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How do you deal with hypo’s at work and communicate them?

Discussion in 'Jobs and Employment' started by Welmoed, Feb 7, 2020.

  1. Welmoed

    Welmoed · Member

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    Hi everyone,

    I am curious how you all deal with hypo’s or hypers at the working place and in particular how you communicate them to your colleagues (while you’re in a hypo/low blood sugar)?

    Below I will first provide a small list of the symptoms I experience in case of a hypo/low blood sugar.
    Then I will put forward some situations in which I have difficulties to act properly or to communicate them effectively to colleagues. In this post I first focus on hypo’s. In the next on hypers.
    What I need to say in advance is that since I have impaired hypo-unawareness I do notice my hypo’s relatively late, resp. mostly by neurological malfunctioning.

    Hypo symptoms:
    - Experience difficulties executing appropriate goal-directed actions (having an impaired sense of which actions are needed to generate certain outcomes).
    - Unable to follow a storyline because for instance when the eight word starts, you have already forgotten the first.
    - Impaired access to memory: don’t know what I intended to say (forgetting the thing that came up a few seconds ago).
    - Difficulties integrating all the sensory input into a coherent whole.
    - Sensory stimuli (sounds, light, colors, smell, etc.) are experienced as overwhelming because the ‘normal filter’ doesn’t function anymore.
    - My lips are less controllable, which makes it difficult to pronounce the words I am intending to say; and if my lips move, they move clumsy and in slow motion.
    - Loss of my facial expressions: failure of laughing, gentle nodding, looking interested, etc.
    - Loss of a great part of my personality: logical/analytical thinking, humor, skills, habits, etc.
    - No power in my muscles (unable to greet colleagues in the hall/corridor by putting my hand up).

    Situations
    - In a meeting with colleagues
    - In a 1-on-1 interaction with your new supervisor
    - When giving a lecture (with a powerpoint)
    - In a phone call with someone who is higher in rank

    How do you deal with these situations?
    - Do you have a card with a text on it describing the hypo-situation you are in and written down what the other might expect (“unfortunately no presentation/meeting possible in the upcoming 15 minutes”).
    - Do you have a separate room in your office where you can go to in order to raise your blood glucose level as fast as possible, meaning: a stimulus-free environment?
    - Have you made some arrangements with your boss that once your sensor is alarming in a meeting, you give a small signal to your boss and leave the room?
    - Are you still able to produce a few simple words making clear that your brain and muscles don’t function appropriately anymore?

    In other words: what do yoú do?
    Can one of you give me some tips and tricks on how to deal with such situations professionally?

    Since I like to start with a new job in a while, I would like to prepare myself by anticipating on hypo-situations and how to deal with them properly….

    Thanks in advance!

    Kind regards,
    Welmoed
     
    #1 Welmoed, Feb 7, 2020 at 10:21 PM
    Last edited: Feb 7, 2020
  2. Antje77

    Antje77 LADA · Moderator
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    Hi @Welmoed, and welcome to the forum.
    Not an answer to your question, but with your late hypo awareness, would you be eligible to a CGM that alarms you before you are hypo, allowing you to prevent hypo's most of the time?
    Are you a fellow Dutchie? Asking because of your name :)
     
  3. Welmoed

    Welmoed · Member

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    Hi Antje, Indeed, I am a Dutchie as well :). Thanks for your warm welcome!

    I actually already have a CGM sensor and even the Minimed 640 G with a basal-stop when my blood sugar drops, but unfortunately I still have low blood glucose levels that go along with neurological malfunctioning. ...

    Regards, Welmoed
     
    • Hug Hug x 1
    #3 Welmoed, Feb 7, 2020 at 10:38 PM
    Last edited: Feb 7, 2020
  4. LooperCat

    LooperCat Type 1 · Expert

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    I have an alarm set on my watch that discreetly buzzes my wrist when I drop to 4.5mmol, so I can pop two dextrose tablets and crack on with my day. Nobody I work with notices, on the whole. And if they do, they always ask if I want to swap places for a minute.
     
  5. Antje77

    Antje77 LADA · Moderator
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    Ah, in that case I'll skip the miaomiao option, as you already have a CGM :)
    Can you get your CGM to alarm at slightly above hypo levels so you can discreetly pop a dextro or a sip of something sugary before your functioning is affected?

    Still no answer to your original question, sorry. My previous work environment was completely different from yours, so I don't think our work-related hypo experiences are compatible.
     
  6. Jollymon

    Jollymon Type 1 · Well-Known Member

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    I don’t communicate the situation. I just eat a snack and take care of it.

    And, I test enough so that a low during work isn’t a problem. Testing to see what I’m doing helps avoid that.
     
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  7. Welmoed

    Welmoed · Member

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    Thanks all for giving feedback!

    Hi Loopercat and Jollymoon,
    I guess I might have more heavy symptoms of a hypo than you have, because a normal hypos takes about 30 minutes with a spike downwards in the middle before I recover and can function normally (in the sense of continuing on executing the thing I did in a proper way). It is maybe only possible to recover unnoticed if you are behind a computer on a desk (but if you are in front of a group pupils or having a feedback conversation with your supervisor it’s more difficult for me…). In cases when you have to give feedback to a group by speaking, or to give a reply that makes sense (that shows a more or less accurate thinking process), I can’t give proper feedback due to these symptoms. You don’t have problems as such then?

    Antje, I believe we might have different work contexts indeed..? I have been working as a teacher, a museum educator and recently on the university (behind a desk: making your own planning, but having to give talks as well). The latter is especially a moment in which hypo's can suddenly surprise me. Maybe you are self-deployed (wild guess)?
    I have at least long time thought that being self-employed may combine well with diabetes (make your own planning and reschedule them when having a hypo/hyper), but I was always scared for what my diabetes-future would bring (what if you become suddenly ill and the diabetes might cause a delay in recovering period, etc)…

    Maybe it is because I have diabetes for 42 years now, that it becomes more difficult to feel these hypo's come into being... It seems likely/possible that you - the more recently diagnosed - still have some active bèta-cells that prevent you from longer/neuroglycopenic hypo's ..
     
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    #7 Welmoed, Feb 8, 2020 at 9:59 AM
    Last edited: Feb 8, 2020
  8. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    Hi. Are you saying you are dysfunctional for 30+ minutes every day? That seems a lot of time and must be a concern to you and your colleagues who won't figure out what is going on unless you do a little office education so that people know not to ask you anything important as you recover.
    Have you tried low carb as a way to reduce the amount of insulin in your system and hence the roller coaster dips? It just seems like quite an anxiety and a cognitive burden to carry IMO if it can be avoided by a change in your regime.
     
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  9. Welmoed

    Welmoed · Member

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    Hi Nicole, actually: yes, I have at least 2 low blood sugars a day (I have been diagnosed to have Brittle diabetes) and that definitely has an influence on my work and my colleagues. The endocrinologist, diabetic nurse/educator and I have done many things to make these hypo's disappear, but they unfortunately still pop up.
    Your suggestion could be a wise thing to do ..to concentrate even more on a low carb diet. I already eat low carb bread and eat very healthy, but the bread is still 'bread' ..so maybe I can gain some profit there in order to reach more steady and high blood sugars...Thanks for your advice!

    By the way - a little straightforward question maybe -: is your dog a hypo-dog...who smells your hypo's? He/she looks actually exactly like the hypo-dog of a friend of mine :). She likes having this dog so much!
     
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    #9 Welmoed, Feb 8, 2020 at 10:50 AM
    Last edited: Feb 8, 2020
  10. Antje77

    Antje77 LADA · Moderator
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    My former work place :) :

    [​IMG]

    Not a good place for hypo's, as there's only the two of us, skipper and mate, plus a bunch of tourists who have never sailed.
    I guess the main difference between us is that I'm lucky enough to manage to catch most of my impending hypo's before they're there by scanning my Libre 35+ times a day on sailing days and my diabetes behaving pretty predictable as long as I choose lower carb foods.

    Depending on the weather and on a couple of other circumstances I take some preventative carbs before action moments when running on the low side. I have had hypo's for which I had to sit down for 15 minutes while sailing, but only on very easy days with the most relaxed skipper I've had. Those circumstances allowed me to practise running lower (obviously failed :wacky:) and I simply sat down with my hypo treatment and told my skipper he'd have to manage without me for the next 15 minutes.

    With how your diabetes behaves, knowing how I manage hypo's at work seems to be completely useless for you, sorry, I wish I could be of more help.

    At what number do you have your CGM alarm? Would it help to have it warn you earlier or are you unexpectedly dropping so fast that you're already below 3 when the thing thinks you're at 5.5?
     
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  11. Welmoed

    Welmoed · Member

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    Hi Antje,

    Beautiful previous work place (I see you are a true Dutchie indeed ;))!!

    Your former work place would indeed actually have been a very difficult one for me, I guess ;), (although it looks nice.. out in the open air!). On the other hand, I am also someone who doesn’t give up easily and have a strong will to bé there and act as good as I can. This temperament kept me going ..and made me go on working with diabetes for a very long time. I still do, but at a different pace and with more respect for my diabetic delays (because they are of course there independent on how strong your will is to keep on going).

    When it comes to your advice of changing the reference number on my pump (resp. the number you use to stop your basal insulin delivery): unfortunately, I have the minimed 640G and on this pump the number to stop your basal delivery is the SAME as the number for restarting the basal delivery again (leading the blood sugars to rise sky high after a basal stop). Especially when I raise this reference number, it takes too long before my pump starts pumping insulin again.

    I am waiting for the Tandem X2 pump. I heard this pump had the option of choosing different reference numbers for up and down: that would be great! Fingers crossed.
     
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  12. LooperCat

    LooperCat Type 1 · Expert

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    @Welmoed - if you’re having 2 or more of these hypos a day, I wonder if some basal testing might be in order? Sounds like you’re getting too much insulin, especially if they happen at similar times each day. The mySugr basal testing guide is very good and comes up if you google it. As for working, I was a teacher until recently, until I made a career change and am now training to be a paramedic. Like you, I eat a low carb diet (<30g daily), which means smaller doses of insulin, and therefore less hypo risk (for me) - when I do go low it’s a slow drift down rather than a sharp drop. I’ve combined my pump and CGM to create a diy artificial pancreas system, which adjusts the basal rate of my pump every five minutes to keep me in range; it’s not perfect but I’m where I want to be most of the time. When I’m on an ambulance shift, (12-14 hours), I set my watch to alarm me at 4.5mmol, and all I need to do is take a couple of glucose tablets and that seems to do the trick. But basal testing had been key to all this - it’s the foundation that you can build everything else on.
     
  13. Antje77

    Antje77 LADA · Moderator
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    No, I mean your continuous glucose meter, does it have alarms to warn you?

    edit: I don't use a pump so I don't know how a pump with a CGM works. I use the Freestyle Libre, and if I had hypo's like yours I would order a miaomiao to go with it immediately to have it warn me when I'm dropping. As it is I'm good with only scanning.
     
  14. Welmoed

    Welmoed · Member

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    Hi Antje,

    Since my sensor-alarm 'for low' is inside my pump (I do not have another tool to read glucose curves or set an alarm), I can only change the alarm to a higher level by also adjusting the reference number on which the hypo/basal-stop is activated. Unfortunately, I can't make the alarm go off at a higher level without (after a while) also have a stop of insulin delivery and afterwards having a high blood glucose again (see the problem I referred to in my previous reaction).

    Maybe there is someone who knows a way to put the output of the guardian 3 sensor also on your mobile phone ? (Maybe I could then add a separate alarm based on the data on my phone...).

    Thanks for your reflections on this subject! :)

    Loopercat, I am still reflecting on your input ;). I will therefore react later!
     
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    #14 Welmoed, Feb 8, 2020 at 5:14 PM
    Last edited: Feb 8, 2020
  15. MeiChanski

    MeiChanski Type 1 · Well-Known Member

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    Hello medtronic and the guardian link 3 sensor is not compatible on watches and phones. Which is unfortunate but their upcoming and newer model Medtronic 780G will be compatible with Apple.

    I have the 670G, my pump warns me at 5.0 to give me time to intervene and it beeps on a hypo.
     
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