Induced Hypoglycemia Ordering Pancakes
That was the motto at the local IHOP (International House of Pancakes) near my parents home in CT on Sunday morning….here’s the story…
It all started like a normal Sunday morning when the entire Kasper clan converges on Grammy and Poppy’s house. We all arrived Friday evening in time for a holiday meal and synagogue. It was Kol Nidre, the evening service of Yom Kippur, the holiest day on the Jewish Calendar. My brothers and I each brought our families to celebrate this solemn holiday with my parents. Our arrival in Ct was staggered, but by dinner time there were a total of 17 of us sitting around the table for our holiday meal.
I grew up in this house. We moved there when I was three, just before my brothers were born. Growing up it seemed big enough. None of us ever felt that our space was being invaded (except, of course, when we got our very first Atari game and Space Invaders was all the rage!!). However, put 17 of us in this house, and it gets a bit tight. Anyway – we packed as many of the cousins in bedrooms as we possible could, and Rachel and I stayed at a local Clarion Hotel.
This morning, when I woke up, I left Rachel in the hotel to sleep (aren’t I a good husband?!?!) and went to the house to help out with the morning craziness. As it turns out both Matt and Jake woke up with reasonably good blood glucose levels, so I suggested to my Dad that we all head down to the local IHOP for a special breakfast. Sounds good…we were off!!
Pancakes, as much as they look innocent enough sitting stacked neatly on the plate crowned with a big dollop of melting butter, are our worst nightmare!! As hard as we have tried, getting the bolus right has never worked. For the T1D parents out there, we have gotten very good at the home made kind….try the Fiber One Complete pancake mix…Follow the recipe on the box and 116 grams of pancake is 36 carbs. Because of the ingredients, and the ratio of carbs, protein, and fiber, we have found that a normal bolus works and the kids don’t spike or crash as a result.
IHOP, however, is an entirely different story. Those pancakes are supercharged with carbs that have always made the kids blood sugar skyrocket….high and fast….and then they come crashing down a few hours later just as fast. What we have found to work is the pre-bolus strategy. About 15-20 minutes before they eat, we bolus the pancakes…the advanced time for the insulin to work seems to be perfect, and a few hours later they don’t seem to crash. However there is one flaw in this plan….waitresses make mistakes!!!
So we’re sitting at IHOP having ordered a few minutes ago, and Grammy says “I’d better bolus now so that I don’t go to high later.” Imagine that…Grammy, Matt, and Jake all share the same strategy….great idea….we’ll do that as well!! We had ordered about 10 minutes before, and having been to may IHOP’s I know that it only takes about 20 minutes to make our order. No problem. Well, about 40 minutes after we had ordered the food (and reminded the waitress that we had been waiting for some time) my mother was so fidgety that her hands were shaking and her left knee was bouncing up and down at a rate of about 150 times per minute. Matt began to have a look of concern in his face, as though he knew that his blood sugar levels were dropping and was hoping as hard as he could that the food would arrive in time. Then there was Jake…his “whine factor” went through the roof, which is a clear sign that he needed to check….50!!! Bad news and no food in sight.
Our food arrived shortly after having advised the manager that either we needed to eat or there would be three diabetics each with an emergently low blood sugar. My mother and Matt began eating…clearly with a mission, but casually enough that they were able to enjoy the meal. Jake, however dove into his with a vigor that one would expect to see from a starving child who is eating for the first time in a week. There was only one problem…he opened his mouth and his eyes as wide as the plate, shoveled the pancakes into his gaping mouth, swallowed each shovel full without even chewing and then slouched over on the seat nearly unconscious. At the end of the meal, when we compared the time that we administered insulin to the time that the check stated that the order had been placed in the system, it was clear…the waitress had not put the order in.
We have been living with T1D for 6 years. I can honestly say that I can count on less than one hand the number of times we have had to deal with a situation like this. As much and as fast as he shoveled, his blood sugar would not go up, and his level of consciousness continued to go down. The reality of how this must feel to a person with T1D did not hit me until shortly after the ordeal had settled down and Jake was sitting on Rachel’s lap. Two things happened. First, Jake realized that in his frenzy to feed the beast called T1D, he had inadvertently swallowed a loose tooth….OMG, what was he going to tell the tooth fairy?!?! Second, he asked when he could have his pancakes…his level of consciousness was so low that he did not recall that he had just finished the entire meal in three bites!!
Jake is in bed now, and I told him that I would write a note for the tooth fairy so that she would appropriately compensate him for the incisor that now sits somewhere in his lower intestine. Here’s what my note will say:
Dear Tooth Fairy,
I know that you are very busy, and that there are many teeth for which you are exchanging a surprise tonight. The loss of this tooth, however, involves some very special circumstances which come with a very special wish. Unfortunately I am unable to tell you what those circumstances were because my blood sugar was too low for me to even remember. Therefore, rather than leaving me money for my very special tooth, I would gladly trade it for a cure…I’ll look for it when I wake up in the morning!!
While we are all very hopeful, I suppose I should go and stick $5.00 under his pillow before he wakes up!!