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Thursday, August 20, 2009

Oops...I did it again!

Ever feel like you're king/queen of stupid? That's how I'm feeling this morning. I swear, I'm a bright girl. Ask anybody. I went to school, managed to get decent grades in difficult classes (when I applied myself) and even went on to get one of those highly sought after bachelor's degrees that people proudly display on their walls as proof of their intellectual elitism.

Yet, sometimes, I do the stupidest things. Like most people, I don't typically go around bragging about my stupid behavior. Instead, I favor smacking myself in the head in private and vowing to use my head as more than a hat rack in the future.

But last night's senseless act can't be kept private for many reasons. First off, writing is therapy, and maybe if I commit this one to print where it can confront me in the future, I won't be so stupid again. Second, I know there are others out there in my shoes who are guilty of my same stupidity. I am posting today to give them hope. I'm sure that like misery, stupidity also loves company.

I have reactive hypoglycemia, a somewhat uncommon form of low blood sugar that is now known to be a side effect of certain malabsorptive surgical weight loss procedures. I say "now known" because reactive hypoglycemia didn't have a name or much attention untill 2007 when bariatric researchers started studying patients who had a very odd reaction to consuming certain foods.

Instead of causing their blood sugar to skyrocket, simple carbs and sugars (even natural ones like in fresh fruit and juices) caused their blood sugar to plummet. In the world of blood sugar, 80 to 100 is good; 50 to 79 is when even normal people start feeling shaky or grumpy and need to find something to eat quick; under 50 signals danger with big, red flashing lights. Scientist dubbed this condition "reactive hypoglycemia" to group the patients whose blood sugar fell in reaction to the very foods that should have elevated it.

So, see, I'm special...unique...everything my mommy said I was when growing up. She just apparently left out the other qualifiers to indicate my natural inclination toward senseless behavior.

I rode the reactive hypoglycemia roller coaster for about a year after my emergency intestinal surgery in 2007. Those knotted innards were either slowing nutrient absorption enough to allow my body to react normally to complex carbs and sugars (simple sugars and carbs were always my enemy) or the reactive hypoglycemia was triggered by the trauma of that health crisis. No matter what, 2007 was a nightmare year for me. I didn't understand the rhyme or reason of what my body was doing, and not one of my "expert" docs could help me figure it out.

Then I moved to Merced and met a physician's assistant to whom I owe my life. Not only did she know about and understand reactive hypoglycemia, she taught me to manage it. She even gave me a glucometer to help me monitor my sugar levels at home. It was a newfound freedom to be able to equate my symptoms with one of the glucose zones I listed above. It also helped me figure out my body's rhythm. For example:

On a typical day, I wake up with a blood sugar level of 100. Then I eat breakfast and it drops to 80. If that breakfast is high in protein, I stay at 80 till my next meal. If it is not -- or if it includes sugars like toast, jam, juice or their ilk -- then it drops to 70 and sometimes 60 within 30 minutes. And I find myself forced to eat regardless of hunger just to achieve balance.

In the last 18 months or so, I've learned a lot about my body. I've learned that my hypoglycemic episodes are triggered by stress in addition to food, which means I sometimes suffer severe low episodes during stressful times (like when a deadline looms at work or I'm confronted by a personal crisis) even if I'm eating like I should.

Enough back story, let's talk about last night.

Last night, I had dinner with friends. I'm usually really good when eating in social situations. The conversation and activity provide enough of a distraction to give me time to step back and make wise eating choices. My worst moments are when eating in a rush. We had a family-style dinner that featured lots of chicken, veggies, noodles and rice.

Typically I would serve myself tablespoon-size portions of noodles and rice with four times the amount of chicken and some veggies so that the protein and fiber in my meal could slow the absorption of the carbohydrates. I might feel a little fatigued after that -- what many refer to as "food coma" -- but I would be otherwise fine.

However, I'm four months pregnant. And pregnancy has added nuances to managing my hypoglycemia: I find meat less appealing than usual and I have to share my available blood sugar with the baby growing inside of me. The good news is that the baby will always get what he/she needs. The bad news is that there is not always enough left over for me.

So last night, I go to serve myself what I know I should eat only to realize the chicken is unappetizing to me. I have a mental battle with myself (eat it anyway; no, if you eat that, you're going to throw up in front of everyone, eat it or you'll get sick, don't eat it or you'll get sick...and so on). I tried to compromise by serving myself two small chunks of chicken with a heap of veggies and sauce in hopes I could disguise the texture.

My plan seemed to work. I got through dinner, making sure to eat enough to satisfy me without overeating. After the meal, we sat and socialized for 30 to 40 minutes. I felt that faint feeling of fatigue that told me I would need a protein boost when I got home, but the conversation wasn't lulling to the point that it was clear we'd leave anytime soon. One friend ordered a sweetened beverage. It sounded good, and for a moment, I thought it would give me a needed boost till I could get home.

This beverage is one I've had before and I know that if I order it before my meal, I can sip it super-slowly while eating and suffer no ill effects. I've never tried order it as "dessert" before. I've surely never tried drinking it by itself without some type of protein to balance it out -- and I've never been dumb enough to drink almost half of it in the span of 15 to 20 minutes.

But last night, I was apparently struck stupid and did just that.

By the time I got home, I was feeling queasy. I had a long list of work to do and couldn't be bothered to listen to my body so I drank a glass of water. Thirty minutes later, I was soaked in sweat: That's the first symptom that I'm in the danger zone. I went to the bedroom and tried to undress myself but didn't have the dexterity needed to accomplish the task. I manage to send Brian (who had just gotten home) a text: "C me." When he got to the bedroom, I was lying in the fetal position and tugging at my clothes. He helped me out of them and instantly knew the problem.

True hypoglycemic episodes cause sweating, shivering, shaking, brain fog, impaired speech and hallucinations. And I was in the throes of every symptom at that time. I didn't realize he left but he returned with string cheese and a glass of water. He started prepping my glucometer to test my sugar for a benchmark. I was at 30.

I had trouble wrapping my brain around the situation but I knew that something was missing. In the danger zone, you need 15g of pure sugar -- fruit juice, honey, candy, even cake frosting -- to give your body an immediate boost before consuming something equal in protein and carbs (like cheese) to balance the sugar levels and head toward normal.

I tried to think of what was in the house he could give me, but it was hard to think and harder to articulate. Finally, I muttered something about chocolate and he brought me a small piece -- less than an ounce. I grunted and stuck it in my mouth. It was a good choice because it melted without much chewing. Next was the cheese. Chewing was very difficult. I was having trouble getting my brain to cooperate with my body, but I was managing.

Brian helped me test again. 50. Getting better. Lucidity should have come at any moment, but I found myself still slipping in and out. I was trying to think of my trigger. I remembered my after-dinner drink. Stupid, stupid, stupid. I asked for another cheese stick.

Then I had a brief hallucination of dying and winner the 2009 Darwin Awards for doing society a favor by chlorinating the gene pool. Just my luck.

I tried to stay conscious while Brian soothed me with a cool cloth, but something didn't feel right. I had him help me test again. 40. Brian said 30 minutes had passed since it all started. Crap. Sliding backward...why was that happening?

Struggling to remember my doctor's instructions, I couldn't decide whether to have Brian seek medical help or try to eat more sugar. The backslide didn't last long, the fog lifted a little, and I remembered the final part of my doctor's advice: "As soon as you're stable enough to walk under your own power, get to the kitchen and eat something else...ideally, protein and carb.

I couldn't fathom eating more cheese or touching any meat so I settled on a little nectarine with a few spoons of heavy whipping cream. Small amount of protein, small amount of carb. Besides, I'd rather dump from the dairy in the cream than feel like I felt.

That did the trick, and it wasn't long before recovery fatigue set in. For me, episodes like this are followed by extreme fatigue. My body likes sleep while it heals itself. I can easily sleep 12 hours after an experience like this. Usually, it's a dead sleep. Sometimes, though, it's filled with vivid dreams. Last night was a vivid seven hours of dreams. I woke up as exhausted as when I lied down. I immediately went to the kitchen for more fruit -- just in case -- which I will shortly follow with another cheese stick. Today will have to be a good eating day so I can build up my body's glucose stores.

It's a stiff lesson. It's probably been a year since my last episode of this level of severity. Writing it all out is hard, because nobody likes to admit to being senseless. But it's also necessary. I know what I did last night is standard behavior for others with the same affliction as me. They feel out of control, maybe even desperate. Some may not even understand why their bodies do what they do. They need to read stories like this to know they aren't alone -- and that there is hope.

For me, it drives home the same message I've been telling myself since 2007: I am not anatomically normal, and I probably never will be. But, like most things, this can be managed. I just have to take care to do so. The best news ever, though, is at least I don't have to worry about my stupidity affecting my child -- unless stupidity is genetic. If that's the case, let's hope the baby has Brian's intellect.