The Road to Santiago.

September 29, 2002


7:30 p.m., outskirts of Pamplona: I'm sitting in the Bar Arga (named for the river Arga which runs around the north side of Pamplona) eating a tapa (canapé) of cangrejo con mahonesa (crabmeat with mayonnaise). This particular trip I haven't been eating tapas, because for the past four years, I have not eaten bread. But when I tested my blood just a moment ago, it was 74 mg/dl. Normal folk have a blood level of 88-98 and mine indicated that I was approaching a state hypoglycemia and that was a state I didn't want to be in.

To avoid going "hypo" I ate the tapa. It was a tough decision, but someone had to make it. Seriously, folks, hypoglycemia is the big fear of diabetics. It causes a very unpleasant feeling and if left unchecked, could result in serious problems including diabetic coma and virtual death. (Does anybody remembers Sonny Von Bulow??) The diabetic "gone hypo" appears confused: he is weak and may stagger. Thus, a lot of people assume he is drunk. But let me assure you, he is not. He is staggering along a dangerous path and needs help. He needs a quick dose of sugar-fast! One of the best ways is to give him a glass of orange juice. The high natural sugar will raise his blood sugar quickly.

What causes hypoglycemia? Well, one cause is that the diabetic takes more insulin than he needs for the intake of carbohydrates in his food. (This can occur also with non-insulin diabetics who take glybideride or other medicines. Another reason may be an increase of physical activity, which burns off more carbohydrates than normal, resulting in an excess of insulin. This is the problem that a hiker such as I, or an athlete, has to be concerned about. Another may be illness. (Remember just a couple of days ago in Madrid?) Illness may cause changes in metabolism.

I remember the first time I "went hypo." It was years ago but it seems like yesterday. It was my birthday and several of us were going to celebrate with a special meal. But first, we went to see a local play. It was longer than we expected. By the time we got out I was "bouncing off the walls." I asked my friend to pull into the first mini-mart he saw and I ran in to buy a candy bar. After a few minutes, my friend came in to look for me. I was standing, staring at the candy stand unable to make a decision. Which one should I buy? If he hadn't rescued me, I would have stood there until someone called the police.

Another time, I was asleep and began trashing around in bed. My partner awoke to see sweat pouring off of my face. She aroused me — afraid of what was happening. We tested my blood and it was 20 mg/dl — a dangerous state indeed! She wanted to call the EMT's but I insisted, NO! Instead I had several glasses of orange juice and we kept testing and testing until my blood was up to over 100. Was I right or just foolish? I think the cause of the event was that I miscalculated my dose since at that time I had just changed my insulin regimen.

The second such event occurred a year or so later. I was alone and my cat woke me up. Since I was sweating profusely, I knew what was wrong. I started searching the kitchen for some carbohydrates. Crackers — none in the house! Orange juice? None! (We had gotten rid of all carbohydrates.) I knew that there had to be some sugar somewhere. I finally found the stash put away for guests' coffee. (It's a good thing that it wasn't hidden too well!) After a couple of spoonfuls of pure sugar (yuk!) I laid down and waited for the sugar to kick in. The cat stayed by my side.

This state of hypoglycemia is the reason most diabetics don't want to take insulin or try to control their disease. They don't like the feeling of being hypoglycemic or they are afraid. Not to control the sugar is a Hobson's choice that could result in blindness, amputation, or even kidney and/or heart failure. Well, what is the answer? It is testing-frequent testing. Personally, I test at each meal and before bedtime. During special times like above or when I'm sick, I test every couple of hours. Two hours after a person eats, his blood sugar is at a high point. Three hours after eating, it is back to baseline. Thus this is the method that I am using. And since I am alone, I want to err on the high side.

It is 8:25 and my blood is 89 mg/dl. Normal, but it should be higher after eating a couple of slices of bread. Did I miss a dose? I went back to look at my food log. I must have over calculated the amount needed with the menestra verdes (green vegetable mix) and pastel de San Marcos (whipped cream torte). I feel chagrined. I need to find a carbohydrate guide for Spanish cuisine. Well, I guess I should keep testing every couple of hours until I stabilize.

Actually, I've had a lovely day. Most of it was spent in the Museum of Navarre (this province). It was quite interesting. But I feel that I wanted to tell the above story because it's more relevant to my purpose of the "walk." More about the museum later — perhaps.

¡Mañana me yoy a Roncesvalles! Tomorrow I go to Roncesvalles.

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