Dazed, I roll out of bed and suddenly become aware of how hot I am. Beads of sweat are rolling down my back, making my pajamas stick to my skin. I look at the number on my Dexcom – there isn’t one.
It just says LOW.
I grow more alert and turn to my test kit to do a fingerstick check and verify my Dexcom reading. My meter says that I’m 44.
And suddenly, I’m feeling that low. I need sugar, stat. I could open the bottle of glucose tabs conveniently perched on my nightstand, chew 5 or 6, and then get settled into bed and fall back asleep relatively quickly. But the desire to get downstairs and eat the contents of my kitchen strikes, even though it’s 1 A.M. and eating too much at this time of night wouldn’t be good for either my blood sugar or my sleep hygiene.
Ignoring my more rational side (as well as my glucose tabs), I grab my phone, my meter, my PDM, and my bathrobe and stumble down the stairs in the dark. I turn on the ceiling fan in my living room in a desperate attempt to cool down faster before I walk into the kitchen.
My eyes fall on a cupcake sitting innocently on the counter.
I don’t think twice – I tear the wrapper off and three bites later, it’s gone.
I collapse on the couch, directly under my ceiling fan. I am a sweaty mess. This low is hitting me hard. I put the TV on in a futile attempt to distract myself while I wait for the cupcake to kick in, but instead of paying attention to what’s on the screen, all I can feel is gross for choosing to eat a damn cupcake at 1 in the morning instead of doing the “right” thing and treating my low from the comfort of my bed with glucose tabs.
20 minutes later, I start to feel chilly. I’m no longer perspiring and I feel all of my low symptoms subside. I’m better, so it’s time to head back upstairs and try to fall back asleep.
I toss and turn for a bit, cursing diabetes and its middle-of-the-night low blood sugar curveballs, and the stupid 1 A.M. cupcake that my diabetes somehow convinced me to eat to treat a low instead of waiting to have it at a time that I could actually enjoy it.
Diabetes strikes again, I think as I drift back to sleep.
I was a mile into my regular morning walk when the beeps started.
The beeps were coming from my Dexcom app on my phone and they were alerting me to a low blood sugar. Rather than correcting the low, though, or even opening up the app to dismiss the alarm, I just kept walking.
Outwalk the low blood sugar, Molly.
I really couldn’t understand why my blood sugar was low in the first place considering that I had no food in my system or insulin on board (other than my standard basal rate). Fasting workouts tend to virtually guarantee stable blood sugars for me, which is wonderful because otherwise exercise tends to make me crash. But what was different about this morning? I was utterly befuddled. My Dexcom alarm chimed a second time.
Outwalk the low blood sugar, Molly.
Even more confusing was my complete and utter determination to not treat the low blood sugar until I got home. I had glucose tablets on me, so it’s not like it was a matter of lacking a treatment. Rather, I think I was more focused on maintaining my fasted state for as long as possible, since I almost always do an exercise circuit (weight lifting, cardio training, HIIT intervals, etc.) when I return home from my morning walks. My low alarm rang a third time, just as loudly as it had before.
Outwalk the low blood sugar. You’re only 15 minutes from home.
I was deaf to my Dexcom’s persistent alarms for the next 15 minutes as I somewhat floundered down the road home, letting my impatient puppy tug me along. It’s almost like she knew that I was low and was trying to hurry me home, and I was 100% okay with that because my brain was starting to get fuzzy.
Outwalk the low blood sugar…
At long last, nearly half an hour after my first low alarm sounded, I was crossing the threshold of my front door and fishing my phone from my bag. I tapped through my notifications and cleared the low alert, noting that I was 66 mg/dL and definitely needed to eat something before continuing on with my morning routine. I sighed, set my sight on the kitchen (where a low blood sugar food stash awaited me), and resigned myself to the fact that I couldn’t outwalk the low blood sugar this time.
Have you ever noticed that certain activities have a swift and obvious impact on your blood sugar levels?
Well, if you aren’t a person with diabetes, then the answer to that is probably “no”…but I digress! Recently, I realized that there are five things that absolutely, definitely, without-a-doubt make my blood sugar plummet before long. Here’s my list – what’s on yours?
1 – Vacuuming. I live in a fairly small condo – less than 900 square feet total – but when it comes time to vacuuming the floor, it takes me a good chunk of time to do a thorough job. Maybe about 30 minutes total. So it shouldn’t be surprising that by the time I’m done, I’m normally a little sweaty and often in need of a snack because all that moving around has made my blood sugar drop.
2 – Baking. This might be surprising because I’m the type of baker who must lick the spoon and sample the finished product as soon as it’s done, so you might assume that this activity makes my blood sugar go up. Not so. And this is because I am also what I call a “frantic baker”. I shuffle around the kitchen, rifle through cabinets, curse when I can’t find an ingredient and need to rush out to the store to get it…now you must get the idea. I’m always in motion when I’m baking, which pays off in the end. I need to try my baked goods in order to boost blood sugar that went low in the process of creating them. This is one of the many reasons why I love baking!
3 – Playing with my puppy. Little Miss Violet is four months old now and more rambunctious than ever. She loves fetching, running, chasing…and nine times out of ten, I’m fetching, running, and chasing right along with her. Before too long, Violet’s winded and on her way to dreamland while I’m on my way to the kitchen to grab something that will treat my low blood sugar.
4 – Cleaning the bathroom. A self-professed neat freak, I have a very specific process when I’m cleaning the 1.5 bathrooms in my condo. This process probably isn’t the most efficient because it involves a lot of walking up and down the stairs to gather various cleaning supplies, but it does do one thing well: lower my blood sugar, of course.
5 – Walking. This is pretty dang obvious because any sort of physical activity/exercise is bound to make my blood sugar drop, but not in the same way that walking does. I swear that 10-15 minutes of walking at a normal pace is enough to drop my blood sugar by about 100 points – that’s how effective it is for me. Walking is my sneaky little trick when my blood sugar is a tad too high: Instead of taking insulin to correct it, I just have to get a quick walk in and I’m falling fast in no time.
One of the many reasons why I love the diabetes community is that I’m constantly learning new information, finding inspiration, and enjoying support from my fellow friends living with T1D. Sharing our stories with one another leads to us finding that it’s more than diabetes that we have in common.
Here’s an example: My friend, Cherise Shockley, recently wrote an article for DiaTribe in which she made a confession to herself regarding how she counts her carbs. I recommend reading the extremely well-written article to get a full sense of what she discovered, but in short, Cherise recently realized that her carb counting is inaccurate because of the “glass ceiling” for entering carbs into her pump for bolus calculations. In other words, Cherise’s personal maximum of carbs that she was comfortable with dosing for using her pump wasn’t aligning with the actual amount of carbs she was consuming. This excerpt explains part of it:
That was my moment of truth. I told Natalie I ate my favorite chocolate chunk cookie that day. She asked me how many carbs the cookie contained, and I told her 68 grams; she wondered why I only bolused for 55 grams. I paused before I replied – I did not know the answer.
Natalie then asked me if I had a glass ceiling for entering carbs in my pump. She explained that this means even though I know I eat 63 carbs, I will only enter 50 carbs in my pump because anything higher than that concerns me. What she said was interesting; I had never heard anyone describe it to me in that way.
When I read this, I said, “Yes! Finally, someone is able to articulate exactly how I handle carb counting!”
This is the truth about my carb counting: I have limits when it comes to how many carbs I will bolus for at a time, but those limits do not apply to the actual number of carbs that I consume.
To explain, I am only comfortable with bolusing for a maximum of 60 grams of carbohydrate at a time. I do not know how I came up with this particular number, but I do know that there are situations (e.g., holiday celebrations) in which I am absolutely consuming more than 60 carbs in a sitting, and yet I only bolus for that amount.
Still confused by what I mean? Read the full article to understand, but this excerpt from it helps to explain why this fear of bolusing for more than 60 carbs at a time exists for me:
To learn more about carbohydrate glass ceilings and why some people have one, I talked to Dr. Korey Hood, a professor of pediatric endocrinology and psychiatry and behavioral sciences at Stanford University who has lived with type 1 diabetes for over 20 years. Dr. Hood told me that all parts of diabetes management can be challenging, and carb counting is particularly tough because it is hard to be accurate and precise. He always recommends people with diabetes meet annually with their diabetes educator (CDCES) to get a refresher on different aspects of diabetes management, including carb counting.
Dr. Hood said that the glass ceiling is most likely due to one of two issues – worries about hypoglycemia or the meaning behind taking such a big dose of insulin. Dr. Hood said that “many of us with diabetes, particularly those on insulin, worry about going low. Why wouldn’t we – it is a terrible feeling! We often experience fears of hypoglycemia because we had a terrible low in the past and have a desperate desire to avoid it in the future. When we worry about hypoglycemia, we scale back our insulin dosing. This prevents the low but also likely results in high glucose levels. So, it really is not a good strategy.”
This was a major revelation for me because suddenly I realized what my reasoning is for my carbohydrate glass ceiling: I have a hypoglycemia fear. I have experienced scary episodes in the past (fortunately, none of which have required medical attention). I have friends who have experienced severe hypoglycemic episodes, and when a colleague of mine experienced a low episode that was so bad that I had to call 911 for him, it left a mark on me. So on the occasions that I do eat more than 60 carbs in a sitting, I simply don’t take the amount of insulin that I should to account for those carbs, and I wind up going high, exactly as Dr. Hood describes in the quote above.
When it comes to diabetes, there is no such thing as “perfection”. My blood sugars cannot and will not be perfect 100% of the time. But one thing that I do have control over is doing the absolute best that I can with carb counting and bolusing. It’s time I hold myself more accountable to my carbohydrate glass ceiling…in fact, it’s time for me to smash through it.
A ginormous thank you to Cherise for being so open and honest in this piece and for inspiring me to own my carbs, too.
There’s never necessarily a good time to have a low blood sugar: Whenever they happen, they’re bound to be at least a little inconvenient.
But I was thinking about it the other day and it occurred to me that there is most definitely a worst time for a low blood sugar…at least, for me.
And that time is the middle of the night.
I love sleeping, but like many adults, I simply don’t get enough of it. So when something like a low blood sugar interrupts my slumber, it’s downright intrusive and honestly a bit scary, because I always have an underlying fear that I’ll sleep through my Dexcom alarms.
Take a recent middle-of-the-night low blood sugar for example…I was dealing with a lingering low at 1:30 A.M. I’d only been asleep for a couple of hours when I heard my Dexcom sound. I ignored it the first 3 times it went off, but something – my intuition, maybe – told me to roll over and at least check to see the level that my Dexcom was reporting.
I was somewhere in the 60s: low enough that I needed a juice box. I promptly drank it and got settled back under my covers, assuming that I would shoot back up in no time.
Not quite. I don’t know how many minutes later, but I looked at my Dexcom again and it said I was 56. I did the whole “confirm the number with my meter” shtick and ate some glucose gummies to supplement the juice box. I was irritated and my eyes were oh-so-heavy, but from there I forced myself to turn the television on and try to get distracted by a show so I wouldn’t fall back asleep until I knew that my blood sugars were stable again. Before too long, I was heading up, so I did my best to lull myself to sleep, though I tossed and turned for awhile before I finally did drift off.
All in all, I lost about an hour to an hour and a half of sleep because of this one instance! Not all of my lows are like that – sometimes I can fix them in 5 minute flat, other times they keep me up for upwards of two hours – but it doesn’t even really matter. It’s more so the principle of the thing.
Plus, think about how freakin’ ridiculous it is that people with diabetes have to eat something sugary to come up from a low – that in itself isn’t wild, but it IS grating to have to do in the middle of the night when you aren’t hungry and were enjoying a deep sleep. Also…ever try drinking orange juice after you’ve brushed your teeth? It’s unpleasant, to put it mildly.
So you have it: The middle of the night is the absolute worst time for a low blood sugar, in my semi-expert opinion.
There should be an asterisk after this blog title…because this is going to be about the lowest bg that I can really remember and have an actual blood sugar to associate with it.
Let me elaborate…
My real lowest low happened when I was in high school – I got out of bed one morning, stumbled down the stairs, and slurred to my mom that I wanted a bowl of Special K cereal for breakfast (she couldn’t understand what I said and promptly panicked before realizing I must be low). I don’t know what my blood sugar level was that morning because I neglected to do a fingerstick check, but I do know that it was a downright freaky incident that’s cemented in my memory.
But another new incident recently occurred that shook me in a similar way.
It was 1:30 A.M. I was nodding off when I heard my Dexcom alarming. I checked it and was somewhat surprised to see that I was 92 with two double down arrows. (I say “somewhat surprised” because in the earlier evening hours, I spent 3-4 hours chasing a stubborn high blood sugar and definitely wound up stacking insulin doses.)
Even though I wasn’t feeling any low symptoms, I decided to start treating the low. I ate two boxes of mini raisins, equaling about 20 carbs…
…and swiftly grew worried when I saw the number on my Dexcom app to continue to drop.
Okay, let’s have another box of raisins.
Alright, let’s do a fingerstick check.
Sheesh, I’m fumbling around in the dark, trying to locate my meter…
By the time my Dexcom said “LOW”, it was confirmed on my meter that I was, indeed, quite low. 35, to be exact.
And that was a number that frightened me.
Thank goodness I wasn’t alone when I was dealing with this 35 (that wound up lingering for a solid 15-20 minutes before slowly creeping up about 45 minutes after I ate my first box of raisins).
Thank goodness I had someone there to make sure I had plenty of sugar in my system before I fell asleep.
Thank goodness I had a can of regular ginger ale, some Reese’s, Dove chocolates, and popcorn all within arm’s reach (yes, I really did need to eat all those carbs in order to treat this one low).
Obviously, I recovered from this scary low, but it taught me that now that I’m living alone and won’t always have someone around me in the middle of the night, I should start thinking about inviting someone to follow me on the Dexcom app.
The next day, I talked to my parents about what happened and the three of us agreed that my dad will receive notifications if/when my blood sugar drops below 55. I feel a lot better knowing that he has access to my levels and that he knows to contact me if I’m low.
I’m not exactly grateful that I experienced this very low blood sugar…but I do appreciate that it’s reinforced the importance of having a nightstand fully stocked with low treatments as well as making sure that my family has a way of checking in on me when I may need their support.
We all know that 2020 has been a sucky year, so it’s not exactly surprising that immediately following Halloween, the world seemed to throw itself into the holiday spirit.
Between the commercials on TV, Black Friday sales, sparkly decorations, baking galore, and Hallmark movies, the Christmas season kicked off early and with major vivacity. Normally, I’m the kind of person who prefers to enjoy one holiday at a time, and I was somewhat repulsed to see all the Christmas merchandise in stores before Halloween was over.
So even though Thanksgiving hasn’t even come and gone yet, I’ve abandoned any remaining willpower I’ve had to hold off on decorating for Christmas. Like the rest of society, I simply couldn’t hold back my desire for some cheer!
One afternoon last week, I decided to haul up my Christmas tree and its accompaniments from the basement and start the process of decking the halls…
…but my diabetes had other ideas.
I’d just finished assembling my modest tree when I heard my Dexcom alarm sounding off, alerting me to a low blood sugar.
And I hate to admit it, but it didn’t surprise me – I’d felt the oncoming low for about 10 minutes prior.
I just wanted to decorate so badly that I was willing to ignore my blood sugar in order to embrace the Christmas spirit!
Alas, not too long after I heard that alarm, I knew I had to change my priorities as I started to get sweaty and a little woozy…so I left my tree naked and sought out a low treatment, slumping at my table in defeat while I ate it.
My diabetes told me it was too early to decorate for Christmas at that moment in time…
But you know that I told my diabetes otherwise later that night when I spent hours trimming the tree!
‘Tis the season and ain’t no way that my diabetes will prevent me from basking in it.
The thought occurred to me that I should write a blog post on this subject sometime around 3 A.M. after I shoveled a slice of cheddar cheese into my mouth.
Low blood sugars combined with odd hours of the night aren’t foreign to most people with diabetes, but they can be…interesting when you aren’t prepared to handle them with low snacks stashed away in or on your nightstand.
To elaborate, I almost always have a box of raisins or a bottle of glucose tablets sitting on top of the nightstand next to my bed – but there are those times that I run out and forget to replace them.
In those situations, I really have no choice but to eat everything in the kitchen head downstairs and scavenge in the kitchen for something that will bring up my low blood sugar.
Usually, I consume things that make sense – a handful of cereal, a glass of juice, a few marshmallows…whatever the kitchen is stocked with that will work fast. And this is absolutely the best tactic when dealing with a middle-of-the-night low because it helps ensure that I will be able to get back into bed (and hopefully fall asleep) as soon as possible.
But every so often, I go absolutely apeshit in the kitchen and EAT ALL THE THINGS!!!!!!!!!!
Okay, not ALL the things, but definitely way too many things.
I blame it on the fact that my body is in that savage, must-eat-food now mode: Hungry and full cues aren’t a “thing” in that state. So I kind of mindlessly eat junk until the symptoms of my low blood sugar go away. This can take at least 15 minutes, so as you may be able to imagine, I can go overboard with food consumption.
And my choices can get more than a little weird.
Here are the most bizarre food items that I’ve eaten when dealing with a middle-of-the-night low blood sugar. I classify them as “strange” because either 1) they don’t do anything to help low blood sugar because they’re low carb, 2) they’re kind of disgusting, 3) the quantity is odd, or 4) a mix of all of those qualities:
A slice of cheddar cheese (mentioned in this post’s introductory sentence)
About one-third of a Nutella jar (that was so yummy but damn I shudder to think about the calories and fat in that serving)
Too much peanut butter to quantify (please see above comment RE: Nutella)
SUGAR-FREE syrup (emphasis on the sugar-free because WTF was I thinking when I straight up drank two swigs from the bottle)
Exactly three frosted mini wheats (I don’t even LIKE this cereal but I guess in this situation I thought that consuming no more, no less than three was a brilliant idea)
Pickles (not weird at any other time of the day because I love pickles but maybe not the best snack in the early morning hours)
Welp, now my stomach is churning slightly as I think about all the junk I’ve eaten at ungodly hours of the night…if you don’t mind me, I’m off to go restock my low snack supply on my nightstand so I don’t have to make any early-A.M. hour trips to the kitchen any time soon!
For anyone who may be unfamiliar with Baqsimi, it’s a relatively new form of glucagon that comes as a nasal spray. I haven’t had to use it yet (and I hope that I don’t ever have to, really), but there’s a lot of pros to Baqsimi when comparing it to a traditional glucagon kit:
It’s shelf-stable – it doesn’t have to be refrigerated.
It doesn’t expire until 2.5 years from now.
It’s completely ready to go as-is, no mixing or measuring needed.
It’s compact and totally portable.
It’s easy to use (and understand how to use!).
All of those factors contributed to my decision to finally pull the trigger and ask my endocrinologist about writing a prescription for me. It’s not that I’m suddenly worried that I’ll need Baqsimi; for me, it’s more of a peace-of-mind situation. I always thought that my glucagon kit was next to impossible. Sure, I know how to use it, but I have to refresh my memory every so often because there are so many steps involved in the process: inject the syringe into the vial, mix the contents, wait for the glucagon to turn clear, stick the syringe back into the vial, withdraw the liquid, and then finally do the injection…there’s a lot going on there. And if I actually did need glucagon one day due to a severe hypo, I wouldn’t exactly be able to easily walk whoever I was with through the process because I’m sure I’d be totally incapable of doing so (depending on how bad my symptoms were).
It’s just a lot to ask of every single one of my family members and friends to know exactly how to inject glucagon into me in the event I ever needed one of them to do that, so having Baqsimi on hand takes so much of that fear and anxiety away.
And the icing on top of the cake is that it was super easy for me to get Baqsimi…like, it only took a few hours, which is amazing. All I did was reach out to my endocrinologist’s office using their online messaging system, ask my doctor for a script, and…bam. It was sent into my local pharmacy, and before long, I was cruising through the drive-thru with my dog to pick it up. I’m lucky, too, because all I had to pay was $25, thanks to my insurance (sometimes, it’s not as bad as I think it is).
Twenty-five bucks for peace of mind and a life-saving medication…that’s something I can get behind. I’m glad Baqsimi has finally joined my diabetes toolkit.
Anyone who has ever experienced low blood sugar knows that it’s an icky feeling.
The shakiness. The sweating. The desperate desire to eat the entire contents of your kitchen.
It’s an unpleasant experience, but the one thought that has always made low blood sugars slightly more bearable for me is that I have to consume fast-acting, sugary, yummy carbs that are medically necessary. I’ve had some fun with that medically necessary bit in situations over the years: “Hey, stay away from that cupcake, I need it for my blood sugar!”
In any case, I’ve come up with my 10 favorite low blood sugars treatments that I’ve discovered work best for me…and tend to also be pretty tasty (well, maybe not #3, but everything else is a winner for most people in the flavor department).
1. Marshmallows. Even though I feel like I’m playing chubby bunny (you know, that pointless game when you see how many marshmallows you can fit inside your mouth at once and your cheeks puff out like an adorably plump rabbit munching on carrots) any time I consume a marshmallow, I can’t deny that they work incredibly well for low blood sugars. While I don’t mind the flavor of marshmallows, I definitely don’t love it, so I can always resist the temptation to over-correct a low blood sugar when I use marshmallows to treat it.
2. Mini boxes of yogurt-covered raisins. This has been my go-to for almost 10 years now because they’re just so convenient. The mini boxes are highly portable and contain about 11 grams of carbohydrates, which is perfect for not-so-bad lows that just need a little boost.
3. Glucose tablets (or gummies). They’re the old standby for a good reason: They were specifically made for treatment of low blood sugars, and they’re also extremely quick and easy to consume whenever, wherever (cue Shakira and her hips that don’t lie).
4. Frosting. So bad for you, but so good to eat by the spoonful when dealing with low lows. I don’t often have frosting on hand, but if I have some leftover from baking, I’ll throw it in the fridge and try to forget that it exists until I need it for a low blood sugar.
5. Orange juice (or a juice box). I feel like juice was a signature treatment for lows in my childhood: Since small children often drink juice boxes, it made a lot of sense. But back when I was working in an office full-time (sigh), I had a couple of juice boxes stashed away in my desk drawer because I got a kick out of feeling like a little kid with her juice boxes while sitting her grown-ass adult woman’s work cubicle (yes, I know I’m kind of weird. Embrace it.)
6. Starbursts. In college, I met a fellow type 1 in my social psychology lecture hall who swore by carrying starbursts for low blood sugars. She explained that four of them had the exact same amount of carbs as four glucose tablets, but they were far superior in taste because, well, starbursts are candy. I’ve kept this in mind over the years and its come in handy: More than once, I’ve been in a situation where I’ve had to get carbs fast but didn’t have glucose tablets on me, so I bought a sleeve of starburst to treat oncoming lows. They work well and they’re especially delicious when using the pink or the orange starbursts (not the yellow or red…fight me on it).
7. Skittles. What I love about using Skittles for low blood sugars is the 1:1 rule. One Skittle has one carbohydrate, so it’s extremely easy to figure out how many will bring up blood sugar, depending on how low the low is. 10 works well for when I’m in the 70s, whereas I might have 15 when I’m in the 60s. All bets are off when I fall below 60, though, and I’ll settle for a large, uncounted handful – maybe the whole dang bag – instead.
8. A piece of fruit. Ooooh, a genuinely healthy option on this list! The horror! But it’s a fact that fruit works just as well as any piece of candy or sugary treat for bringing up a low. I’m not talking about a single blueberry or strawberry, though: I’m talking either an apple or a banana – something that has some genuine carb content to it in a single serving.
9. A couple handfuls of cereal. This is a riskier choice because the lack of restraint I have around cereal when I’m low, but who else can relate to waking up at 2 A.M. to treat a low and being too tired to measure something out, so out comes the cereal box and handful after handful of Lucky Charms or Cookie Crisp are consumed in a very short span of time?! There’s no questioning cereal’s efficacy in a hypoglycemic situation, but when it comes to controlling the amount eaten…well, that’s a hard thing for me to do.
10. Fruit snacks/gushers. Embarrassing story from my childhood: Remember those commercials in which kids who ate gushers had their heads turn into giant pieces of fruit? Well…I was convinced that eating gushers would lead me to the same fate, so I avoided them until one day I finally realized it was just a stupid commercial (albeit with very freaky graphics) and it was totally safe to consume gushers. And thank goodness, because they’re delicious and great for lows! So are fruit snacks of just about any variety, though I’ve had the most luck with Mott’s and Welch’s fruit snacks.
Do you have any low blood sugar treatments that I didn’t mention here but should consider trying? Drop a comment to let me know what it is and why it’s your favorite!