Friday, September 2, 2011

I Ate a Bowl of Cereal on Wednesday Morning. Thus, I Must Be High.

The recovering addict's lament: Being forced to prove to the general universe that you're not still abusing drugs or alcohol for the rest of your goddamn life every motherfucking day. It's irritating, unfair and unnecessary. Especially when you put SO much effort into maintaining your sobriety on a day-to-day basis.

I'm all too familiar with this bullshit.

For roughly the past 2 years, I've suffered on and off from reactive hypoglycemia, or dangerously low blood sugar levels, triggered by a carbohydrate-rich meal, which subsequently leaves me in a state of near-coma. I slur my words, I'm at times confused, at times sharp as a tack mentally. I walk into walls. I desperately want to go to sleep. The typical remedy for an attack of this nature is for me to sleep it off for a few hours, after which I'm stable and go back to my normal routine. In layman's terms, it's the opposite of diabetes.

According to Wikipedia, "Reactive hypoglycemia, or postprandial hypoglycemia, is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring within 4 hours[1] after a high carbohydrate meal (or oral glucose load) in people who do not have diabetes. It is thought to represent a consequence of excessive insulin release triggered by the carbohydrate meal but continuing past the digestion and disposal of the glucose derived from the meal.

The prevalence of this condition is difficult to ascertain and controversial, because a number of stricter or looser definitions have been used, and because many healthy, asymptomatic people can have glucose tolerance test patterns said to be characteristic of reactive hypoglycemia. It has been proposed that the term reactive hypoglycemia be reserved for the pattern of postprandial hypoglycemia which meets the Whipple criteria (symptoms correspond to measurably low glucose and are relieved by raising the glucose), and that the term idiopathic postprandial syndrome be used for similar patterns of symptoms where abnormally low glucose levels at the time of symptoms cannot be documented.

For diagnosis, a doctor can administer an HbA1c test to measure the blood sugar average over the past 2-3 months. Additionally, a 6-hour glucose tolerance test will chart blood sugar during the past six hours.

According to the U.S. National Institute of Health (NIH), a blood glucose level below 70mg/dL at the time of symptoms followed by relief after eating confirms a diagnosis for reactive hypoglycemia."

These attacks have been more problematic and frequent in the last year or so, more so since my gallbladder was removed and my pancreas has been misbehaving, interfering with my work, with taking care of my son, with my general functioning, to the point of endangering my employment and causing me inconveniences such as not being able to drive long distances behind the wheel of a car because these attacks happen unpredictably.

A few attacks have raised the question by uneducated nimrods who attribute my condition to me being high on drugs or drunk on alcohol.

Example A: I was in the hospital with pancreatitis. An inpatient. I was on morphine for pain, every 2 hours via IV, and taking 2 mg of my benzodiazepine, Estazolam, to sleep at night, IN THE HOSPITAL. Without my prior knowledge or consent, my former PCP subjected me to a toxicology screening the day of my discharge. I was just hanging out waiting to be discharged when a nurse came in to draw blood. Odd, I thought. So I asked her what she was drawing. "A tox screen." "FOR WHAT?" I asked. "WHO ORDERED IT?" I asked. The clueless nurse "didn't know." My PCP came into my room and I proceeded to rip her a new asshole. She claimed drawing it to "prove" to her proctor/supervisor (remember, she was a resident @ the time, working under a proctor physician, who was convinced I was a junkie) that I didn't have any street drugs in my system. Because sure, while hooked up to a heart monitor and getting shot up with morphine, I was surely snorting up heroin and sneaking vodka from my suitcase. Ultimately, the tox screen showed exactly what the doctors had been administering to me in the hospital: opiates (morphine) and benzos (Estazolam). Thanks for the vote of confidence, dumbasses. Did anyone bother to check my glucose level during the episode? Nope. They just assumed I was doped up.

Example B: I had a hypoglycemic attack on my birthday, May 9th, at work. It was particularly severe, and I had already had an endocrinology consult about the symptoms, and was scheduled to have a glucose tolerance test. Incapable of functioning, one of the doctors I work for, in tandem with my supervisor, a chronic alarmist who means well, ordered ANOTHER toxicology screen on me, fearful I was using or drunk at work. Because duh, that't not Crystal Light in my Evian bottle, it's absinthe, motherfuckers! My supervisor was aware of my addiction history, but the doctor I work for who ordered the test claimed not to know I was a recovering addict. I told my employers exactly what they'd find in the test: benzos that I took to sleep the night before. I didn't even have any of the Rx'd narcotics I was taking for pancreatic pain in my system at the time. And my blood alcohol level was 0.0. Again, did anyone bother to check my glucose level while they were drawing my blood? NOPE.

I ended up having a meeting with my supervisor, the doctor in question, and TOC, who suggested the meeting to get the issue out in the open and who seemed to be the only one not questioning my sobriety. In an effort to prove myself, which I really shouldn't have had to do, I promised to copy them on the results of the endocrinologist's glucose tolerance test.

So I finally had the test in May. The patient drinks a VERY sugary drink, and they draw blood once an hour for 5 or 6 hours to see what the patient's sugar levels are as a result. During the course of the test, my sugar (which started out at 80) dropped to 35 (at which point, I passed out cold and slept for the duration of the test), which every doctor who saw the results agreed was VERY, VERY low. Proof positive I had reactive hypoglycemia. I copied my employers on the results and essentially threw it on my supervisor's desk, mumbling under my breath that they could all kiss my ass.

Example C: Wednesday. I'd been doing relatively well with the attacks as of late, and after stopping the medication the endocrinologist Rx'd that blocks the body's absorption of carbs because it caused me severe diarrhea and contributed to me losing 17 lbs in 2 months, still followed a low carb diet and watched my sugar intake.

What the hell, I thought. I had a bowl of cereal for breakfast. Quaker Oatmeal Squares with blueberries and almond milk, one of my favorite treats. Seize the day! I had to take Luke to school that morning and be at work by noon. I ate the cereal at around 6:30 am, and by 8am, sitting beside Luke while he ate his breakfast, the attack hit me. I was falling asleep, catatonic, hallucinating (he told me I told him a package came for him in the mail, and was rambling other incoherent blabber). I *should've* woken my mom up and had her drive Luke to school because I was in no shape to drive, but I didn't. Risking life and limb, I drove Luke to school, came home, and went back to sleep.

I texted my supervisor that I was having a hypoglycemic attack and would be about an hour late to work. I slept for around an hour, tried to get up and function, but was still in the throes of the attack. I went downstairs where my mother said I "looked awful," and she proceeded to accuse me of being high on my anxiety drugs. She said, "I told my therapist about your anxiety drugs and she said you're going to get re-addicted to them and..." blah blah blah. (For starters, I've NEVER been addicted to benzos. Secondly, perhaps my mother's therapy time would be more constructively spent dealing with her problems as opposed to critiquing my drug use.) I was coherent enough to slam my hand on the stove multiple times, yelling out, "I'm NOT on FUCKING DRUGS! I'M HAVING A SUGAR ATTACK!" My mom's response? "I'm not so sure about that."

Thanks. Thanks a lot. It only took her 3 years and my finally pleading her to take the giant padlock off the liquor cabinet in the basement to convince her I wasn't planning on drinking anymore. But there I was AGAIN, trying to convince someone that my hypoglycemia wasn't the result of me taking drugs. Ultimately, my mom apologized that night after I voiced my disdain for her accusation, and we're cool about that, but I explained it to her exactly the way I explained it at the meeting with my bosses after the tox screen at work: Accusing a recovering addict of using, being high or drunk when they're totally not is like plunging a knife right through the middle of one's chest. It's the ultimate bitch slap.

I take the benzos twice a day, AS NEEDED, if I'm under acute anxiety. 1mg of Estazolam. I don't even take it every day during the day, and when I do, I'm perfectly capable of functioning. It just calms the crazies and settles me down. I don't get "high" off of them. True, as I pointed out to TOC, I do quiet down and I'm not a ranting lunatic like I am when I'm anxious, but I'm not a comatose, hallucinating wreck either. I take 2 mg every night for my chronic insomnia, brought on by and compounded by my tachycardia and my GAD and PTSD. That part is no mystery to any of my physicians.

The hypoglycemia is a mystery, especially considering my dad, his brother and both his parents were diabetic. The endocrinologist says this condition predisposes me to developing diabetes as I age, which sucks. In the interim, as an FYI to everyone, though, I'm NOT drunk. I'm NOT high. I just wanted a goddamn bowl of motherfucking cereal. Case closed.

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