written for a local magazine
I have type 1 diabetes. It’s necessary for me to inject insulin multiple times a day, and closely monitor my blood glucose levels. I’m also on what the BC government calls BC Employment and Assistance for People with Disabilities, which means I receive a small amount of money every month to pay all of my expenses. Type 1 diabetes is not the cause of my disability, but a complicating factor.
The money’s usually all gone after a week, maybe two. I buy groceries, of course. But there is never enough, and I inevitably go hungry during the last week of each month.
The insulin injections, however, cannot stop. I can reduce the amount I inject by trying to guess ahead of time how many carbohydrates I will or won’t be consuming. And for the most part, I can get it right. But sometimes, more times than I like to admit, I don’t get it right. I get it terribly wrong. The result is a condition referred to as hypoglycemia, often sever hypoglycaemia.
Hypoglycemia is low blood glucose, the fuel the body and brain need to function. It results from taking too much insulin in relation to carbohydrate intake. It becomes severe when there is no treatment. Situations where no treatment occurs arise when the individual is unaware that he or she is experiencing hypoglycaemia, the brain needs glucose to function don’t forget, and/or there is no means by which to treat it.
The Canadian Diabetes Association defines severe hypoglycemia in the following way:
Severe hypoglycemia, a major concern in the treatment of
type 1 diabetes, is generally defined as a plasma glucose level
<4.0 mmol/L with neurogenic and neuroglycopenic clinical
manifestations sufficiently disabling to require outside assistance
(1,2). The proportion of patients affected and event
rates for severe hypoglycemia are high, with an accompanying
array of transient and sometimes permanent physical and
psychological disabilities. Death rates range from 2 to 4% in
adults to 8% in children (1).
In other words, the outcomes of severe hypoglycemia are serious. One can even die. The Fire Department in my neighbourhood knows me by sight and by name. That’s how often they’ve had to revive me from unconsciousness or intervene as I entered into seizures. The simple treatment is food. Some quick sugar, glucose tablets are best but unaffordable, followed by something more substantial, like a peanut butter sandwich. But if I’m going hypoglycemic due to a lack of available food, how do I treat it with food?
Regarding people of lower socioeconomic status, the Canadian Diabetes Association has said this:
Lower socioeconomic status is also associated with food
insecurity: according to results of the Canadian Community
Health Survey (4), 48% of Canadians in the lowest income
adequacy category were found to have food insecurity, and
60% of individuals on social assistance had moderate or
severe food insecurity. Food insecurity includes compromised
quantity and quality of foods consumed, and disruptive
eating patterns that could influence the onset, treatment
and recurrence of severe hypoglycemia.
Well, that’s me in a nutshell. With little or no food in my apartment, or in my near future, I still have to inject insulin. My eyes, heart, kidneys, fingers, toes, limbs and peripheral nervous system depend on my maintaining healthy blood glucose levels. And yes, blood glucose, in the absence of adequate insulin, can rise even if one doesn’t eat.
That’s why I always have a bag of sugar in the cupboard. It’s cheap and easy to store.
This morning, I injected a comparatively small amount of insulin because I had very little food for breakfast – tomorrow is cheque day. By 1:00 pm – I don’t eat lunch, I can’t afford it – my blood glucose level was at 2.1 mmol/L. A healthy fasting level is between 4.0 and 7.0. I felt seizures coming on. And because I had nothing else, I knew it was time to get the bag of sugar from above the fridge. Three to four tablespoons usually works for me, gets my blood glucose level above 4.0. Today, I consumed four tablespoons, each tablespoon swallowed whole followed by a gulp of water. Yes, it’s bloody hideous!
And that’s why I eat sugar right out of the bag, because that’s what you do if you’re poor and insulin dependant in Canada. Oh, Canada!