How often do I have high/low blood sugars that need treatment? 🤔 A question from the audience!
Learn how I attempt to avoid the high and low blood glucose readings (that are, more or less, a part of life as a Type 1 Diabetic).
What about you? How often do you have highs or lows that require treatment? Let me know in a comment!
If you prefer to read the information in the video above, please find a written version right here:
High or Low Blood Sugars?
This week, I have another question from the audience. And it’s a personal one-ish. Well, I don’t want to get your hopes up, it’s not that bad. Actually a normal question, but it is more personal natured one. So I’m looking forward to answering it. Because this person writes:
How often do you have a real low or high blood sugar that you need to correct? Is it rare, or is it part of everyday life?
I thought this question was very, very interesting. And I guess I’m not that open, perhaps, with my blood sugar levels online, because I frankly don’t think it’s very interesting to share them. If you want me to, I could share more of my day to day values. (If you do, please leave me a comment so that I know because I cannot read your thoughts out there! 😃)
High and low blood sugars are of course part of living with Type 1 Diabetes and no one can deny that. The frequency of them, however, can greatly and amazingly be influenced by different lifestyle factors, for example. For me, for example, a low carb lifestyle has really helped to eliminate most highs and lows. I no longer get those extreme highs followed by extreme lows, because I simply follow the law of small numbers so I don’t have that much insulin in my body. And also not that much insulin required, that I get those quick drops. Furthermore, I don’t eat that much sugar and carbs so that I get the high highs. You can do a lot with lifestyle factors!
It’s also a question of definition. For me is low is below 3.2-3.5 mmol/l, which is about 65 mg/dl, and my highs are already around 6.5 mmol/l or 117 mg/dl. It’s really a question of definition. Do you mean those super-highs of 400 mg/dl and then down to 20 (22 mmol/l to 1.3)? Or, do you mean this sort of gradual, just on the verge kind of sugar surfing highs and lows? It differs from person to person.
The number 1 thing that I would advise people in this situation is to check your basal settings. Whether you have your long acting insulin or an insulin pump with a basal setting, make sure that those dosages are correct. That can save you a lot of trouble! This is something that I do on myself, as well, I make sure that my basal settings are correct (or as correct as they can be because life happens and things go up the wall sometimes) If you want me to do a video about how to basal test properly, then also let me know in a comment!
If your basal dose is correctly set, you also need less corrections to get the results you need. If you’re too low or borderline too low, for example, and your basal isn’t too high so your blood sugar won’t keep going down much further. With the right settings for you, you only need very little carbs to get you back up into a healthy safe range. Same with highs, if you are borderline high, you don’t need that much insulin to get yourself into a nice, safe healthy range again, because your basal insulin is correctly set.
I correct before there is a high or a low. Of course when I can, things like sleep, illness, travel, stress and things like this too much work (guilty as charged!) can of course make this a little bit trickier and hinder me from keeping that level of control. But whenever I can, I do react before it the low blood sugar or the high one is a fact.
Managing this before they’re a fact, I cannot say enough that a CGM, a continuous glucose monitoring system, really is worth its weight (well, really is worth its value) in gold, because they’re quite expensive. They’re small, but expensive things. Anyway, they are worth absolute gold so that you can react before there’s a high or there’s a low blood sugar.
CGM’s are of course not exact. I don’t know of any CGM system that is absolutely exact. Especially when my goal range is so small, it is very, very annoying that it is more most often 1-3 mmol/l (18-60 mg/dl) off. It’s not really exact, but it is invaluable to see the trends! Where is your blood sugar trending? If your blood sugar is steady and starts to trend downwards, then you can already treat so that you need a lot less and the the hypo doesn’t become a fact. Or, if you see that you’re trending upwards, you can play with either temporary basal if you are in a pump, or wait it out and see what happens ,or correct with insulin. For the trends, and the CGM is fantastic and I could not recommend any more!
Reacting in time actually also helps the Standard Deviation of your blood sugar, as well as your Time In Range, which is what reacting in time will help. This will also help your HbA1c. That little trifecta is a fantastic measurement of health for diabetes. And that also is helped by reacting in time so that you don’t go high and don’t go low, but you can react before it is a thing.
Doing it this way, reacting before a high becomes a high or low becomes a low, makes them very rare. It actually makes them more rare than then it would be, if I, for example, added a ton of sugar, or the recommended amount of carbs for example. This is true for me, and I’m not going to talk about anyone else. But for me if I added that, I would have many more highs and I would have many more lows, because I would have to fight the carbs as well as my body with the stress, work, illnesses, and all of the other 45 things that always influence our blood sugar.
This is my Dexcom G6 24 hour curve from 20th February, and I’ve marked where I used my method and reacted before a high was a high and a low was a low:
I want to hear from you:
Do you have highs and lows often and that you need to react to? Or are they rather rare for you? Let me know in a comment. I’d be happy to chat with you there.
Ps! Join me live next time, Thursday’s at 6pm CET on my Facebook or Instagram for another episode of Type 1 Thursday!
Let’s talk about treating hypos/low blood sugars in today’s Type 1 Thursday!
How do you treat your lows? What do you use?
Comments and questions are, as always, welcome!
If you prefer to read:
Hello and welcome to Type 1 Thursday with me Hanna Boëthius, one of the cofounders of The Low Carb Universe. And of course, also a type one since 34 years this year. Yay. Let’s celebrate. That’s a question actually for an other T1T about dia-versaries. Do you celebrate your dia-versary? Or do you not? I tend to not really because I don’t really see the point. But let’s keep that for another live.
Today, we are talking about hypoglycemia. And that is, for those who maybe aren’t as in with the diabetes lingo, low blood sugars, so when your blood sugar level drops too low, and you maybe won’t be able to carry on as usual.
Yes, this will also happen, of course, when you are low carb, this is no guard against lows and hypos, but I will tell you this, it will happen less, because of the of course now legendary law of small numbers. Because you’re not adding tons of insulin and tons of sugar, you don’t have the that huge error margin. So you’re playing with small amounts of sugar and small amounts of insulin, so that you don’t ever really dip that low. Anyway, so hypos do happen and they still happen on and off for me.
What has changed for me, of course, from when I was high carb to eating low carb, and therefore took a load of insulin is that the amount of carbs needed to treat a hypoglycemic episode is, of course, a lot less. And I will go through this in a little bit to show you the comparison.
Hypoglycemia has different symptoms, you can be shaky, you can have a bit of brain fog, you can’t really think clearly your vision can go blurry. And you can, there’s so many different things that for example, at times, I’ve had that my nose get goes tingling, or my lip. But now I rarely experience these episodes. And when I do they’re not as low like my blood sugar level is not as low as it maybe it has gone before.
What happens when you have a hypoglycemic episode is that you’ve taken too much insulin, there’s nothing in the world that can cause you to hypo and but actually taking too much insulin for the required thing that you took more insulin than you needed in that in that specific example.
So for example, maybe you took a little too much for the meal that you just had, or maybe because of exercise, you got extra insulin sensitive, there’s so many variables that can make you sort of overdose on insulin, but you know, apart from just shooting up too much. So yes, there are many, many reasons for why but there’s only one sort of correlation as to why you get a hypoglycaemic episode, and that is taking too much insulin for in comparison to your needs. And that’s it.
What I think is very, very interesting, when you do go low carb and high have lower blood sugars than desired is actually that ketones, and this has been proven in some fancy study or another, actually seem to have a cognitive protection for your brain. So even if your your blood sugar is low, and you don’t have enough, well enough, let’s call that sugar in your system, your brain will still function, because it is also fueled by ketones, so it always has fuel rather than relying on only sugar, which is of course, a little bit, well, maybe not ideal. It’s always nice to have double, and fuel sources for your pretty little brain to keep busy with.
What is the definition of a hypoglycemia?
This is something that we can debate forever, because it is very, very individual. So for me, for example, I think the official one is under 3.9 mmol/l, which is about 60 mg/dl, is the lower limit. Anything under that should be treated as a low blood sugar.
According to the conventional method, one should treat hypoglycemia with eating 15 grams of carbs, wait 15 minutes, measure again, and repeat if necessary. That is what it’s taught to all of us diabetics out there. I have figured out that I maybe need something a little bit different than that specific method. But then again, I don’t do things by the book anyway, do I so no surprises there.
Because my carb sensitivity has gone up so much. I’m so sensitive to carbs now because I don’t need them too often. So that’s something I’m happy about. Because in return, my insulin sensitivity has gone up like crazy.
What I usually do is I if I measure a low or if my CGM tells me that I have a low, I will take, listen to this, two grams of glucose. And maybe four grams, if it’s really, really low, and then I will be fine within about half an hour. And because I can keep cognitive for longer, how do I say this without getting into trouble, at relatively low measurements, I can still stay cognitive. And I don’t mind waiting instead of shoving everything in my face, like have done many, many times. When I was high carb, I sometimes needed 25 to 50 carbs to treat a low because I simply had that much insulin swerving around in my system and it being too much for me, of course. So that’s why I needed so many carbs to treat back then. And now I need to for maybe if it’s a really bad one, I will need six grams of glucose.
What is low for me? I don’t generally treat until sort of around the 3.0 mmol/l, about 60 mg/dl. And that also depends on if I’m at home or if I’m out and about. If I’m at home, I can take my time treating it, I don’t have to hurry up and get into a safe zone. But that’s different if I’m out and about, and then I take two grams of glucose, I will minimize the basal on my pump, so that it is at 10 or 20%. So that doesn’t keep giving me insulin during my low as well. That’s usually is enough to get me up to a safe sort of 4.0 mmol/l, so 80 mg/dl to 5.0 mmol/l. And this is where I feel the best as well.
I don’t want to overcorrect it either, because this is not comfortable. This is where the most damage happens to your to your system, with either continuously high blood sugars or jumping blood sugars. I try to avoid that those two things as much as possible, which is why I don’t, or I try not to, over treat my hypos when they do happen, which is not very often anymore. I do not read my kitchen over there to find whatever I want to eat, because this is the opportunity to just eat all these things that I normally can’t, because then I would be over treating it. Anyone who has had a hypoglycemic episode or a low blood sugar knows that it’s a terrible feeling. It’s an absolutely terrible feeling. And your natural instinctive is to just stuff your face with as much food as possible, to be safe, and to be to get your blood sugar into a safe range.
I have relearned this. I actually had a period of my time of my life where I was really really afraid of hypos. So I knowingly kept my blood sugar at a higher rate, which I don’t recommend either, because that didn’t work out, as everything else that I tried back then. What I do now is I keep my calm because I know I have this alternative fuel source that will keep fuelling my brain, which are of course ketones. But if it does happen, and this is not a sponsored post, I pay with my own little cents and dollars for these, I take one or two of these, which I can find in any pharmacy. One of these is 2.2 grams of pure glucose. I take one of these, and then I put my pump on a minimum basal rate. And then I retreat after 25 to 30 minutes, if the level hasn’t changed. I want to show you my favorite flavor as well, which is blueberry yogurt. If you’ve had to use them, you know that the taste of glucose tabs isn’t fantastic, ever. They do taste like chalk. They don’t have very imaginative flavors, but this one is actually the best one out there.
Glucose tablets are just another medicine that I need to actually save my own life at times. So I don’t see it as an opportunity to stuff my face or or treat myself to anything. It’s just another part of medicine that I need to in order to be well. That is how I treat my normal hypos.
I have to touch wood here, I haven’t had hypoglycemia where I need help from other people. in very many years, since I actually started low carbing, those have completely disappeared. Before, it used to be a lot more, as I was playing with a lot of active insulin in my system. And that is sometimes a recipe for disaster. I also have, as I spoke about in the previous episodes, a glucagon kit in the kitchen so that it’s easily easily reachable for my husband, for example, and who is mostly the one who’s here with me, or for myself, if I would really need it. And this could be a case of life and death. This is where the glucagon does so, it activates the liver to push out its extra sugars, and glycogen storage. And that’s how the blood sugar raises itself. Well, not by itself, but how it’s prompted to raise with a glucagon kit. And those are always good to have around, because you never know how you’re going to react to something. In case something isn’t going to plan, then it’s good to have one of those. And you can actually, which is in emergency cases, you can also micro dose these. So for example, if you have a stomach bug or something and can keep anything down, not even liquids, although going to a hospital is a very good idea if you can’t keep down liquids. GLucagon could be a treatment option then, as well. I also read that they’re working on a nasal glucagon, like a nasal spray to activate the glycogen storage in that way, which I think would be fantastic. Because that mechanism of filling a glucagon kit can be quite intimidating. Luckily, I have drilled this into my husband’s brain, so he would be able to do it in the case of an emergency. But normally, I can do with one or two or maybe three glucotabs if it’s really bad, and I am happy.
As I said, this is not a fun topic because hypoglycemia are very, very, very uncomfortable. And even more so when you are maybe with people who don’t quite understand what is going on. But as long as you know that you can treat your own hypos, then you are pretty much all right to go and enjoy everything.
Anyway, I love that you were here with me today that you’re watching that you are sharing successes, writing all of these things. Thank you so much for the hearts and the likes and loves.
I’ll be back next week with another episode of type one Thursday. I’ll see you then. Bye!
And the other way around, too. But that’s the topic of another story.
Being such a big part of our lives, it would be weird if it didn’t mix in and mash up your plans sometimes.
Sometimes we’re talking about interrupted sleep, another time it’s an unplanned meal on the menu. And sometimes it’s about being so tired, simple chores can be compared to climbing Mount Everest. At least. Not to mention the guesstimation game we play with the pancreas on our hip, in a pen or syringe. Up? Down? A little up and then down? The other way around? Or even *gasp* stable and level? (Watching your blood sugar do a salsa dance on a cgm is sometimes entertaining, as long as you don’t put too much personal attachment to the numbers)
You can almost never tell with 100% accuracy where your blood sugar will end up after a meal, some insulin or just by plain old living.
And sometimes you can’t let the stubbornness of diabetes get in the way, either.
Like the other morning, when I had to get to an appointment I had.
I woke up at 4.4 mmol/l (79 mg/dl), which I was happy about. My cgm curve looked smooth from the night and I was even more happy about that.
I jumped in the shower, washed my hair, moisturized and brushed my teeth. I was feeling a little sleep-groggy, but nothing else.
I went to put on my clothes, got dressed and noticed an odd, fuzzy thought popping up in my head that usually stems from the low-blood-sugar-drawer in my brain.
Nevermind that right now, I had other things to do, like taking my morning medicine (thankfully not insulin) and supplements.
When I got back downstairs from the kitchen, my next task was to do my make up. But I decided to check my cgm first, which showed 4.1 mmol/l (73 mg/dl).
Ok, I thought, that’s not bad, although I’m dropping. More of the odd, fuzzy thoughts popped up, and I decided to check my blood sugar on my blood sugar meter, if only to ensure myself that I wasn’t low.
3.4 mmol/l (60 mg/dl) “treat your low BG!”, my d-companion Doris (OmniPod) was telling me.
“Ahh, eff-word”, I said out loud. “I don’t have time for this!”
I usually don’t treat lows until below 3.5 mmol/l, as I find they usually recover fine from there with just the help of lowering the basal on my pump. But as I was leaving, and it was 0.1 mmol/l lower than my usual threshold, I decided to pop a glucose tablet and shut of the basal on my pump for 30 mins.
Knowing I’d be completely OK within 15 minutes, but had to leave the house in 20, I had little choice but to continue with my morning routine and my make up, which is a fairly effortless task.
If you’ve never experienced a low blood sugar before, let me tell you that it can be quite “interesting”. It feels a bit like being tipsy, without having had anything fun to drink. Or like being in a very fast, accelerating car while standing on the ground. It can be dizzy, vertigo, confused and temporary vision problems all in a big merry go round that doesn’t want to stop right now. (It can also feel a gazillion times worse than that, but thankfully that wasn’t the case this time.)
Having to think twice if you’re *actually* using foundation and not the bright pink blusher heavily all over your face is a challenge I’m usually blessed from. I usually know where things go in terms of make up…
Or double-checking that the eyebrow pencil is still brown and you didn’t accidentally reach for the turquoise eyeliner to fill in your eyebrows instead. Or concentrating so hard on getting mascara ON my eyelashes and not only underneath my eye. Not to mention actually getting that blusher semi-equally distributed. Or checking that the foundation isn’t blotchy anywhere.
This can, but probably shouldn’t, be compared to doing your makeup after a good after work drinking session with your colleagues. In short, no bueno.
Throughout this particular mornings routine work, I kept thinking if I actually managed that well with everything, or if, once I was back on track again, would find myself looking like some Cubist rendition of myself. Or like a clown. Or like Gene Simmons from Kiss.
All I could imagine seeing once the low blood sugar fog had lifted was some weird version of myself, as it would have been painted by Pablo Picasso himself. Or something equally scary.
This time I was lucky, though.
When my blood sugar was back in normal range again, I saw that I looked more or less like myself, if only ever so slightly more tired.
What do you do when your blood sugar drops low, do you keep going or stop and wait? What does your decision depend on?
https://hannaboethius.com/wp-content/uploads/2015/04/blog_low_makeup-1.png1200800Hanna Boëthius/wp-content/uploads/2016/04/HannaDiabetesExpertLogo@2x.pngHanna Boëthius2015-04-22 15:02:092015-04-22 15:02:09The Low Blood Sugar Make up
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