Tag Archives: hypoglycemia

Low Blood Sugar Dreams

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I don’t know about you but when I have a low blood sugar at night, I end up having dreams I remember when I awake.  If my low comes on really slowly, and most of mine do, the threat isn’t as immediate and I sometimes find myself in a lucid dream while somehow acknowledging I’m low but refusing to stop the fun.

The other night I dreamt Kelly Kunik, a diabetes blogger, ran and won a marathon.  Last night I dreamt that I was suddenly Angelina Jolie’s secret agent, hired (hmm…I don’t remember getting paid) to hack into a computer (though hmmm she provided a password) and retrieve some secret information before Brad Pitt found it.  Where was Brad Pitt in my dream, you ask?  He was lurking in the shadows trying to get the info before I did!  He was not very skilled at trying to get to the computer because I wasn’t very good and I beat him to it (he was much like his dopey character in “Burn After Reading”).  Then I got the info, whatever it was, back to Angelina “Boss” Jolie and she thanked me with a silent nod (though I never got paid…) and then I ninja rolled on the carpet and leapt out of a window in my black secret agent suit, never to be seen again.

At that point I let myself wake up because my mission was over and my blood sugar was low.  So I muttered to my husband, who had been in my dream dancing at Angelina and Brad’s party, “Aleeeex…”  He jumped up in the most freaky alert way “Low?!”  I nodded.  He brought me juice.  Then I laughed because the last thing I remember from my dream is someone saying “Wow, your Alex can really dance!”  And from what I remember he was doing something undeniably goofy.

Wacky dreams happen to me when I have lows and I find it helps with the sting of resentment towards lows, that’s for sure :)

Does this ever happen to you?  Any crazy dreams you can tell us about that will make me not so embarrassed about what I just shared?

What I Just Learned About Glucose

Definitely replacing this!   photo courtesy of Bill Longshaw

Definitely replacing this! Photo courtesy of Bill Longshaw

 

I’ve learned a number of useful tidbits from reading Good Calories, Bad Calories by Gary Taubes.  Here are a couple excerpts from his book which I found rather eye opening: (pages 199-200)

“The key is the influence of glucose or fructose not on blood sugar but on the liver.  Glucose goes directly into the bloodstream and is taken up by the tissues and organs to use as energy; only 30-40 percent passes through the liver.  Fructose passes directly to the liver, where it is metabolized almost exclusively.  As a result, fructose “constitutes a metabolic load targeted at the liver,” the Israeli diabetologist Eleazar Shafir says, and the liver responds by converting it into triglycerides-fat-and then shipping it out on lipoproteins for storage.  The more fructose in the diet, the higher the subsequent triglyceride levels in the blood.”*

“*For this reason, fructose is referred to as the most lipogenic carbohydrate.” 

Seriously?  Isn’t “lipo” Latin for “fat”?

Apparently, our bodies will also adapt to exposure to high-fructose diets and “the more fructose in the diet and the longer the period of consumption, the greater the secretion of triglycerides by the liver.”

“Moreover, fructose apparently blocks both the metabolism of glucose in the liver and the synthesis of glucose into glycogen, the form in which the liver stores glucose locally for later use.  As a result, the pancreas secretes more insulin to overcome this glucose traffic jam at the liver, and this in turn induces the muscles to compensate by becoming more insulin resistant.”

*****

And just as a reminder, high triglycerides are a risk factor for cardiovascular disease.  Also, table sugar and high-fructose corn syrup are both half glucose and half fructose. 

So if I am understanding this correctly, my intake of candy and juice and occasionally a dessert to treat low blood sugars is effectively increasing my likelihood for high triglycerides, cardiovascular disease, and insulin resistance? 

I bought glucose tablets today.  (Again, I could be misinterpreting the info as I’m not really into science-if anyone is and disagrees with my conclusion, do help a girl out!)

For more convincing and more info on why glucose tabs are the best low blood sugar treatment, read what certified diabetes educator, Will Dubois has to say.  His is not as serious as this post for he has a great knack for humor. 

Enjoy:  Know Your Glucose

Also, see here for a list of foods highest in fructose

Stay tuned for a post coming up discussing how I lowered my basal insulin requirements by 25% in just a week.  Part of the magic happened when I switched to glucose tablets for lows but that wasn’t all!  Also I’ll be reviewing Gary Sheiner’s Type 1 University online class on weight loss :)

CGM Study and Why a CGM?

Courtesy of Salvatore Vuono

Photo courtesy of Salvatore Vuono

 

The CGM study that endocrinology offices do all over the country is a blind-to-the-patient, study.  I started yesterday.  I signed a form agreeing that if I broke or damaged the sensor I’d immediately pay $900 to replace it (striking me as a bit harsh considering accidents can happen).  Then the woman in charge of fixing me up, a dietitian, inserted the sensor and told me that I would not know what my graph looks like but they will.  She said they might call me if something needs to be changed.  She handed me papers to fill out.  I need to write down when I test and what my sugar is, when I eat and how many carbs I eat, how much insulin I take and detailed exercise info.  I hate writing down all this stuff-perhaps because I’ve been told to, but it won’t be too bad considering it’s only a three day study. 

I will return the sensor along with the paperwork on Thursday and in several weeks I meet with the doctor to go over the results.  I don’t know if my insurance will cover this yet.  I know they pre-approved the study so hopefully they will approve and cover my permanently using it.  Someone at the Diabetes Sisters Conference told me I needed to have two lows under 50 per day while on the study for insurances to justify covering the CGM.  I would rather go without it than have to lie to get it.  For reasons of justice and pride I will not lie.  However, I’ve already had two low readings in the 50’s and 60’s which I don’t consider problematic since I feel my lows at 60 and I am comfortably at home all day and can easily enough treat when needed.  If I was out I’d make sure I ran my numbers closer to 120 than 80.

I feel strange that someone might know what my blood sugars are right now and I don’t.  It’s an uncomfortable feeling and I look forward to experiencing the CGM along with the receiver (is that what it’s called?).  Of course, this is If some unknowing party decides I should have it.  (rolls eyes)

I cried earlier today reading a post at The Princess and the Pump written by a parent of a child with type 1 diabetes.  This young girl has a CGM and her parents heard the alarm in the middle of the night, testing their daughter and finding her dangerously low.  The little girl eventually had two low blood sugar induced seizures and ended up in the hospital.  The parents are wondering if a faulty pump cartridge is to blame.  The point is, the CGM saved this girl’s life.  And just because I haven’t experienced ever needing help from a low blood sugar doesn’t mean I won’t one day.  This story alone is enough motivation for me to want one if I can get access to it.  If it isn’t covered by insurance I cannot afford it.  So fingers crossed. 

For those non-diabetics reading out there I ask you this; If you had type 1 diabetes and a simple device could alert you to dangerously high or low blood sugars (both of which could quickly lead to death) would you want it?  If this was your child, would you want to know that a device was looking after their blood sugars while you and your child tried to do something normal like sleeping safely at night?  Do you think it sounds reasonable that diabetics out there ask for their insurance to help cover the costs of a potentially life-saving device?  I do.  I mean, death is permanent.  Technology like this can make all the difference. 

Here is the best explanation I’ve ever heard of why insulin isn’t a cure that I hope everyone will take a minute to read:  Not Even Close

Driving and Hypoglycemia

 

Have you ever driven while suspicious of having low blood sugar?  Have you ever thought you should stop and test but said to yourself, “I’ll test when I get to the next light” or “I’m almost there”?  Or do you always park the car, test, fix your low, and then be on your way?

How do we feel on this matter?  It’s an ethical one for sure.  What might make it awfully common is the fact that for a diabetic, lows are not once in a lifetime matters.  They happen plenty enough so that we don’t panic over many of them.  We might even classify them for our personalized experiences:

Class 1 Low

Just starting to feel low, around 60-65 when tested, energy level is still decent

Cass 2 Low

Feeling a bit shaky but not too bad.  About 55-60 when tested

Class 3 Low

Active insulin on board causing this to be a violent and sudden low.  These feel the worst for me.

Class 4 Low

Blood sugar in the 40’s also known as Eat. Sugar. Now.”

Class 5 Low

Sugar in the 20’s and 30’s. Red alert light beeping loudly in brain, heart feeling heavy and beating fast, and mixed in is a feeling of <yawwnn> “I’m so sleepy…”

(Please note the above is MY classification, it may not be how lows feel for YOU)

Since I am most often dealing with Class 1 and 2 lows, I will often test at a light or a gas station or parking lot, intake sugar (as long as I don’t have active insulin) and as long as I feel ok then continue on my way.

I’m thinking I should instead stop the car somewhere safe and only attempt moving it again once a blood test confirms an adequate blood sugar level for driving.  Inconvenient, yes, but what would you say this is:

A type 1 diabetic woman once told me about how one time she felt funny while driving and decided to ignore it because the kids were screaming in the back seat and she was in a hurry.  Next thing she knew she was being helped by paramedics after having crashed her car.  They tested her sugar to be 43.  She and her kids were fine but she said she learned her lesson.  As we all should before something happens…

What do you do when you’re driving and feel low? 

And do you classify your types of lows?

Do Nighttime Lows Give You Headaches?

 

It only happens a few times a year but there are times when I wake up in the morning, test, and discover I’m low.  I don’t even feel low when this happens and since it’s first thing in the morning, I assume I’ve been creeping down slowly throughout the night instead of shooting down fast.  Then, and it never fails, I start having a headache, much like a migraine over my eyes.  This only progresses throughout the day, getting stronger and stronger and doesn’t go away until the next morning, providing I don’t have any more lows.  If I have another low within 24 hours my headache really flares up and I feel like I have to lie down because it’s seriously overwhelming.

When we’re low, we lack glucose.  Our brain needs glucose to function and so I imagine this is what causes the headache?  I don’t know.  Anyway, does this happen to any of you?  I never get this headache after a low during the day, it’s always if I’ve had a low during sleep where it was prolonged.  I sure hope this doesn’t kill off too many of our brain cells when it happens!

If I’m not the only one this happens to, then it could be useful information to spread.  If someone is having headaches for no apparent reason, I’d suggest setting an alarm or two and testing overnight.  I did this to find out if my headaches were being caused by nighttime lows (that would often rise by morning thanks to the liver) and I found out I was having lows at night.  No wonder I was feeling so tired every morning!  I adjusted my insulin and voila, no more headaches.  (Make sure to talk to your doctor before adjusting insulin).

So, am I the only one this happens to?

The Best Low Blood Sugar Treatment

 

There are good reasons for using all sorts of different options for getting blood sugar up. 

Dr. Bernstein suggests glucose tablets for their fast acting sugar supply and for the fact that it’s measured, so you know exactly how many grams you’re getting. 

Many parents of children like to use candy because it works quickly, is welcomed by the child, and I think we’d all agree, a child suffering a low blood sugar deserves a cheer me up.   Sidenote: I was once low to the point of having a hard time chewing my Smarties candies and proceeded to choke on them.  Sometimes a really bad low might call for something easier to intake-like kids gel-like candy!

Most adults I know tend to lean towards juice because it’s easy to find, carry, and consume quickly. 

Still, others use anything they might enjoy:  some ice cream, a waffle with some maple syrup, some fruit, etc.  I’ve had all of the above hundreds thousands of times.

I like to change up what I use for lows but, I must say I do prefer juice because it’s so fast and easy (no chewing/munching).  (Although this may not work too well for very young children)  There is another reason I like juice.  Typically, after drinking juice for a low, I follow that with some water to swish around in my mouth.  When I use candy or other solid sugary substance, I feel like it’s stuck in my molars (in fact, it is).  The only time I’ve ever had a cavity in my life was the year I used candy or glucose tablets for every low blood sugar.  Coincidence?  I don’t know, maybe.  But, juice is also convenient for adults at work (you look like you’re just thirsty as opposed to having a sugar craving in the middle of what is supposed to be time for working).  I can recall lows in meetings full of older men and feeling a little funny when I took out some candy for a low.  Some of them would make jokes like, “Looking for a sugar high?” or “you just ate enough calories for lunch with that bag of candy there” or even the despicable “Ha ha, what are you, five?”.  When I had juice, I noticed no one ever said anything.   So although I’m ok with awkward situations like these and didn’t mind telling these rude fellows they were just jealous that they didn’t have the guts to eat candy in public, I know some people prefer to avoid the awkwardness.  Besides, I have a hard time stopping eating candy.  I will eat a few pieces resulting in 15 grams of carbs and next thing I know I’m giving insulin for the extra candy I enjoyed all too well. 

Either way, I’d say the best low blood sugar treatment was just whatever one is more comfortable with.  Some of us have had too many glucose tabs to ever have another.  BD Orange glucose tabs make me nauseated just thinking about them.  But, when I was a kid, mmmm they were delicious!  Whatever works best for the individual should be used-always taking in consideration just how low one is. 

I’m glad we have so many options these days aren’t you?

Oops, I Did it Again

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(Click on diagram to see full view)

I wrote a widely read post last year about the time, about 3 years ago, that I accidentally gave 20 units of humalog instead of lantus. 

Well, I made that fatal mistake, again.  This time, I had the previous experience under my belt.  I also had a lot of juice in the fridge.  I was also lucky that my parents and youngest brother were visiting.  So they and my husband took care of our twin toddlers and I immediately began chugging juice. 

First I quickly downed 32 ounces of orange juice.  That amounted to about 100 carbs.  My blood sugar was 146.  Thank goodness it wasn’t lower.  Then I had 8 ounces of grape juice which was 40 carbs.  Within the next hour I was continually downing 8 oz. glasses of grape juice.  My blood sugar peaked at 196 but, quickly dropped from there.  I was extremely nauseated and after an hour began having diarrhea from all the sugar.  I was trying to just make it about two hours into the “clear”.  Just 20 minutes shy of two hours I began throwing up grape juice.  All the juice was a bit much.  My blood sugar hit it’s lowest during the two hour ordeal at 93.  I still had insulin working and I couldn’t drink anymore darn juice. 

My dad made the above diagram.  I emailed him the data and he put it together in an interesting and easy way to read.  As you can see I drank the perfect amount of juice to stay above 90 at all times and avoid going dangerously low.  I also needed the head start that it indicates that I got.  I drank a large portion of the juice within the first 30 minutes of giving the insulin shot.  This is because when fast acting insulin peaks and there is a lot of it, you better be prepared.  My goal was to keep drinking juice and bring my blood sugar as high as possible so that when the insulin peaked, I’d have some cushion.  It worked but it was definitely not fun.

When I tested 93 I decided to be extra safe and call 911 and asked them to send me an ambulance.  I explained that I accidentally gave 20 units of fast acting insulin instead of 20 units of lantus and the 911 operator said very abruptly, “Oh, I see your problem.”  “We’ll be there right away, just hang in there.”  Last time I did this I didn’t believe I could drink enough juice so I automatically got myself to the ER where they administered a lot of intravenous glucose as I continued to plummet below 70.  When the paramedics arrived they had me test and we found I was 98.  Finally moving up!  I looked calm but I had been so nervous and they found my blood pressure was 160/100, my pulse “faint, barely there” but, It looked like I did it.  The final count of about 72 ounces of juice worked (67 ounces is 2 liters).  They stayed a few minutes asking me questions.  I got the strong sense that they don’t normally visit fully alert diabetics every day.  They didn’t know what A1c meant.  They wanted me to eat some solid food to settle my stomach.  I tried to explain I had hit my limit with drinking juice and just wanted to be safe rather than sorry and didn’t mean to bother them. 

The four responders looked at me as if a little confused, a little amused, and a little impressed.  One said, “you seem to really have things under control”, which I appreciated hearing after making such a simple and dangerous mistake.  I explained why it happened:  I normally use a 100 unit syringe for my lantus and a 30 unit syringe for my humalog.  Well, I ran out of my 30 unit syringes so I was temporarily using my 100 unit syringes for both my lantus and my humalog.  The problem is that I am so used to automatically drawing up 20 units of lantus once a day in that 100 unit syringe.  So when I was giving insulin for dinner that night, I automatically drew 20 units of humalog and injected it.  Then I suddenly had a flashback of what I had just done and I thought…”oh great, here I go again”.    I’m wondering if I should have some easy to eat candy available in the case this ever happens again.  It shouldn’t happen again, now that I am well aware of how important it is that I be strict to keep stock of both types of syringes.  You know those Queen Anne cordials?  A few days ago I had one and thought to myself, I could have tons of these-they’re that good!  Well, they’ve got TONS of sugar.  Maybe I should stock up on a few boxes of those?  Maybe that would work better considering 2 liters of fluid is most uncomfortable and not as efficient on blood sugars once you start throwing it back up.

Don’t worry, I’ve at least stocked up on the 30 unit syringes for use only with humalog.  I feel safer already.  I had let my sugar run to 180 after this incident because I was so scared to give insulin and let’s face it, old habits die hard.

Last year’s Christmastime drama included me accidentally dislocating my then 6 month old’s shoulder and spending Christmas night in the ER holding her still for X-rays.  This year’s drama will give me an interesting story to tell others about how my husband and I and my parents all scrambled together to do the math needed to keep me alive and decide what plan of action to carry out.  We contemplated taking me to the ER but, if you read the story about the first time I did this, you’ll see I really didn’t want to go there.

This really is a reminder to me and my loved ones showing just how fragile life with diabetes is.  You can be human and make a tiny mistake and it can cost you everything.

In any case, possibly learn from my mistake, or laugh at it, but definitely don’t do the same :)

PS:  I make the point to tell this awful story because it may serve as useful info.  For example, if I were younger or had given any more than 20 units I really would have needed to quickly just get myself to the hospital (while eating/drinking sugar).  Also, had I not been willing to miserably overload myself with juice I would have had to quickly decide to go to the hospital in that case, as well.  Someone weighing less would also have a greater problem with this much insulin overdose, too.  Anyway the key is not hesitating.  I’d hate for people to think this can easily be handled at home.  (I barely got away with this).  Do note however, I didn’t think I could drink one liter of juice.  I’m a small person and yet, strictly deciding I had to allowed me to drink over 2 liters.  Just thought it was interesting :)

How Many Scares Does it Take? And Why Aren’t I More Worried?

 

Since I’ve never had to use a Glucagon, I’ve never been good about remembering to get a new one once the old one expires.  Thank God they always expire instead of get used but still…

Last night, I caught a stomach virus that’s been going around.  I started feeling really awful around 8:30pm and just laid down on the bed.  I don’t know if I ever fell asleep but I do know that at some point I felt low but, couldn’t move or hardly talk.  Luckily, my husband was in the room and noticed I was trying to say something.  I was able to mutter the word, “low” and he took off for some juice.  He sat me up in bed and put the bottle of orange juice up to my mouth.  I downed two bottles.  A little later he tested my sugar which was 47.   Then an hour later my sugar was 52 and I started feeling nauseated and thought I might throw up.  Well, I did-plenty of times.  30 minutes later I was 44.  I downed lots of sugar even though I thought it was just going to come right back up.  I was beginning to have a major headache from the lack of glucose in my brain.  30 minutes later I was 42! 

I started getting scared.  I had downed all the juice in the house and had begun drinking several cups of sugar water (not appealing to a nauseated stomach).

I called my parents and my dad showed up around midnight with jello, crackers, juice, and most importantly, a glucagon.

Why didn’t I ever have one ready? 

Luckily I never threw up again and my blood sugar stabilized at 80, but I did get welcomed with blood sugars over 250 and 300 in the early AM hours.  Yay, isn’t it wonderful to bounce from one extreme to the other?

This made me realize (and so did my insistent mother) that I don’t have an emergency kit.  I’ve written about it and I myself don’t have one?  So anyway, here is what I will assemble as soon as I’m able:

Juice

Glucose tabs

Glucagon

Glucose gel

Crackers

Ketone strips

And as my mom thoughtfully pointed out, this kit should never be used except for emergencies.  That way, when there is an emergency you don’t say, “Uh oh, I’ve already drank my kit’s juice supply”.

Anyway, Is there anything I’m missing?  Let me know, I want to be prepared next time!

You know, this being Diabetes Awareness Month… I know a lot of non-diabetic people who have had a least one near death experience.  They tell the story at dinner tables, parties, and reunions.  They write about it in their journals and memoirs.  It’s a big deal.

We diabetics probably can’t keep up with our near death experiences.  There may be too many!  I mean, I can tell you at least 10 different times I came close to the worst case scenario but, it’s not even a big deal to me anymore.  Ok, it is, but, I’m kind of jaded.  Like, when I get scared after an incident like this and I think, Man! I could have died…I turn around and realize I’m not the least bit frightened or anxious about it the very next day. 

It’s like my way of life, my “normal”.  You know how some people who grow up in violent places are numb to violence?  Sometimes I feel numb to fear about my diabetes.  Maybe that’s just me.  Maybe I’ve just accepted everything I know which could go wrong.  Maybe I’ve got bucket loads of faith that I’ll be alright.  Maybe I’ve simply gone too long without a super frightening experience.  It’s true that I haven’t ever gone unconscious or had a glucagon shot or been in the hospital with ketoacidosis.

Here’s something I found just plain sad last night.  My husband looked at me when I was 42 and not able to drink more juice and said, “Do you want to make a trip to the hospital?”

Without thinking twice I looked up at him like a child that could never tell a lie and said, “No, they’ll kill me!”

So we’ve got some fear and trust issues eh?

All in a day’s life with diabetes. 

Just another one of the million reasons we need a cure.  No one should accept the faintest possibility of death with so much calm.

Do you know about DIB Syndrome?

 

DIB stands for Dead in Bed.  It is a real syndrome that happens to a small number of diabetics.  We are not sure yet about it’s causes although it seems to be related to hypoglycemia.  This week, a 13 year old girl suffered from this and a family out there lost their precious type 1 diabetic daughter.

More info about DIB Syndrome can be found here.

And for a touching post which takes the words out of my mouth, I’ll let Kerri take it away.

I only write about this for awareness purposes because this is yet another strong reason a cure for diabetes must be found.  Just typing it all out is frightening and sad and reminds me of why I get up in the middle of the night, every night, just to test and make sure I’m doing alright. 

My thoughts and prayers are with the family of the little girl.

Treating lows may add pounds by the end of the year

 

One of the most stressful things I deal with is carrying just a few extra pounds around.  I’m not overweight but, I know where I’d like to be and I struggle to get there.  When I do the math, I realize treating low blood sugar or preventing it during exercise with juice or glucose tablets adds up to plenty of unwanted pounds by the end of the year. 

It is no wonder to lose weight I feel like I have to run double the miles or for twice as long as the next girl.  Or I have to eat less than her.  I work hard just to NOT gain weight.  Obviously it is better to exercise than to not but, sometimes I feel like exercise complicates things.  I have to try and do it at the same time every day or I get more blood sugar fluctuations.  I also have to have snacks or juice nearby to combat the drop in glucose during the workout.  That is another thing.  I hate stopping in the middle of yoga to go get sugar.  And yet another thing!  I’m trying to be all healthy and there I am, being forced to take in sugar.

In the end, I know exercise is well worth the hassle.  And I have been able to lose weight.  It just takes twice the effort and time.  If I have to walk around with 15-20 extra pounds…I’ll survive.  What I won’t survive easily is not taking care of my diabetes and taking care of it includes exercising. 

If you are having too many low blood sugar episodes talk to your doctor.  You need to fine tune the control so that you don’t have too many episodes (which are risky) and so you aren’t guzzling juice or popping glucose tablets all day long.

Tip:  Doing the same workout at the same time every day helps you know how your body is going to react so you can anticipate your blood sugars.

Tip:  Find out what number your glucose needs to be so that you will not need to stop your workout for sugar.  Example:  maybe you need to begin at 140 instead of 115.  I do this before yoga and it typically means I end up at 80!  (Obviously this varies depending on circumstances but, it usually works well!)

Tip:  When beginning a workout routine, for the first couple work outs, check before, during, and after in order to find out how a workout affects your sugars.  This is important because different workouts affect your sugars in different ways.  For example if my blood sugar is 120 before running it is usually 100 after running.  If my sugar is 120 before yoga, it is usually around 60 afterwards-big difference.

Forgive yourself for those few extra pounds.  You work so hard-give yourself a break.  And yeah yeah… I’ll try to do the same :)