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  • Phyllis Kaplan

Scary low on a plane.

No, not snakes on a plane, but scary low blood sugar on a plane.

This past week I had the good fortune to travel to Ireland, and the scenery was amazing, as was the gluten free food, and cider! Diabetes-wise, this trip was harder than previous trips with regards to managing my diabetes.

The story actually starts the day before the low-on-the plane.

On our last full day in Ireland, we spent the day walking around Dublin, much along the same lines we had done the previous days in the different places we visited.

We set out at a leisurely pace to the Guiness Storehouse. Along the way my CGM alerted me that my bg was on the low side, hovering around 70. Low enough to treat, but not to stop so I treated it along the way. Glucose tabs, followed 20 minutes later with fruit snacks, followed 20 minutes later with some more glucose tabs. At the next stop, a building supply store, I had decreasing energy so I waited outside. Bg was hovering around 60, so I opted tor a protein bar. Just as my husband came out of the store, my bg dropped down to 31, as I slid (as best as I could) down the brick wall of the store to the ground. I did not feel well at all, but I was aware, conscious and able to somewhat communicative. I take these things as a win amongst a super low. I eventually got to 60 and we walked up the block to sit in a cafe. I waited, and waited, and waited some more for my bg to even out, and finally when I got up to 90 and no active insulin we hit the pavement. All was good for the rest of the night, though I ran my bg a bit higher than usual, on purpose. The next day was the day we flew home. We woke up earlier than usual, had breakfast in the hotel and made our way to the airport. We breezed through airline check in, Dublin security, US security, then through US customs and immigration (thank goodness for Global Entry). We read and heard that this whole process could take up to 3 hours so we didn't stop to eat, or shop before security due to the "it takes a long time" hype. We did it all in 30 minutes, but there was only 1 cafe once we went through security. Bummer, but I had a backpack full of snacks. 'Cus you know with diabetes and celiac, you never know when you are going to need those snacks! Finally at 11:45am the flight took off and I had my first snack, and chose a movie to watch. We were an hour into the flight and I started to not feel well. My CGM showed 65 with a down arrow. Lunch was served, but I had no desire for it. I mean, on a normal day does anyone actually like airplane food? What I really wanted was to to lie down. My stomach was extremely upset, I was sweating buckets, and could barely keep my head up. I motioned for my husband to get me a sugared drink, and he naturally got OJ. I couldn't drink it. My stomach was so upset the thought of it was bad. My husband encouraged me to drink it, which he was right to do. I took one sip and knew things were going to get bad quickly. I had an window seat and of course they just served food, but I had to get up. I mean HAD TO GET UP. The poor woman sitting in the middle, then my husband on the aisle, then me. They seemed to sense the urgency. It might have been my pale green disposition.

Luckily I made it to the restroom. And vomited, then vomited again and again. Still sweating buckets. Let me tell you, airplane bathrooms are often not great, but it seemed as though this one wasn't really aired out much between flights. But there was nothing I could do about it. Eventually things calmed down, I was able to get back to my now aisle seat, and drink some Coke. I had about 1/4 of the can and took a nap, while continuing to check my CGM.

Finally, after about an hour of feeling the worst I'd felt in a long time, my bg climbed up, and up, and up some more. It was a quick increase from 65 at the start of this, to 220+. My guess is a rush of adrenaline or perhaps my body's own glycogen kicked in. The sweating stopped, and I was able to get some sleep.

This was one of the scariest things that has happened to me in all of my years living with T1D. I wasn't alone, my husband was at my side throughout it all. I'm sure this was even scarier him, but he kept his cool. I knew the flight staff was aware something was off, and apparently kept checking in. But I made it. I'm not sure how, but I did. Now that I'm home, and back on my regular schedule I will start checking carb to insulin ratios, see how my bgs are doing after food, as well as going back to basics with measuring food and carefully monitoring things. I will also check in with my diabetes team at the Joslin Diabetes Center for assistance.

We had a glucagon with us but in our checked bag. From now on the glucagon will be in carry on, and I am going to look into the nasal spray glucagon that just came out. in my 46 years with T1D, I only needed glucagon once, soon after diagnosis. But this experience has highlighted the importance of always having it nearby.

I feel like I will forever have that plane-bathroom-deodorizer smell on me. You know it -- it sort of goes with the blue toilet chemicals.

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