Highs and Lows

Highs and Lows

Chapter 4: New Friends

(Uchiha Sasuke’s point of view)

At the end of my physics lab I was finally able to listen to the message that Naruto had left me.

"Hey Sasuke. I just called. Your phone's stupid. It erased my first message. Anyway, give me a call back alright?" There was a pause before he spoke again. "Oh, yeah, wait. This is Naruto. Right. Call me back. And change your voice mail message. It sucks."

I snorted. This guy was unbelievable, but it made me smirk at his antics nonetheless. Change my voice mail message? I don’t have a personal message, just my name. He could hate it if he liked. It wasn’t as though I ought to waste my time explaining that I was unavailable and for them to leave their name and number. Not to mention why should I tell them to leave the time they called? First of all, if I didn’t pick up, obviously I was unavailable. Second, if they had my cell phone number, then I had theirs. I rarely give this number out. Third, the voicemail would automatically tell me what time I received the voicemail.

I shook my head, wondering why I was wasting my time thinking about how leaving an elongated voice message was a waste of time.

Even though I had already called him once, our conversation had ended quickly. I called Naruto back.

"Hey Sasuke!" Naruto said enthusiastically. I think enthusiastically was the only way he talked.

"Hn," I made a non-committal grunt.

"Er, I guess that’s a hi. Umm, anyway, uh…"

"You were going to talk to me about the doctor’s office?"

"Right! Yeah, so are you busy this Thursday?"

"I have a class from 8:00 – 9:15, then I am free."

"Cool! Schedule an appointment for 10:30. I have a class then, but I’m going to skip it. I’m gonna come with you since Dr. Tsunade said she and I ought to discuss the CGMS I want you to try since I want to try it too." For some reason, I wasn’t surprised he was skipping class. I was, however, surprised that he would be coming with me.

"You’re coming? And what is a CGMS?"

"Yeah, that okay? Easier if she trains us both. And a CGMS…wait…" he paused and I could hear him muttering under his breath, "yeah, that’s it. A CGMS stands for a continuous glucose monitor system. It’s a device that constantly monitors your blood sugar."

"I’ve heard of that. They’re rather expensive. I don’t want to buy one," I explained. I doubted my father would give me a pay raise for that if I told him what I needed it for. After all, he’d already been threatening to pull my funding for school.

"No – no! It’s a free trial. The doctor’s office has a supply that they let patients use." Now that’s a tempting thought.

"Fine. Thursday at 10:30."

"Cool!" Naruto rattled off the number and gave me the address, telling me to give him a call once I got the appointment.

"Bye!"

"Bye."

- - - - - - - - - - - -

After my class on Thursday, I headed over to the place Naruto had mentioned. It wasn’t too far from campus. I was unsurprised to see Naruto waiting outside of the building, waving at me enthusiastically. I idly wondered if he had ADHD.

He led me inside the building, walking backwards as he told me that he had managed to get all his work for his class done, so it didn’t matter if he went to class or not. I honestly didn’t care.

"This is Central Medical," Naruto informed me excitedly as he opened one of the many doors in the office building. This office looked like all the others we has passed, the only difference was the gold lettering on the glass door that read:

DR. TSUNADE, M.D.
ENDOCHRONOLOGY
CENTRAL MEDICAL

"I'd never have guessed," I deadpanned as I stared right at the big, capital letters CENTRAL MEDICAL.

Naruto squinted his eyes, looking at me as though trying to figure out if I were being serious or not.

"Was that a joke?" he asked. My eyebrow twitched.

"Sure."

"It's just, you don't seem like the type of guy who jokes much. You must be the sarcastic type."

Obviously.

"Speaking of jokes, do you know any blonde jokes?"

The expression on his face made me want to say, "Yeah, you're a dumb blonde joke," but I was afraid he might not get the joke.

"Why?" I asked instead.

"Tsunade-baa-chan loves 'em!"

"Hn."

"I bet you don't know any. Don't worry. I'll tell two," Naruto said grinning at me as though telling her a blonde joke in my place was doing me a favor.

"Thanks," I bit out.

"You know, you seem extra irritable. Should you test?"

"Test?"

"You know – test! Check your blood sugar. I get really irritable when I drop low. So do most diabetics that I know."

I just looked at Naruto.

I'd never really talked to any other diabetics before, but what he said made sense. With no one else to compare things to, I'd never asked if having a low blood sugar made other diabetics feel irritable.

Realizing we hadn't even walked through the door yet, I opened it, and walked in, talking as I went.

"I'll let them know I'm here and then 'test' when I sit down." Naruto just nodded at me as he walked up with me to the front. For half a moment it felt rather silly walking in with him. The idea that someone was coming with me to my doctor's appointment felt strange. I don't even remember the last time my own mother had accompanied me, but I did know it had been years. Naruto had said that he was here for an appointment too. He had explained that Tsunade was going to talk to him about the same thing, and as it was strictly informational and not an actual doctor’s inspection, it would save her time if we did the informational session about the technology together. My doctor's visit would be private, and then the training would be done together.

While it almost felt like Naruto was babying me by coming, it was strangely nice to think that someone else would be there. It was almost like he cared – even if he was getting information for his own benefit as well.

"Shizune-nee-chan!" Naruto greeted warmly. I looked at the woman behind the counter. She had dark hair and eyes, and looked nothing like Naruto. Clearly the older sister term was just to add affection to their relationship.

Apparently Naruto got along with a lot of people, not just me.

"Hi Naruto," Shizune said. She was typing away at her computer, not even looking up from what she was doing when she answered, knowing his voice immediately.

"This is Sasuke!" Naruto said loudly. I could practically feel the twitch in my eye. Shizune turned from her place at the computer and smiled at me.

"Welcome to Central Medical. It's always nice to see new faces. Can I have your referral and insurance card?"

I reached into my pocket and pulled them out, unfolded the referral and gave both items to her. She handed me forms to fill out, forms that asked details to my previous medical history. As I turned she said something about getting my insurance card back to me as soon as possible after she had made a copy of it for their records.

"Don't forget to test your blood sugar," Naruto reminded me. I bristled. I don't know if I were more annoyed at the fact that he had remembered and I hadn't, or that he seemed to be implying I still seemed irritable.

Nonetheless, when we sat down, I pulled out my glucometer and "tested" my blood sugar.

52.

Naruto looked over my shoulder, looking at the number. Normally I would have brushed off anyone who had tried to meddle in the personal matter of my health, but in a strange way, I didn't mind as much since he was a diabetic as well. I wouldn't have to explain that the blood sugar reading implied I needed to take in sugar to correct the imbalance.

When I pulled out glucose tabs, Naruto gave me a strange look.

"I hate those things," Naruto said vehemently. He reached into one of his cargo pockets, and pulled out a small juicy juice, orange flavor.

I didn't know whether to be offended that he seemed to think that just because he didn't like the glucose tablets that my tastes should mirror his own, or be grateful that he was offering over an orange juicy-juice.

Stupid as it sounded, one of the things Naruto had babbled about over the phone the night we had first met was how he always carried two juicy-juices in his cargo pockets. His favorite flavor was orange.

I always carried a supply of glucose tablets. I know if I had one low in a day, I was likely to have another. Offering me his juicy-juice was like offering away all but a few of my glucose tablets.

I took the juicy-juice, deciding to feel begrudgingly grateful that he'd given up what in many ways was half of his supply of back-up medicine. Naruto watched me, as though making sure I was going to drink it, before I downed it in a few sips. Then I turned my attention back to the medical questions in front of me.

After I filled out the medical forms, I handed them back over the counter to Shizune. She handed me back my insurance card. Just as I grabbed the card, the door to the right opened, and a young woman with bright pink hair and kind green eyes came out. She called my name and beckoned me to follow her. Naruto waved heartily at the nurse.

She rolled her eyes, but smiled at him warmly. She turned her attention back to me. Her warm, friendly smiled turned a little friendlier as she eyed me up and down.

She led me into a back room, took my weight, height, blood pressure, and checked my pulse.

"Dr. Tsunade will be with you shortly," she said, flashing me a very flirtatious smile. I didn't return it.

In most of my doctor visits, my experience was that the nurse came in, took the normal stats, and then I would have to wait for the doctor for five to ten minutes. I was pleasantly surprised when the door had barely closed behind the nurse before it opened again. A blond woman with her hair pulled back in two-pig tails entered the room. The stern look in her eyes seemed to contradict the juvenile picture of her pigtails.

"Uchiha Sasuke?" the doctor confirmed, looking down at the chart in her hand and then back at me. I nodded once. She introduced herself as Tsunade.

She started off asking me normal questions about eating habits, diet, patterns that I might have noticed affected my blood sugars, etc.

Dr. Tsunade asked me when was the last time that I switched my basal rate. I explained that about two and a half years ago, right around my sixteenth birthday, I had suddenly started having a lot of highs in the middle of the night and that my former doctor had switched my basal rate. (She seemed none too pleased to hear that Doctor Orochimaru had treated. She said he was inept.)

I did explain that after changing my basal rate, my numbers had gone back to normal. Then I moved from my house to my apartment, and the new life-style seemed to have brought about all the lows.

Dr. Tsunade explained in detail that there were several possibilities that could affect why my blood sugars were dropping low in the middle of the night.

She looked at me hard in a very calculating way, clearly thinking.

I couldn't help but remember that Naruto said that she liked dumb blonde jokes. She was a doctor, so she must have passed medical school. Then again, the person who passes with the lowest scores last in medical school still passes, and therefore can still become a doctor.

Hopefully she just enjoyed blonde jokes because she found them idiotic.

"Have you recently switched from a larger bed to a smaller bed? Perhaps your bed at home was a double but the bed you sleep in now that you're college is smaller? Or perhaps vice versa...?" The question startled me.

"Yes, actually. I have a queen size bed at home, but in my apartment I have a single bed."

"I see," she paused, thinking hard. "You said you started having problems with your blood sugars around your sixteenth birthday?"

"Yes."

"I wonder…did, by any chance, you happen to get a new bed for your sixteenth birthday? Your queen bed?"

I looked at her, surprised.

"Yes," I said slowly.

"Do you, or did you ever, check for twists, knots, kinks, in your insulin pump tubing?"

"No," I murmured, and I realized suddenly what she was getting at.

I felt so stupid.

One of the first things that the initial insulin pump training explains is that you should frequently check the cord that runs from the insulin pump to the injection site to see if there are knots. If there are too many knots, insulin will not run through the cording, and it will result in high blood sugars.

Another thing that can result in high blood sugars is a change in sleeping habits. Diabetics wear their insulin pumps to bed, so it’s possible the cord can wrap around too tight, preventing insulin from coming through. A chance in sleeping behavior due to a different size bed is not uncommon.

"May I see your pump?" I reached into my pocket and pulled out my insulin pump, carefully unwinding the coils from the chord. She actually seemed more interested in the tubing/cording, obviously to see if there were currently any kinks or knots in the chord.

The chord. I felt so, so stupid. Why hadn't I been keeping a better eye on it?

I think I understood where she was going with this logic. My sleeping patterns had changed when I went from a single bed to a queen bed. I rolled around more. The cord wrapped around me at night. I hadn’t thought anything of how often I wake up with the cord wrapped around my torso. I had adjusted my basal rate so that it incorporated this new sleeping habit. Now that I was in a single bed again, my sleeping habits had changed again.

"Well, there are no twists or knots at the moment. And my guess is that there haven’t been any for a while. Did you find yourself moving around a lot more on your larger bed? Twisting and turning more?"

I all but groaned. "I’d constantly wake up with the tube wrapped around my body because of how often I would move around in the middle of the night."

"My guess is that about two years ago when your sleeping habits changed, you would frequently twist the cord around your body in the middle of the night, preventing the insulin from properly going into your body. For that time, your basal rate was set not to your body, but to your sleeping habits. It seems like the basal compensated for that. Now that you’re in a smaller bed, you don’t have as much room to move – so you don’t. Therefore, you need to switch your nightly basal rate lower. Did you have a low blood sugar this morning?" she asked.

I hated feeling like an idiot.

"Yes," I gritted out. "But I’ve also been having some highs as well; it’s not just lows."

"It's very likely that you're having a mix of highs and lows due to several factors. First, going from a double bed to a single bed can change sleeping habits. Usually cases like these show the opposite change, that your blood sugar would go high, but each person is different with how they sleep as well as how it affects their insulin levels. It's more likely that you move around more on a bigger bed, and that your chord was getting wrapped around you when you moved around a lot. When kinks appear in the tubing it stops the flow of insulin from the pump into your body. This results in highs. If there are no knots or kinks but you expect to have one, and give yourself insulin to try and counter-act the high, then it will result in lows. An attempt to find a pattern in highs and lows based off of this problem can be difficult because there really is no pattern. It's usually a good indicator to check the cording if it doesn't seem like food, exercise, or stress is causing unusual changes in your blood sugars. There's no rhyme or reason to it, and it can actually be hard to see as the problem. Nonetheless, I think that may be your problem in this case."

"In other twisting the tubing around my body was causing my blood sugars to go in and out of whack?" I asked slowly, trying not to sound as upset with myself as I felt.

"It would explain a good deal of your numbers flip-flopping as they are, and it would explain why there's no set pattern. Having trouble sleeping due to fears of having high or low blood sugars tends to cause higher blood sugars. As you probably know stress also causes high blood sugars. You're more stressed now. Not to mention that the lack of sleep causes highs as well. Studies have recently shown that people who are not diabetic can actually reach a state of border hyperglycemia just because they don't sleep. It could be counteracting the lows you were or are having."

I processed this information, but at the same time, I couldn't get over the simplicity to the possible problems to my unpredictable blood sugars was my sleeping behavior.

"I must impress upon you the need to get a normal amount of sleep, especially once we get your blood sugars stabilized. Staying up, pulling all-nighters will result in high blood sugars. In fact, it will cause high blood sugars to anyone – it's just worse for you because you are diabetic. Being in college, if you know anyone who pulls all-nighters, try and impress upon them the problems that it has on their bodies."

Yeah, right. College students wouldn't listen to that.

"Now, I know that we had planned on doing the training with the new CGMS to test your blood sugars continuously, but for now, we should hold off. I want you to see how your body reacts without the monitor attached to you as the continuous glucose monitor might actually be more of a hindrance than a help considering your problem. I want you to come back in two weeks. Keep a log of your blood sugars, as well as a log of what you eat. I suggest you also wake up once during the middle of the night to get a nightly glucose reading. Also check for any knots in the line, just in case. If that's successful, in two weeks, I will train both you and Naruto on the CGMS. If I didn't have any idea of what the problem was, I would have started you on it today. However, I find it much more reassuring if we can fix the problem before we start that. Fixing something manually rather than through trial and error with the CGMS is much better for your body."

Not really knowing what to say to that, I murmured a "thanks" before heading back out to the lobby and scheduled an appointment for two weeks.

Naruto looked up from where he sat when I entered the room.

"We doing the training now?"

I shook my head.

"Two more weeks. Dr. Tsunade wants me to try something first," I explained. I felt slightly bad that Naruto had wasted his time. He didn't seem upset though.

"I figured it would work out that way. She said we'd only do the training if she couldn't think of what might be causing your problem. The CGMS monitors blood sugars constantly, so it can prevent you from going high or low, but it doesn't diagnose what causes said high or low."

Naruto said goodbye to Shizune and turned to leave with me.

"You came here even though you thought you might not get the training?" I asked.

"Yep!" Naruto said, his hands in his pockets. I didn't know why but I felt strangely touched. Naruto had given up his morning to come with me to the doctor's appointment. It didn't make any sense. He'd helped me out, and I had wasted his time. He had even given me his juicy-juice.

He seemed to genuinely care. I tried not to make too big a deal out of it because he seemed like the kind to care about anyone, but the fact that I had been the one he cared about made me feel a bit off-balanced.

"What did Tsunade-baa-chan say was the problem?" Naruto asked. I smirked at the name he used for the doctor, but it turned into a scowl as I scoffed at my own stupidity.

"She believed I was twisting the cord as I slept. The knots prevented the insulin from moving through the tube and into my body effectively. Now that I’m sleeping differently, it’s not twisting any more which is causing the lows because the basal rate is too high."

"Wow! That sucks. It makes sense, but it still sucks. It's always the little things. I remember this one time that a patient called in. Her blood sugars were sky-high, and she had no idea why. She'd been on vacation at the beach, and all of a sudden it was like her insulin had no effect on her. Turns out the woman never puts her insulin in the fridge, so when she first got to the beach home, she didn't put it in the fridge. The problem was that she went to the beach home, but didn't stay there because it was too warm. She turned the air conditioner on, but then left until the house cooled down. The house was so hot that it ruined the insulin. The woman hadn't even thought of what would happen if she kept it in the too hot house. I guess room temperature is okay for insulin, but I guess having it that hot wasn't. But man, Tsunade-baa-chan seemed to pull that out of nowhere when she asked the woman about the temperature she had stored her insulin at! She's an awesome doctor," Naruto babbled in remembrance. He turned and smiled at me like it was no bid deal. I gave a half smile back.

Naruto clasped his hand around my shoulder and squeezed.

"For a while I wondered if you even knew how to smile."

"Idiot! Of course I know how to smile," I snapped back. Naruto just grinned.

"Just glad to see you actually show me that you can," Naruto said, giving my shoulder an extra squeeze before he put his hands back in his pocket, looking slightly upward as though he didn't have a care in the world. I had smiled once or twice in his presence before. He probably just didn’t remember. Idiot.

I had the strangest urge to smack him.

No, I didn't want to smack him because I envied how happy he was. No, I didn't want to smack him because he seemed to have the ability to care about anyone.

No, I wanted to smack him because a strange feeling was coming over me, and I knew it was his fault.

I liked the attention he gave me. I liked the way his hand felt on my shoulder.

And something about his smile made my gut twist in a strangely pleasant way.

I don’t know that I have ever really had any close friends before. I think he was my first, true friend.


Next Chapter: Pizza, Fruit-Punch, and Fencing


General information about diabetes:

A basal rate is the amount of insulin diabetics take through an insulin pump. The basal gives a small dosage of insulin every 7 to 15 minutes to counteract the constant flow of sugar produced by the liver.

There are many reasons why diabetics might go high or low. Sadly, it’s very hard to pinpoint the exact problem. When a diabetic does everything that the doctor tells him to do, he can still have major problems. It’s extremely frustrating.

The cord/tubing that connects the insulin pump to the incision site can get knotted or kinked. If that occurs, then insulin will not enter the body of the patient resulting in highs. That can be extremely problematic. People changing bed sizes might find a change in their sleeping habits (i.e., the amount of times they roll around, etc.) that can (though rarely) cause problems with their blood sugars. Usually people have more problems with highs going from a double bed to a single bed rather than lows, but each person’s sleeping habits are different. Sasuke’s case is rare, but still possible.

Notes about my life:

I’ve had issues before where there have been knots in my line and it results in a high blood sugar. I haven’t had problems where it twists around my body, but it is possible, and if you don’t think to fix it, problems result. Little, silly things can cause highs – or lows. It’s very frustrating sometimes because it can be very difficult to pinpoint the exact problem.


Let me know what you thought! ~ Jelp