In preparation for a new job, I have to have a drug test done (pee in a bottle). For some reason, I thought it needed to be a fasting test.

I went down to the lab about 11:00 am, and had nothing to eat since dinner the previous nite. Well, I saw on my CGM that I dropped below 80, but for some reason, I didn't grab my jelly bellies. Evidently, I was very unresponsive, and the next thing I knew, there were about 6 paramedics and 2 cops in front of me.

I was so stupid, when they asked me if I had diabetes, I couldn't even answer them. When they tested me, I was at 32. They started an IV drip of D-50 (very badly, I might add - my arm is horribly bruised), and by the time my BG got up to about 160, I was able to reason.

I have been that low more times than I care to admit - my personal worst was 17, and I was able to treat that one by myself. I don't know what happened this time.

They wouldn't let me drive, or even walk home (I live about a mile from the lab), so they took me home in an amubulance. I can hardly wait to see the bill - I currently have no insurance, so this is gonna be a killer.

This was really embarrassing. I've only had the paramedics called on me a couple of times in my 26 years with diabetes - this one was the worst, though. The young paramedics (they all looked younger than my kids!) assured me on the way home that I was good - they said they have had far too many battles with diabetics who were combative.

I am still at a loss to understand why I didn't pay attention to my CGM. Won't happen again (easy to say, now).

Tom

I too have been in the situation where I was unable to communicate my diabetes - I think when you get that low - you can not count on anything at that point. Prior to CGM - having a hard time coming up with a word was one of my tipoffs that I was getting low.

I had the paramedics come to my house once. I knew what was up once I came around - but they wanted to take me to the hospital - I said no and they had me sign a wiver (which could barely do). 5 minutes after they left - I could sign my name normally.

I hope that with the CGM this never happens again. I travel a lot - and set my alarm for 2am every morning just to check - I do not want to be in a situation where I end up alone with no assistance.

Sorry to hear about your experience.

I also have never had an issue with a "fasting" blood test when I tell them I am a diabetic - the tests work just as well unless they are testing you for diabetes

Tom,

Sorry you had such a scary experience.

For future information, test fasting is usually for bloodwork (mainly lipid profile). What you need to avoid prior to a drug tests are poppy seeds. They can give a false positive.

Good luck with your job search. Couldn't you get COBRA to tide you over?

Sorry you had to go through that, Tom! When I've had to go to the lab for fasting tests I have, a few times, eaten a glucose tablet or two when I sw I was dropping low. Most of the time it's not a problem because my BG tends to go up once I'm awake and if I don't eat, my body will just do a liver dump since I'm not giving it any food. I'm glad that happened while you were at the lab and not out on the street (or driving!).

I've been treated at my job and once at my sister's house where I came to at the scene and the paramedics wanted to transport me to the ER. All of those times I refused. Twice I had to sign a waiver (like Mike) and it wasn't a problem. At my sister's house they just hung around until they saw me eat something. Those guys *were* young. My oldest niece said she went to high school with them, and she hadn't been out of school for very long.

Also, the one time I was transported to an ER from my job (I was so out of it, I don't remember the paramedics showing up) they pushed my BG really high and then expected me to eat a plate of white carbs, which I refused. They wanted someone to come pick me up but I was only 3-4 blocks from work and walked. I had to promise them that I would eat something when I got back to work. I understand they need to cover themselves in case you go low again, but I don't think there's too much of a chance of that when they've already pushed your BG to almost 300. I asked them if they would give me insulin when they wanted me to eat the plate of white food and they said they couldn't!

Hi Tom,

Sorry to hear of your experience.

The last time I needed professional help was about 40 years ago, when as a teenager and before CGMs and home BG monitors. I awoke to a low which I could feel, but for some reason decided to lie back down for a few minutes. When my mother could not awake me, she and a neighbor carried my limp body into a car and with a police escort, got me to a hospital. The emergency room was crowded and while I waited, my liver kicked in just in time to hear them say I had a 22 BG.

Today, there are just times that life gets so harried that after I note a low BG, my mind skips to the next thing on my To Do list, and I may be late in treating the low. Perhaps you had a lot on your mind that day and unintentionally ignored the low?

Wow that is pretty scary! I schedule all my fasting labs or proceedures first thing in the morning as
early as possible to prevent this. Glad you better now.

As others have said, my fasting tests are always early in the morning and I don't hesitate to use glucose tabs as necessary.

Ricardo,

I think that's precisely what happened. I was so concerned about this new job that I just spaced out my CGM. I still can't believe this happened.

The good new is: I went back this morning to do the pee test, and the folks there told me they didn't think I would get billed for the ride or the help. They had overheard me saying that I had no insurance, and they noted it, and they think they will let it pass. I sure hope so!!

BTW, when I went back this am, I made sure I was up over 200. I'm finally back to a normal range, but gosh....

Tom

I have also ignored lows because I was doing something and didn't want to stop. This is why I now keep bottles of glucose tabs everywhere, so I have no excuse. I have also cleared CGMS alarms without even looking at the pump because I had my mind on something else.

I remember one time when the paramedics came to my job they asked to see my insurance card and wrote down some info. Nobody ever asked for it any other time, except when I was actually brought to the ER I guess. I actually always assumed ambulance/paramedic calls were paid for like police and the fire department - we were all entitled to use them. It never occurred to me that they would bill insurance or an individual! Maybe it depends on who shows up? I believe, although I'm not 100% sure, that it was a FDNY ambulance crew who asked for my insurance. The kids that showed up when I was at my sister's never did and I don't recall any paperwork from them either. I know there are volunteer ambulances and I can't see those charging people, either.

I'm sorry this happened to you, and I'm real glad you are okay. And YAY - they did not drive you to the hospital (I have lived in cities where you've no choice), they would not consider waiving the bill! I like your EMT service and am glad they helped you beyond the bruising.

Now, I will cross my fingers that you pass your drug test

Tom,

Add me to everyone who has said how sorry we are that you went through this. My guess as to way you didn't pay attention to your CGM alarm is that you were probably VERY low by the time it went off. It sounds like you were dropping very quickly, and we all know there is a lag between the CGM and BG.

No one has mentioned the fact that your basal must be wrong if you dropped that low just because you skipped breakfast. PLEASE try to adjust it.

I am having a problem with that myself. The past two mornings I woke in the 50's. When it happened yesterday I made an adjustment which lessened the slope of my CGM graph but did not stop the low from happening. I made yet another change and will wait to see what happens tomorrow morning.

Linda B.

This is an interesting post for me to read. Last night my daughter fell asleep before supper and her BG was fine, so I let her sleep but tested frequently because I had given her an extra BG bolus and since we're barely a month on the pump, her rates are not perfect yet. She got down to the 80 range, but with no IOB, I let her sleep. 45 min later I tested again (we don't have CGMS) and she was 35!!!! I was able to wake her and get her to eat some jelly beans and drink a tiny bit of juice. Knowing at what level some people pass out, this worries me big time! It seems that Hadlee is able to go extremely low and still be concious(sp?) Sadly, this is not the lowest low she's ever had, she was 27 once. It's just amazing what our bodies can take.

I've been shocked several times with low readings that I don't understand how I'm even concious! That's when you don't necessarily worry about going too high and you're just shoving any type of glucose into you that you can get your hands on. But, I also know that sometimes at higher "lows", I've gone into the "losing it" stage.

In Germany about 10 years ago, my glucose was in single digits, but I didn't know it for the 2 days before I awoke.

One thing to keep in mind when you are trying to maintain very tight control. The tighter control you achieve, the closer you are to suffering lows, i.e. less room for miscues, mistakes, etc. Good endos are well aware of this and will advise a good target bg. I have really been trying to maintain a little tighter control but have backed off a bit due to more lows. Unknown factors such as illnesses, stress, etc. often can wreak havoc, especially before you know you are even experiencing them.

The pump is a gold mine though in that you don't have to worry about the peaks and valleys of long term insulins like many of us started with years ago. Before I got on a pump, I got on Lantus in Germany prior before it came to the US and that helped a ton since it was fairly level for almost 24 hours. I developed tremendous respect for the German endo that got me on that and he even sent it to me when I returned to the States since Lantus was still 8-10 mos from approval here. I'm not sure that was above board but I never asked him and he never said anything about it. One of the sharpest Docs I ever met. The couple times I've been back to where I lived in Germany, I always stopped by for a visit. He was a hell of a skier too!! We'd ski for the morning and then have a couple Weissebiere's for lunch. Fond memories............

Peter B

Was the extra BG bolus a correction? If so, it sounds like her sensitivity factor is wrong, causing the pump to over correct the high. I hope you have a call into the trainer. She should NEVER go that low from a correction.

Also, for future reference, I never go to bed if my BG is not over 100. When it's 80, I eat one or two glucose tablets to get it up over 100. I just feel safer that way.

Linda B.

Linda B, yes it was a correction, but at that point it had been about 4 hrs after the bolus. We lowered her evening basal rates on Monday. I talk to her nurse (thru Animas) every few days. Her sugars are still in the 300-400 range a lot of the time. We just started on the pump about a month ago, so we are still making lots of changes. It's hard because her BG's are so high most of the time, but also go low occasionally. We are sadly used to this. Hadlee's BG's have been pretty much uncontrolled since she was dx'd which is the reason she's a pumper now. We are being patient, we know it takes time. I think her nurse is more frustrated than we are!:)

I got a bill a few months ago for $300 for the ambulance ride. Although I'm working now, being unemployed for so long, I'm in a world of hurt, and a collection agency is threatening me. What a drag....it's been a tough year.

Tom

That really sucks, Tom. A $300 cab ride for a one mile trip!?! I'm sure you weren't thinking properly but I'm sure you could have refused any additional services and left on your own, even if you had called a cab. One time I was brought by ambulance from my job to a hospital a few blocks away. A co-worker rode in the ambulance with me and stayed awhile but then she went back to work. After I don't know how many hours, with my BG well into the upper 200s, I wanted to leave. First they said I couldn't until I ate the "diabetic meals", which was all white carbs. I asked if they would give me insulin to cover the food and they said no, so I refused. I told them I was going to leave NOW and so they hurried up and sent the doctor over. They asked if someone was coming to get me and I said no, I work 4 blocks away and was walking. They put up a bit of a fuss but I assumed them I would eat when I got back to work so off I went.

In the few (5? maybe) times I've been treated by EMTs I only once remember them asking me about insurance. That time, I wasn't even transported as I refused to go to the ER once they got me conscious at work. I've never received any bills for ambulance rides/visits. Only twice did I end up going to the ER and I'm sure I got my insurance onfo to them because I don't recall any hospital/ER bills either. I always assumed it was a city service, like the fire department but I guess not. Two of my visits (one transport to the ER, one refused transport) were outside of NYC.

Can you set up some kind of payment plan?

Hey Tom,

Remember me? I'm the biostats person from a few years back. It's been awhile. I see a few familiar names here. Thought I'd pop back in to check on some information about different types of insulin.

One thing I've done for years is to buy a County EMS membership. By doing this, the ambulance service in the county agrees not to charge you above and beyond what your insurance coverage will pay. I've done this in several different states. I've had to use EMS more times than I would like to admit in the past year, but I haven't had to pay a dime.

Since I live in one county and work in another, I buy both. They cost me $130.00 per year or $65.00 each. One trip will pay for itself.

Hi Susan,

WELCOME BACK!!! It's good to see you again... you were always one of my favorites.

I've been doing a lot of experimenting with different insulins lately. I'd always used Novolog, but I recently got a bunch of Apidra from a kind friend.

I'm not sure what to think, to tell you the truth. I seem to be taking about 10% more of the Apidra than I was Novolog, but that can be attributed to many factors, I think.... change in location, lifestyle, yadayadayada.... I have Humalog that I'm trying next.

Anyway, DON'T BE SUCH A FREAKIN' STRANGER... good to see you again.

Tom

Ahhh, Tom, thanks so much for your kind words and your PM. I'm looking forward to being just as active as I was before. It's been a long, hard trip since I went off line the first time, but I'm thankful that I'm still here and terribly healthy.

And to say it proudly, I did accomplish two very important personal goals in 2011 -- 44 years with Type I diabetes and making it to 50 years of age. Now I'm trying to come to terms with the fact that I might actually get to SPEND my retirement fund instead of just leaving it in my will.

Wow.... six more years and you get the Joslin Medal! Good for you! However, at 50 years of age, you're still a pup!

Tom