Monday, March 5, 2012

Self-Defeating Behavior

Blackness surrounded me.

The clock on the nightstand next to my bed probably read something like 1 a.m., but I wouldn’t know – because my eyes were closed. At that hour, all I wanted to do was sleep. And I was almost there.

But a faint noise was keeping me awake, just enough to stop me from stepping over that line into sleep-land. Not a beeping, as I’ve sometimes heard overnight and during the day as a diabetes device alerted me to a High or Low blood sugar. No, this was a vibrating.

Reluctantly pulled back from the doorway where sleep would fully cover me like a blanket, I opened an eye groggily and looked around.

A sleeping wife next to me. The covers pulled over my body. A faint night-time glow from the window off to the side. I’m sure the Riley Dog was nestled on her blanket next to the bed, but I didn’t turn over to look.

Reaching down to my waistline where my insulin pump was secured, I pulled the small pager-sized device up to my open eye to have a look. The backlight provided what I needed to see the message displayed across the screen: “No Delivery.”

Annoyed and still not even close to being awake, I grunted at the device. You know, #likeyoudo in that half-asleep mindset when you’re not even close to being awake.

I’m sure a thought or two went through my mind about WHY that alert was occurring, about the underlying reason for it – bad infusion site, pump tubing kink, reservoir blockage, or just the Sleep Gods bribing the Diabetes Device Gods in order to screw with me.

I’d been unconnected from Dexcom for a day or so and hadn’t yet put in a new sensor, so there was really nothing else to alert me of a problem. This was the time to get up and do a blood test, to identify whether I might have been insulin-deprived for any significant length of time and whether something more than a few clicks of the pump button would be needed.

As sometimes happens, I didn’t listen to that sage internal voice..

I vaguely remember grumbling to myself and saying, “I’ll deal with you in the morning.” I might have sworn at my pump, too.

The decision was clear: simply put the pump on snooze and go back to sleep.

And sleep I did, for the rest of the night. Without batting an eyelid or being awakened by any more pump alarms.

Of course, just because I wasn’t awakened by any pump alarms, that DOESN’T mean they weren’t going off and trying to wake me up.

Yes, apparently they were. I just didn’t hear them.

And that’s why I woke up to pump beeping several hours later, telling me that there was a now a long history of No Delivery and that I was basically depleted of insulin most of the night. Doesn’t help that I’d gone to bed in the 300s, thanks to eating a fat-heavy earlier dinner that night.

A blood test confirmed how I felt: High Blood Glucose.

High as in: You’re higher than the kite Benjamin Franklin set sailing in search of lightening. Ketones, too.

It was a fun morning of bringing the sugars back down and getting the ketones out of my system. By mid-morning, I was back into the 300s and then by noon I was 265. Skipped lunch and got back down into the 100s by mid-afternoon.

Was it worth it? Did I choose the right path, going for those hours of sleep immediately rather than taking 15 minutes to investigate and remedy the pump problem? Probably not. That was the move of a lazy man who just wanted his sleep.

Ironically, my Daily Bible verse that day had been from Proverbs 10:4 and it specifically warned me about this – “A slack hand causes poverty, but the hand of the diligent makes rich.” Translation, as I applied it to this situation: “C’mon, Hoskins, don’t be a slacker. Do what you need to, even if it’s in the middle of the night. Or you’ll cause your own poverty in the diabetes world of in-range blood sugars. But if you wake up and be diligent in addressing that No Delivery alarm, you’ll be blessed with good morning numbers.”

My choice sealed the morning’s path.

I know better. Even in retrospect, I know what I should have done. But I didn’t. And, somehow – amazingly – I fully expect to make that same choice again before long. Not every time that alert or a similar one disrupts my sleep, of course. But I’d be willing to guarantee it happens again. Because that temptation to keep sleeping is a strong one for me.

Self-defeating behavior, it is. I guess that’s how I roll sometimes. Luckily, Dexcom will be back on board soon and will hopefully help me deviate from these sleepy-time decisions - even when I don't have the will-power to respond to a pump alarm and get out of bed. God, I hear you. Here's me, trying not to be a slacker.

Because aside from divine beliefs and all that, I just don't like having High blood sugars.

10 comments:

Kelly said...

Same same. Sometimes being the "slacker" makes us feel more in control I think. I do it often...WHY do we do these things?!! Im REALLY good at slacking during the sleeping hours lately. -Sigh-

Scott E said...

Even with a CGM (I use the pump-and-CGM-in-one), it still isn't always effective. I pretty much never get "no delivery" alarms, perhaps my type of infusion set doesn't lend itself to those warnings, but I do get bad sites that lead to ketones every so often. But in the middle of the night, I give a correction-bolus based on the CGM alone and go back off to sleep. There's plenty of regret in the morning. (No, I don't advocate doing this, and lately I've told myself "you'll regret this in the morning" and that gets me on track)

Sarah Sugabetic said...

I have had a few of these nights myself. Being high is tiring in itself, but it just makes it all the worse when you're woken up from a good sleep - adding to the already existent OSSAS ( the Oh Sh!t Sugar Attitude Syndrome {yeah, I just made that up!}).
One thing I try to tell myself is that if I don't fix it now, not only am I causing bodily harm, but I won't rest as well either. So I can either wake up cranky and high, or a bit better rested and coasting back to normal.

tomswife said...

It is so difficult trying to do what nature does for the rest of us. The "good news" if it can be called that -- is that you were high. My husband ignores those beeps when he goes low -- which seems to be about once a week lately. then its up to me to force him to wake up and deal with it.

Sigh -- the disease is a challenge -- no doubt about it.

Kelly said...

I wouldn't say that you are a lazy man - you were a tired man. Big difference! It is also easier to think about what you should have done after the fact and when you are awake. Even when I have the Dex on, I don't hear the alarms at night.

Lilly said...

If I were diabetic, I might have a hard time with this too, as I love my sleep. However . . . after seeing all the havoc that high blood sugars have wreaked on my husband's body, I hope I wouldn't! Be careful, Michael. All those highs do cumulative damage, as I'm sure you know. You only have to read the introduction to my blog to see what it has done to my husband over 30+ years.

Take care of yourself,

Lilly

Natalie said...

Raises hand -- Guilty as charged! I have done that, too, but like Scott, I have only rarely had no-delivery alarms, so at least there is the basal going. But my not-always-achieved goal is to at least take a little insulin based on my CGM -- I KNOW you're not supposed to do that, because of the inaccuracy of the CGMs, but when I absolutely can't motivate myself to wake up enough to test, I figure it's better than nothing. If I bring myself down from a 300 to a 200, it may not be perfect, but it's still a better way to go!

victoria said...

I love your translation of the Bible verse. You should consider doing a translation of the full Bible. NIV, KJV, T1DV. ;)

Jonah said...

I try to put something with sugar and insulin and syringes in bed with me because if I have to get out of bed to do it, chances are I won't treat that middle of the night low or high, even if I do wake up. I've had a number of lows and highs that I did wake up from, felt around for the insulin or glucose, didn't feel it, went back to sleep.
Sometimes I put my meter in bed with me too . If I wore a pump, I might put the infusion sets right there with me, but maybe not- can you change a site half asleep?
I dunno, posts like these make me glad I take Lantus.

Shannon said...

Oh I have totally silenced those anoying beeps in the middle of the night .... always in the back of my mind knowing it's wrong. :/ But in the moment .. when you're still sleeping in lala land... it's hard to make yourself get up? I can't even remember the last night I slept 100% - I'm always "aware" of where my pump is -- am I laying on it? Did it come unhooked? Did I roll too far and that's why the tubing is pulling a litle? :/