13 Weeks: Drama

Week 10 of my second 13 week season: low carb diet and more exercise, tracking my weight, blood glucose, and body fat. You can follow me at my 13 Weeks Facebook page for daily updates, and you can join Fitocracy (free!) and follow my daily exercise, and maybe even start tracking your own.

On Tuesday the 9th of April, about 2PM, I was at work and feeling very strange. I was sleepy, felt sick and shaky, and couldn’t think clearly. I decided to take off early. But driving home, not more than a mile from my house, well, something happened.  I zoned out, I fell asleep, I fainted — whatever it was, I was looking at a green light at the interesection and then I was looking at a red light with traffic starting to cross the intersection.  I hit the brakes, I swerved to drive around the front of the CenturyLink truck in front of me, and I almost made it.  But not quite. I caught the front bumper of the truck with my left rear fender.  I bumped my head against the door frame, and came to a stop crossways in the intersection. After a minute, I pulled off the road.

At first I felt — considering the circumstances — okay. I made sure the other guy was okay (he was) and went to stand by the car and wait for the police.

Then I realized I was feeling really really cold, and even shakier than I had felt when I left the office. I went to sit down in the car and when the police arrived told them I thought I needed the EMTs. Or else it was someone who was calling 911, I don’t remember it very clearly.

Anyway, both an ambulance and a fire truck arrived, and a rather cute female firefighter interviewed me for about 30 seconds before trotting to the EMTs, who came and walked me to the ambulance.  I’m somewhat proud of myself for resisting my initial urge, which was to tell the firefighter “Hey, I’m just sick, I’m not on fire.”

We headed off to the hospital — another new experience — and on the way the EMT put in an IV. I was impressed, my veins are sneaky and this was in a moving truck. He said he’s not sure he could do it standing still. He took my blood sugar with a finger prick, and it was in the 70’s. That’s not formally hypoglycemia, but it’s pretty low, and one reaction to stress is for your liver to pump out glucose. He gave me a bag of cherry-flavored glucose — I presume it wasn’t artificially sweetened — and within a few minutes the shaky, foggy feeling went away.

The ER was undramatic. My EKG was fine, textbook. My blood pressure was quickly down to its normal or a little below, 110/55. No elevated heart enzymes, thyroid level (TSH) was fine, had a chest X-ray and that was fine. Slightly ketotic but urine tests otherwise were fine.

While we were waiting for the tests to come back, I slept.

Solidly.

In an ER bay. For like 3 hours.

By the time I woke up, I mostly feelt stupid. I should have recognized I was exhibiting the symptoms of hypoglycemia and used that excuse to eat a Milky Way. I should have been able to avoid the other cars. I felt stupid for occupying an ER bed when I felt fine except for the little laceration on my head that hadn’t needed stitches, hadn’t even bled much.

The ER doc — who was also quite cute and looked about 19, jeez they’re making them young these days — wanted to keep me overnight for observation, but I was worried about getting someone to feed the cats and such, and checked myself out. I had to make my friend Anil Rao drive me home, which was probably an hour’s round trip for him. He gets gold stars for that.

But so now what to make of it?

I’m type 2 diabetic, I don’t take insulin, and the metformin isn’t supposed to be able to put you in hypoglycemia in normal doses. I’d only had 1000mg and that was the previous night. But I had been noticing my blood sugar getting low (not that low) between meals for a couple of weeks, and several people on the Facebook conversation had already suggested maybe lowering the dose would be good. Since then I’ve heard several of my MD friends saying that they had seen occasional hypoglycemia with metformin in T2DM — and a little application of Google-fu showed that there are a pretty large number, 250+, of anecdotal reports of hypoglycemia in patients taking both metformin and simvastatin.

So here’s a hypothesis: the other things I’ve been doing, taking cinnamon and chromium, and working out, have actually made me more insulin-sensitive, or the insulin sensitivity varies naturally. Any way around, when my body does succeed in taking out more sugar, the metformin does its’ job inhibiting gluconeogenesis, and so my liver can’t quite catch up. So my blood sugar drops.

But that might be just an attempt at finding an explanation instead of just admitting I don’t know.

Still, it brings up something. From the start in this 13 Weeks process, I’ve been trying not to get attached to the weight loss, the glucose, and in particular not to some role as a “diet guru”.  It’s some self-experimentation because I wanted to see how I could improve my own health, and my first motivation for writing the column was to make sure I made it as hard as possible to quit. But when this happened, I felt a real aversion to talking about it, because I was afraid of people’s reactions — afraid they’d say the whole thing had been foolish, that low-carb diets were obviously bad, that I didn’t know anything about the topic. Add to that: for some reason I’ve gained about 6 pounds over the last week. I have no explanation, see no conceivable reason for it, but it’s depressing because it wipes out (I’m sure temporarily) all the weight progress I’m made in this whole season. I feel like I’m failing, and like I look stupid.

If there’s anything about which I have more baggage than if I look funny, it’s about looking stupid.

So there it is. Maybe I was a little stupid, because I didn’t realize I felt bad enough that I shouldn’t have been driving. Obviously, I need to see my regular doc soon and talk about metformin doses. With my blood sugar down and my lipids down, I’m not sure I need either the metformin or the simvastatin.

There’s one other lesson to take away from this, something I’ll need to sit with, and write about, some more. That is this: I’m not a diet guru, and from the start I’ve wanted to avoid sounding like one. Sometimes there are setbacks, sometimes bad things happen, and I’m going to keep talking about it when something doesn’t go my way, as well as when it does. As I slipped into a little bit of a “guru” mentality, sometimes it’s hard to say “wow, maybe this isn’t working” and “wow, I’m not feeling very confident right now about the process.”

But saying that is important for me; I think and hope hearing it is important for you, my readers.

Oops, almost forgot the table.