influence blood sugar, and even it does so in peculiar, often unpredictable ways; you could eat the same thing for breakfast and inject the same amount of insulin on two different days and wind up with radically different sugar-readings by lunch. Though peanuts are essentially free of the kind of carbs that would raise your blood sugar, they can have that effect because of the way fat affects insulin reception. Alcohol usually lowers blood sugar levels, counterintuitively, as do some teas. (Sometimes, though, they don’t, even though they have several times in the past, and you wake up in the morning with a blood sugar reading much higher than you anticipated!) Stress affects blood sugar levels, as does physical activity. Maybe you fall asleep right after dinner, and because of inactivity the insulin never really gets worked through your system. Maybe an area of the body has become so damaged from repeated injections that the insulin doesn’t properly make it into the bloodstream.
Diabetics have to monitor themselves closely, discover patterns in the ways certain foods and activities affect them, and use that information to make educated guesses as to how much insulin to inject, what to eat and how much of it, how much exercise to perform. If a diabetic takes insulin and fails to eat, or fails to eat enough, or fails to eat soon enough (which is why I collapsed that time in the middle of dinner—it took ten or fifteen minutes longer to cook than I had supposed), they can at worst suffer brain damage or slip into a coma. At best, they get dizzy and disoriented, like a sudden onset of drunkenness without any of the fun.
Healthy blood sugar levels fall within a range of 70-110 [mg of glucose per dL of blood]. (Diabetics hope to keep their sugars within that range, or close to it, but it’s impossible to be consistent.) Once levels begin to fall below 70, the symptoms of hypoglycemia begin. At first, it might just be a mild sluggishness, a difficulty concentrating. The brain is hungry. But if blood sugar levels continue to fall, the physical response escalates: sometimes gradually, sometimes all at once, the brain surpasses hunger—it’s starving, at which point you might start sweating as your body temperature rises; severe disorientation ensues.
It’s surprisingly simple to get out of a hypoglycemic episode: just eat some sugar. A good diabetic always carries a packet of Skittles, a can of Coke or a tube of glucose tablets for just such an emergency. But in truth you need two things to pull yourself out of hypoglycemia: one is sugar; the other, rational thinking—and that’s the one thing a hypoglycemic diabetic definitely lacks.
Very enlightening piece. I’m not a diabetic, but I have family members who are and I see their struggle. Thanks for providing your perspective.
It is such an impossible balance sometimes. So many variables to contend with, many we don’t even know of.