Diabetes certainly likes to throw us curve balls sometimes, doesn't it? Just when we think we've nailed a way to handle some particular situation, or recognize what's going on, the rules seem to change and we have to start second-guessing ourselves all over again.
Earlier this week, we saw one of our friends in the Diabetes Online Community (DOC) grappling with this issue regarding low blood sugars -- fellow type 1 Tricia Moore, a nurse in Wisconsin, who blogs at Pancreatically Challenged Nurse and created the Part-Time Caregivers' Guide to T1D. Tricia's seen big changes in how she recoups from her hypos, so she's reaching out to see if anyone in the DOC has thoughts or similar experiences to share.
A Guest Post by Tricia Moore
Lately, my low blood sugar episodes are not following the same rules they have for the past 20 years of living with diabetes. Historically, my hypo-routine would go something like this: discover a low, treat said low, come back into range.
Now, not so much!
I was diagnosed with type 1 diabetes back in September of 1994. This was back when an “exchange” for carbohydrates was 12g, not the 15g we know of now. After the 15g carbohydrates was adopted as the standard, there also came something called the “Rule of 15” for treating low blood sugars. Here’s how that would go:
- Discover a low blood sugar, treat with 15g quick-acting carbohydrates
- Re-test in 15 minutes
- If still below target, consume another 15g quick-acting carbs and continue with the "every 15 minutes check and treat" until in range
- If in range, have something with protein, fat, complex carbs to maintain that blood sugar
During the past two decades that I've had diabetes, so much has changed -- insulin pumps, CGMs, new insulins, phasing out the evil NPH and Regular insulins, new names for diabetes... and of course, realizations that the “Rule of 15” does NOT work for everyone or in every situation.
For me, it used to work well, but recently my diabetes has not been cooperating.
I have been having some very frustrating low blood sugars that seem to linger. I will feel a low, or notice one on my CGM (love my Dexcom G4!!) and then treat. My treatment of choice has generally been the small Juicy Juice boxes that are a perfect 15g carbohydrates. I’ll go ahead and have a juice box and wait for the effects to kick in… only, lately it my blood sugar hasn't been kicking back into range.
I will try to be patient waiting for the low to come up and the juice to kick in, but there are many times lately where I will still be low 15 or 20 minutes later, so I will have another juice box, and often will also set temp basal of 0% on my pump for maybe 30 minutes or so. FINALLY when I start coming up more like 45-60 minutes after the first juice box, I just keep going up, up, up and then have a horrible spike. It's just taking me so longer to recover that I tend to over-recover.
Okay, so my big questions are: Why is this happening? What are some of the causes of persistent, obnoxious lows?
Exercise, Insulin On Board (IOB), absorption issues, basal rates or insulin-to-carb (I:C) ratios being off, or other factors like stress, or that I’m wearing striped socks, or the phase of the moon is causing this?! Who knows!
I generally have no insulin on board when this happens, which would eliminate issues with correction factor or insulin-to-carb ratio, and I haven’t been exercising beforehand, so we can eliminate those ideas. Basals being off, maybe – I haven’t done basal testing in a while but will again soon to see if that’s the culprit… Absorption issues? I emailed the gastroenterologist (GI doctor) I've been seeing to ask him if it might be something GI-related causing delayed absorption of carbs in my system, and he said it’s extremely unlikely.
So really, I'm left with just my continuing questions... and whatever advice the DOC might be able to offer!
About two days ago, I posted this question on my personal Facebook page and got a few tips and suggestions, including this great one: "Maybe try glucose tabs instead of juice -- chewing starts the absorption in your mouth." That's definitely something I might have to experiment with!
Twenty years of living with diabetes, and it’s always something, isn’t it?!
Maybe I’ll go change my socks to make sure that isn’t the reason!
This is definitely frustrating, especially since we know that waiting for lows to rise can be so tough when you're tempted to eat everything in sight. What do you think, DOC -- any ideas to help Tricia?