If you're living with diabetes and have ever experienced severe hypoglycemia (low blood sugar) in public, you can surely relate to this story, told by Terry O’Rourke from Portland, OR.

People without diabetes sometimes wonder, "What did you DO to make such a huge mistake?" But those of us living with type 1 diabetes know that despite our best efforts, it's quite easy (and common!) to find yourself unexpectedly in a diabetes crisis situation.

 

Finding a Way Out, by Terry O'Rourke 

I spilled out of the commuter train, bicycle in tow, into the dimly-lit underground Sydney, Australia rail station. My glucose-starved brain narrowed my peripheral vision and rational thought. Survival mode drove me, powered by a sheer will to live. The mind-numbing hypoglycemia recast my reality into a dream-like, drug-like nightmare. My fellow passengers disembarked and quickly disappeared, leaving me alone. I was left with a singular focus and lifeline: find sugar!

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My trip to Australia 30 years ago took place in the wake of a particularly difficult and emotional time in my life. My wife and I had separated several months prior, the painful end of a 15-year relationship.

Emotional context

Raw emotions plagued me in unending and unresolving circular fashion: loneliness, anger, betrayal, and self-recrimination. My trip to Australia seemed a possible way out of this insidious self-destruction but I knew deep down that there was no quick-fix.

In some ways, the 7,400-mile distance I tried to place between me and my ground-zero turmoil seemed a grandiose attempt to find some emotional respite. My loneliness, anger, sense of betrayal and self-loathing, of course, followed me across the International Dateline and into the Southern Hemisphere. Instead of giving me a way out, traveling to a distant destination only amplified my emotional turmoil.

My plan on the day that led to the Sydney Underground station engaged my sense of adventure and a distraction from my personal woes. I was a fit 36-year-old cyclist who rode endless miles on the hills surrounding San Francisco Bay. A ferry-ride took me across Sydney harbor to an oceanside town and I pedaled northward.

Best-laid plans

In preparation for this excursion I packed a lunch and an abundant supply of snacks and treats in case of expected bouts of exercise-induced low blood sugar. The salty spring air, beautiful beaches, and beachside hilly terrain did soothe my spirit. My body felt strong and I enjoyed this exotic excursion.

After a few hours of oceanside pedaling, I arrived at a town where I boarded another ferry to cross an estuary. At the other side I continued my planned route and ran into more uphill errain than I expected. But I was able to power through. I stopped several times to poke my finger (this was many years before CGMs) and consume juice-boxes, glucose tabs, and dried fruit to catch the falling glucose.

Late in the afternoon, I arrived at the station where I planned to take the commuter rail route back into Sydney. Knowing my vigorous exercise had depleted my glucose levels, I went to an outdoor restaurant and ate a hearty meal of rotisserie chicken with a generous side of roasted veggies.

While I noted that my aggressive day-long bicycle ride had exhausted my hypo supplies, I reasoned that my hefty dinner would take care of my glucose needs while I returned to Sydney using the rail line in reverse-commute fashion. Low-carb eating was not a big topic back then and the slower speed of absorption of the chicken and veggies didn't even cross my mind at the time.

My plan unravels

After dinner, I boarded the train with my bike and was surprised to find myself the only passenger in my rail car. I knew that most passengers were headed out of the city at this time and this circumstance raised no special concern.

Once I sat down and started to enjoy the passing country-side, I pricked my finger and discovered my glucose level was much lower than I expected, especially after my recent dinner fare.

I finger-poked 15 minutes later and saw that my glucose was sinking quickly toward my hypo range. I then realized that I had no hypo supplies with me. I knew better than this! How could I let this happen? The empty rail car precluded even making an appeal to fellow passengers. I was alone as my worries mounted.

My rail journey back into town was only about 40 minutes long and I felt the odds were in my favor for riding this out. I was hoping that the large serving of chicken and veggies would kick in and raise my glucose back into safer regions. I was wrong.

I did three or four more finger-sticks as I watched in horror at this unfolding metabolic calamity. Why did I do this? Why didn’t I plan better? I thought I had this and I didn’t!

I arrived back at the Sydney underground railway station brain-impaired by a severe low. The primitive reaches of my brain dominated my thinking. Get glucose, nothing else matters.

I found myself staring at a vending machine and fumbling through my pockets and bicycle bags trying to make sense of the unfamiliar Australian coins. I spent precious minutes mindlessly lingering in front of the machine before my befuddled brain concluded that I didn’t have the right combination of money to unlock the candy and cereal bars so tantalizingly just out of my reach. Thwarted.

The power of kindness

Which way out? I craved the simplicity of the 'Way Out" signs found in the London Underground as I read sign names with absolutely no meaning understandable to my hypo-addled brain. What should I do? Exit this damn tomb and find some sugar!

A set of turn-styles appeared before me. I felt a strong and unjustified sense of responsibility toward my rental bike. A more rational stance would have been to abandon the burden of the bicycle but the glucose starved brain is anything but rational.

The individual horizontal turn-styles blocked my exit with my bike as did the floor-to-ceiling vertical turn-style. I sensed time running out. Get sugar soon or face collapsing with my bicycle in an underground train station, in a foreign country, so alone, so vulnerable. Why is this so hard?

A station agent appeared and without comment or question magically pushed open an unapparent gate that permitted me, without questions, to pass with my bicycle. I was grateful for his action as my ability to coherently communicate had vanished. Find sugar!

I could smell the spring-time night air cascading down a staircase that appeared to climb forever up to the ground level. Did I have enough glucose in my system to power up that tall flight of stairs without passing out? I didn’t know but I had no choice. I picked up my bicycle and soldiered upward.

At the top, amid the deserted outdoor transit plaza, I clung to my bike and frantically searched for some clue to lead me toward my sugar oasis. A thin, slightly built, black-haired young man floated into view. “I need sugar -- diabetes,” was all I could muster.

My Good Samaritan motioned for me to follow. I did, and the next thing I see is a commuter snack shack counter with human beings ready to make change. At last! I don’t remember what I ordered but I greedily consumed it as my sanity and competence slowly returned.

From the accent and appearance of my Good Samaritan, I later concluded that he was probably a Vietnamese immigrant. His kindness touched my soul and I will never forget it. I just wish he knew how much his simple generosity meant to me.

 

{Terry O’Rourke has lived with type 1 diabetes since 1986 and resides in Portland, OR, with his hypo alert dog, Norm. He was one of our 2018 DiabetesMine Patient Voices Contest Winners.}