I have not been able to bring myself to write lately. Lance has had a massive learning curve, and he is starting to piece things together about his Diabetes, and Type 1 Diabetes in general. He has been asking questions about what it would be like to “free” from the condition, what does a hypo look like from my eyes and why Type 1 and 2 Diabetes have the word “diabetes” in their condition title, when people living with the conditions mostly have very different circumstances.
I am able to satiate his curiosity most of the time. However, he knows about the dreaded severe hypo, and the emotions that remain in our home from the aftermath. He has been hospitalized from severe seizures where doctors feared brain damage, he has been on drips containing saline and dextrose to get his sugar levels back to normal as quickly as possible. He has “lost” a full 24 hours after recovering from the intense side effects of a glucagon injection. He was even “asked to leave” from his preschool due to the mounting pressure and the constant threat of hypos that required emergency assistance. “Burnout.” That’s what I was told. The staff were suffering emotionally and not devoting as much time to the other children as a result of my son’s hypoglycaemic episodes. Holidays have been cancelled, he collapsed after boarding a plane, and he has silently suffered from the symptoms of hypoglycaemia in an attempt to reduce panic at social functions. On many occasions, he has no clue about what is happening to him, and he is unable to communicate that he needs sugar immediately. His brain is severely depleted of sugar, and a simple task such as pouring a drink becomes a confusing and difficult matter. I don’t get my son back until his sugar levels are replenished.
So, I decided to show him what a hypo looked like. He may be only seven , but I feel that he needs to know the truth about his Diabetes, no matter how difficult it is to look him in the eye and tell him that he may have to wait up to 10 years for a potential cure, even longer. It’s no use sugar coating it (bad pun..!!) because his endocronoligist speaks very openly about uncomfortable topics. Lance can also read very well, and he has picked up on enough information regarding the importance of wearing shoes, just from reading an old story in a JDRF magazine.
My paediatrician gave me a fantastic video about 4 years ago about severe hypoglycaemia, and when it’s appropiate to use glucagon. It was given to me as an educational tool, in an attempt to create awareness with anyone that Lance may come in contact with, such as the preschool staff. I viewed it again recently, and as cringeworthy as it was to watch, I decided it was time to sit down with Lance and let him see it for himself.
I asked Lance a few weekends ago if he could spare 2o minutes to watch a video with me. First of all, he was horrified that I didn’t have a copy on DVD, but he soon recognised the orange kit on the front of the case, and the Novo Nordisk logo and he immediately slipped his shoes off, and seemed interested enough that I felt comfortable to put it on. I was nervous, yet interested about his reaction to something that has such a stranglehold of his life.
The video starts of with bad Casio documentary style music, with the commentary provided by a man with a jovial English accent. ( I later discovered from the credits that he is an endocrinologist .) It commenced with a brief explanation of what Type 1 Diabetes is, and how the body needs insulin to remain functioning, and ultimately, alive. There were diagrams that showed how insulin unlocks cells to provide growth. It also showed what happens when the blood is saturated with sugar. These visual representations were extremely beneficial in assisting Lance with understanding HOW Type 1 Diabetes becomes a diagnosis, and rapidly becomes a lifestyle.
Next, was a scene, showing the dangers associated with not following a strict routine, and the perils of mild to medium hypoglycaemia in a twenty- something woman with Type 1 Diabetes. She had slept in as a result of hitting the snooze button a few too many times. She awakens, startled, and begins to panic, as she has to rush to work, with less than 40 minutes under her belt. Her glucometer is set up beside the bed, however, she neglects to check her first blood sugar of the day. Lance picked up on this straight away, and hit the pause button whilst we discussed what she should have done. I was so impressed that he had been observant enough to notice the glucometer, set up and ready. I asked him to press Pause whenever he saw something that could be potentially dangerous, or that could lead to a hypo.
He left it on pause.
I asked if had spotted something else.
I had to bite my lip to avoid bursting into coniptions of laughter. ” Look at her! She’s just got out of bed afer a relaxing sleep, and she’s running around like a chook with it’s head cut off!!”
Again, I commended him on noticing that she was rushing. therefore panicking, which would evidently send her blood sugar levels up.
We recommenced viewing.
The subject then rifles through her wardrobe, looking for something to wear. She mumbles in frustration that she cannot be late for work as she has a presentation to deliver that day. After finding an ensemble, she pushes her way into the kitchen, and begins to prepare coffee. She then clumsily pours a cereal resembling Special K into a bowl, but realises that she is wasting precious seconds as she should be on her way to the bus at this stage.
She bustles into the bathroom, and hurriedly applies makeup and runs a brush through her hair. The commentator reminds us that her stress levels are escalating as a result of panic. She pulls an insulin pen from a makeup case, and quickly administers her daily insulin.
Pause…
“Um, she didn’t count to 5 when she gave herself that insulin-some could have come out which could make her high later..”
Another tick, that was a really important point! Many people hurriedly administer their dose, when in fact, slow and steady wins the race, especially when you rely on your insulin doses via syringe or pen.
Play.
She grabs her bag and has a few gulps of coffee, and a few mouthfuls of cereal, most of which ends up on the floor. She locks the door and hurries to her bus stop.
Pause.
Lance looked at me with eyes like saucers.
“Coffee for breakfast! No carbs in coffee!”
He clung to my arm and continued watching through his fingers. He knew the subject was bound for trouble. It was like he was watching a horror movie for the first time, except he knew where the twists and disasters was looming.
To cut a long story short(er), she actually manages to get to the bus stop where the bus is waiting .(Again we had Pause; this time she was chided because she was running across a busy road and didn’t look to the left or the right! I reminded him that running with no food and insulin absorbing and gobbling up what glucose was in her blood was asking for a hypo. He nodded with the utmost seriousness and we recommenced the riveting viewing.)
At 9.20am, she arrived at work, and headed straight to her office. She unpacked her briefcase and commenced her work. The clock was showing fifteen minute intervals lapsing, ticking away. Still, it had not occured to the subject that she needed to eat to avoid a hypo. Lance was just waiting for the BOOM.
At about 5 minutes to 10, she began squirming in her chair. She rubbed her eyes and grimaced-the uncomfortable pre-hypo warning had arrived. She was yawning and could barely hold her head up. Lance picked up on the symptoms immediately, despite the less than average acting.
“Oh! It’s starting Mum! Even though we can’t see it, she will be so hungry, too…”
Lance was on the edge of the sofa. He was vocally begging her to get something to eat. He reminded me of someone barracking for their favourite football team who screams at the TV in frustration.
Her vision becomes noticably blurry, and she frantically attempts to slide open her top drawer, which held a very impressive hypo stash. She frantically tears open a sugar-laden bar, and begins to push food into her mouth hurriedly. The makeup team affiliated with this project had even gone to painstaking trouble of making her appear almost ghost-like, complete with sweat beads dotting her upper lip and brow. We were then frozen on that image, whilst the commentator recalled everything that lead up to the hypo-which were almost all of the symptoms that Lance had detected.
The commentator accentuated the fact that this was a mild to medium hypo, as the subject was able to recognise the symptoms and treat herself. Lance exhaled a sigh of relief.
“Oh Mum, that was so stressful to watch! I just wanted to scream at her what she was doing wrong!” Lance exclaimed, shaking his head incredulously.
Next was Subject 2. This case study was not so fun to watch. It conjured up memories that are almost identical to what Lance has been through on so many occasions. Still, I was surprised at his enthusiastic response to the first example, so I was more than willing to watch the severe hypo, no matter how painful it was.
The commentator introduces a man in his 30’s. He is married and has decided to spend the afternoon in the garden.
He begins digging and working, with no sign of a hypo pack or any food storage containers nearby. He is really putting his back into it, and seems determined to get as much done as he can.
In the next scene, he is chopping wood. We are then introduced to his wife and her inner voice. She looks at the clock and notices that he has been working non-stop for two hours. Along with her perplexed expression, her inner voice mentions her concern for her husband’s wellbeing.
“Hmm. It’s been a while since Peter has come up for a drink or something to eat.. I better get him something..it’s been over two hours….”
This scenario wasn’t as predictable as Subject 1, so Lance sat in silence, carefully studying what was going on.
Meanwhile, the exasperated commentator mentions that Peter was determined to get some concrete slabs removed from his garden. His wife was upstairs, making rosettes with radishes and other vegetables, completely nonplussed that her husband needed carb rich foods or a drink immediately to avoid a potential disaster. It was a very good representation of the lack of urgency and constant monitoring that is required when a person with Type 1 Diabetes is not being observed or enouraged to replace carbs when undertaking exercise or strenuous activity. The subject also showed no concern about his lightheadedness, and continued on, never once considering that he needed to perform a fingerprick or replenish his carb intake.
Pete’s wife heads downstairs, and the camera focuses on him. He is teetering about, barely able to stand. His head is spinning and it is very difficult for him to help himself, or call for help. due to the confusion he was suffering at this stage. He is greeted by his wife who hands him his gourmet salad (no one familiar with caring for someone with Type 1 Diabetes would offer salad vegetables as a recharge snack!) He stares at her blankly, and he falls to the ground with a heavy thud.
Lance swung himself around and looked at me, with a shocked and concerned expression on his face. Little does he know, and I am so grateful that he doesn’t remember, that he has been in the same situation on countless occasions-the only positive of a severe hypo attack is that he has no recollection of the trauma his little body has to go through.
Wife carefully placed her salad away from the emergency scene, and shook her husband, calling his name, with no response. Inner voice returned, recalling, “I remember the doctor gave me a kit for situations like this!” She races up the stairs and rummages through her handbag. She finally stumbles across a Glucagon Kit, Inner Voice expressing how nervous she was at administering this life saving injection for the first time. The commentator takes over and establishes that Wife is overcome with panic and has had no precious experience with admimistering glucagon. Commentator then shows the precise, easy to understand instructions that are in the inside lid of every Glucagon Kit. Wife then follows the instuctions step by step, places her husband into the recovery position, and gives the injection into his arm. She stays with him, trying to rouse him whilst the injection is kickstarting the glucose stores in the liver that will now release into the bloodstream, allowing his levels to get him within a normal range, and so that he eat something that is low GI and prevent another attack from occuring.
The next scene shows Husband, sitting up and eating some sandwiches and drinking a hot drink. (The salad is thankfully nowhere to be seen!) Lance was silent during the glucagon scenes. After a while, he said to me in the sweetest, saddest little voice, ” He did die, didn’t he Mum. That’s why you love glucagon so much, in case I die.”
I hit stop on the remote and quickly explained what being unconscious meant. I drove home the fact that the man was certainly not dead, but that his body was in desperate need of sugar. I also told him how dangerous it can be to give food or drink to an unconscious person, and that’s where glucagon steps in and saves the day, everytime.
“So, is that what I look like when I have to have the orange needle?”
My stomach was churning, and I could hear my voice start to quiver. I finally replied, “No, you look like you! But glucagon is a very, very important friend to you. In an emergency, like when the hot weather comes? Hypos are sneaky-even you don’t know they are coming. That’s why I love glucagon, because it gets your levels in a safe zone when you can’t do it for yourself..”
He nodded and looked down.
“So I guess I had better test myself as often as I can then, especially when I am running with Chino or jumping on the trampoline?”
I smiled. “That sounds like a fantastic idea. I’m glad you don’t think I’m hassling you when I come to do finger pricks whilst you’re having fun.”
“I don’t ever want to look like that man. I don’t want you to have to worry about that needle so much either. I never think you’re hassling me, I know that you’re just keeping me safe.” my son reasoned.
“Sweetheart, I’m sorry if that was hard for you to watch. I never want you to worry, because I always am watching and listening for you, and I get a sense, or a feeling when it comes to your levels. If you are away from me, I can sense if you are hypo, or if you need some insulin. I know you so well, sweetheart. We just have to stick together.”
I felt terrible that I had exposed him to something that may have visually and emotionally disturbed him.
Later that day, we were walking home from taking our dog for his gallop.
I was still reeling at Lance’s reaction to the glucagon scene. However, he always amazes me with his acceptance and maturity when it comes to uncomfortable subjects.
“Mum, thanks for showing me what a hypo looks like. Now I know. Maybe I can help someone else now that I have seen that video?It’s my diabetes, and I need to know all I can to beat these hypos, don’t I Mum?”
Our hands simultaneously slid into each others.
We really are a fantastic team. In fact, if Diabetes is behaving, then our relationship isn’t far from perfect.