Invisible Illness.

It's one of our last days in cadaver lab, and we are going from cadaver to cadaver, studying the different parts and pieces in preparation for our final lab exam.
I am going from body to body, trying to distinguish between the greater and lesser omentum of the abdominal cavity when I feel the familiar buzz of my mind and a slight feeling of being underwater too long.
Dizzy. Lightheaded. Heartbeat. Difficulty concentrating. I am fairly confident I'm low, but there are thoughts going through my head - back to the last time I got low in lab a month ago:

One month earlier

"Are you ok, Lacy?"
Victor, Robert and Jason asked.
"I don't know... I feel like I've been underwater too long. Ugh, I'm low. I know it,"

This story in a story requires some background:
1. A month before on one of the random snow days I'd rushed to school and realized I only had enough insulin in my pen to last me the rest of the day. But if you know anything about Atlanta traffic and snow, last year was awful, and though that day wasn't looking to be bad we were under a snow warning.
I was concerned and thinking the worst case scenario - what if I couldn't go home that night? I'd have no insulin for the next day.
And so I asked my lab prof if I could leave a little early from cadaver lab to get my extra insulin during lunch for simple peace of mind since I live all the way across town. I would just feel better if I did because, it's my life and it's my Diabetes and mornings can be hectic and things get forgotten. So I got permission and I did and everything was fine, and I just gave my friend Chelsea the extra insulin I didn't use that day to keep at her place across the street in case I ever run into the issue again.

2. My sugars are weird in the morning. I don't know why, but I need amount 2x the amount of insulin I usually do. My insulin to carb ratio is typically about 1:5 - I have a protein shake with maybe 10-12 grams at most in the morning. I've been skipping the coffee this semester and opting for water or tea as coffee can spike me sometimes.
So, theoretically, I should need 2 units, if any, for breakfast in the morning.
But I don't - no matter how good my sugars are when I wake up, I consistently need at least 8.


I gave 8 the day before but still ended up at 220 mg/dL for my protein shake. So since my correction bolus is 1 unit for every 35 mg/dL I wanted to go down, and my goal is 130 mg/dL, I need about 3 correction units.
So that morning on the way to school, I gave 11 units.
Then I went to school and had my morning snack (15 g/Carbs) during break. I remember prepping my bolus before I actually gave it and went to my locker to get my snack in an attempt to pre-bolus for better control; which I just started trying to do to better control my sugars that week or the week before.
And that's when I got confused, because then Chelsea came up to me with pralines from her trip to Savannah that weekend and I just remember knowing I was definitely going to need more insulin since the pralines are pretty much straight sugar and so I couldn't remember if I'd already pre-bolused at that point but either way I gave more for the pralines. I didn't know how many carbs were in them so I had to guess. I ate my snack and we went down to lab.

And so 30 minutes later after wondering why I felt weird, and my lab partners asked me if I was ok and I wasn't, I went into the hall to check my sugar: It was 40. It might have been because I overdid it on the insulin that morning for my breakfast, or on the pralines, or had even accidentally double bolused for snacks that morning. Either way though, this was one of the worst I'd had in a while and I felt like absolute shit. I didn't keep food in the cadaver hall so I went to the locker room, slid down the wall and ate a granola bar and waited to feel better, which was taking a while. Lows can be indescribably bad sometimes and it's hard to describe how debilitating it is.
I had told my lab group I felt low and I was sitting there worried because what would I do in the clinic if this happened? I was mad at myself. My sugars weren't bad but it was frustrating when this happens. No one likes to feel limited by their body when they have no time to be limited, when they want to excel.

Chelsea came out to check on me after about 5 or 10 minutes when I was still feeling awful, and I was expressing to her this frustration and my worries about clinic when my professor - the same one who I'd asked permission for on snow day earlier that month - came out.

She looked at me as I told her I'm sorry, I feel awful and this was a bad low and that I was just waiting to feel recovered and I couldn't remember if I'd bolused twice that morning or if it was just overbolusing on accident. She looked at me as she said,
"Lacy,"
"You do an awful job of managing your blood sugars."

Those words hit me like a train as I furrowed my brows, not sure whether to laugh because it was a joke or if this woman - who saw me 2 times a week and didn't know my blood sugars and wasn't an endocrinologist - was passing a judgement on me in one of the lowest states I could be in, right after I'd just told Chelsea how worried I was and how I'd have to step things up for the clinic as a professional to try hard and not have random lows like this. But lab was different also because you can't exactly eat around dead bodies, so I had to leave to treat versus just keep glucose tabs in my pocket, which I always did on clinic days.

My confused face turned into disbelief and my heart sunk like a rock. I looked at her and said,

"Excuse me?"

"Seriously Lacy, you are not doing good. Forgetting if you gave insulin... forgetting your insulin that one time...you're in your 20's, you need to have a handle on this."

I just looked and looked at her and my voice cracked as I whispered, "I've only had it for four years. You don't have any idea how little time that is to adjust to a complete change in life. And then take that life you've gotten used to and go to grad school which is full of schedule changes and stress and hours of school at a time and ask me if it's going to be hard to adjust. Lows are a side effect of insulin, No matter how hard I try to manage my sugars they will happen sometimes."

"Well have you thought about getting a pump?"
My head fell, "I can't get a pump," I said softly. I couldn't explain to her why because the reason why I couldn't get one (aside from not wanting one) was one that was a well-kept secret currently. I tried explaining how hard my sugars were to manage for no reason in the morning. "Well have you tried greek yogurt in your protein shake?"

Note: Greek Yogurt usually has about 20 additional grams of carbs per serving; the amount of protein it has doesn't really negate that.

"No." I told her. Tears were pouring down my face at this point and I was more or less sobbing. I felt like total and absolute shit - lows make you irritable and emotional and vulnerable physically and mentally as it is and then cue someone coming in and then unintentionally shaming you because life doesn't stop for Diabetes and you have to treat it amongst everything else going on in your life.

And you are Going to make slip ups.You just ARE. It happens. And I can't always help it. Sometimes I can and it's my mistake, sometimes it's just because I get low or maybe my sugars are high even when I've done everything right.

Your life is a scale always with Diabetes, and even when you're balanced, it takes only on slight movement to send you toppling down again.

And so all I could do was cry and cry because I felt like a failure. Would I make a bad clinician? How could I express what I feel? I felt judged, and I felt hurt, because when I first came into this program we received a whole speech about how we should never judge patients for their condition. And I guess this is overreacting but I did feel judged, because I live with an invisible illness and it's so complicated that even in class all I ever hear from professors teaching about Diabetes is,

This stuff is complicated, guys.

Try living it and then being expected to never show that weakness because you're ok. You SEEM normal. And when you're not it's because you're not taking care of yourself right; because the doctor gave you a prescription and you have insulin and you just treat yourself easy as that, right?
But when there's no one size fits all for insulin dosage and it can change on a dime or the morning's are just tricky to treat....
It's not that easy.

And when I show it and I get low all of a sudden I feel shamed for it. I shouldn't have lost track of my bolus but it was a simple mistake, I promise you, and it happens. We are humans and we make errors.

I was angry and hurt and devastated. But all I could say was "I'm sorry, lows just make me emotional," as I sobbed and told the professor that I'd be back in lab soon, that it was nothing, that her words didn't hurt me even though it felt like a slap to the face.
When it's you living with the invisible illness, it's different. When it's you struggling to not let the disease define you, it's different. Because in that moment I was defined as the girl who, according to the professor who told Chelsea before Chelsea came to check on me,

was as she stated, "That girl who never manages her blood sugars,"
I went back into lab wiping tears from my face and experienced a lecture later from the other lab professor who asked if I was ok. "Clinic is better," she said. "You have more freedom. But be careful. I know your illness makes you more... vulnerable to doing poorly."

No. No. When I do poorly it's because of me, it's NOT because of my illness. No.
That day struck me hard, and I've carried it with me since. I've even tightened control over my blood sugars - but I didn't forget about how that day made me feel.



So cue back last Friday when I thought I might be low. I creeped quietly to the hallway, tested, saw the 50 and ate 5 glucose tabs. Then I went straight back in, pushing through the lightheadedness, and smiled at one of the professors as I went back to my table.
Like nothing had happened.

Like my low was just as invisible as my illness.