How I’m Changing My Reaction to High and Low Blood Sugars

I’m doing a total system reboot…of myself.

I want to change how I react to high and low blood sugars.

Why?

Well, I think that it’s about time for me to address my intense fear of low blood sugars, but I also feel that I need to reconsider how I define high blood sugar. I’ve been sick and tired of dealing with constant highs, sprinkled with a few lows, so all of that together has motivated me to come up with a plan.

My plan is two-fold:

Step 1) Change the low and high thresholds on my CGM from 80-180 to 75-160.

Step 2) Pay closer attention to my body’s cues when my blood sugar is low.

how i'm changing my reaction to low and high blood sugars
It won’t be easy to change how I react to low/high blood sugars, but I think it’s necessary.

The first step was extremely easy to follow. I modified the settings on the Dexcom app on my phone so I’m only alerted when my blood sugar goes above 160 and below 75. I’m hearing my Dexcom alarms more often as a result, but I’m also responding to these alarms more frequently, meaning that I spend less time overall above/below my goal blood sugars. It requires a little more work and patience, especially since I experienced a lot of stress and a cold in the weeks since I’ve made the change (stress + sickness = shitty high blood sugars), but I know that it will be worth the effort.

The second step is slightly trickier. I’m the kind of person who starts treating a low blood sugar early – I’m talking as “low” as 90. And that’s not low. Unless I have several units of insulin onboard or I’m about to do a moderate intensity workout, there’s no need for me to eat anything when my blood sugar is 90. But it’s easier said than done, because I actually do start to feel low blood sugar symptoms at 90 (not all the time, but definitely a chunk of it).

So I’m hoping that this is where step one will come in handy. I’ll use my new low threshold on my CGM to reorient my body’s recognition of low blood sugars. I’m also going to work on not panicking when I start to feel low…because I think that’s the real root of my problems. In the last several years, I’ve developed – for no apparent reason – a serious low blood sugar phobia. I do everything I can to avoid them at all costs, and that’s probably contributing to my recurring high blood sugars. And that is definitely not good.

I’m over living my life on a blood sugar roller coaster…so I’m looking forward to smoother sailing with this plan of mine. Updates to come, for sure.

 

 

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Fearful and Falling in Target

What do they pump into the air at Target? Is it Afrezza or something? Because that seems like the only logical explanation for the phenomenon that seems to occur to most other fellow T1Ds when we step into a Target store.

Low blood sugars tend to happen at Target. Also known as “Target lows”, they can occur at any Target, big or small, no matter how long or short the shopping trip.

I experienced one last week. And it was severely exacerbated by the fact that I was visiting one in my new city for the first time by myself.

You are a rare gem.
Damn you, Target, for making my blood sugar go low during basically nine out of ten visits.

As you can see from my CGM screenshot, my blood sugar was definitely not low – not even close to it. I was in the mid-250s by the time I headed to the store, which is absolutely NOT where I like to be. But I didn’t take a correction bolus or even raise my basal insulin temporarily, because I guess I just had that feeling about my Target trip. I didn’t bother checking my CGM again after I parked, figuring that I’d do my best to make it a quick trip with minimal purchases.

Forty minutes (I’d been aiming for 20) after I’d stepped into the store and one semi-full cart (oops) later, I started feeling panicky and gasp-y. I told myself no, no, no, I wasn’t going low, I was just maybe reacting strangely to the scent of all the cleansers in the aisle I was occupying. I could deny it all I want, but in the back of my mind, I knew that I needed to pull my cart over, dig through my backpack, and locate my CGM so I could at least be informed of what my blood sugar was doing.

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Honestly, Target and all other retailers should just make glucose tablets free to any shoppers who are having a low moment.

So I did just that. Upon checking my Dexcom app and seeing that down arrow, I practically started hyperventilating. That’s when the following series of thoughts flew through my mind:

Okay, just get to the checkout…

Ugh, why is there only one open?! Guess you’ll have to self-checkout on low brain. Great…

OMG, Molly, you know you can only scan one item at a time…go faster!

You are NOT going to go down in this Target. Not today!!!

By some miracle, I successfully purchased my items and booked it to my car. Once I loaded everything inside, I suspended my insulin and shoved three glucose tablets into my mouth at once, chewing them so fast and furious that it probably deserved its own movie by the same name…(oh, but that’s taken *tee-hee*).

Normally, I would wait for my blood sugar to come back up before even thinking about driving home…but this wasn’t exactly a normal situation. I was on my one-hour lunch break from work, and I was rapidly approaching the 59-minute mark. The rational part of my brain (the way, way, super-far-back part) knew that I would be okay after about 15 minutes or so, but I was just so stressed about being alone in a strange city and wanted nothing more than to return to the safety of my apartment, pronto.

Of course, I had no idea how to actually get home – I needed my GPS to get to and from Target, and I’m sure I’ll need it to get basically anywhere for the foreseeable future – so I plugged my address into my phone’s GPS app.

And yet I STILL managed to take a wrong turn or three as I anxiously drove back to the apartment.

Less than 15 minutes later, I was parked and my shopping bags and I were inside my apartment. And that’s when I fell apart, feeling stupid for letting the low happen and getting lost on the way home…and feeling extra dumb for crying so hard about it.

Yeah, methinks that I’ll be running a temporary basal reduction the next time I plan a Target trip. I don’t want to be fearful and falling again any time soon.

 

Should I Have Called 911?

Unintentionally, I set a personal record the other day. I experienced my lowest low blood sugar – 34 mg/dL. I was alone. And it was terrifying.

Around 1 A.M., I woke up to my CGM buzzing and alerting me to what I presumed was a mild low blood sugar. I definitely felt like I was low, so I quickly ate three glucose tablets without checking and confirming my low on my blood glucose meter. And soon after that, things got really weird.

I tossed and turned for 15 minutes as I tried to fall back asleep. But I just couldn’t get comfortable. To make matters worse, a bizarre, numb sensation invaded my left arm. As I became more and more aware of it, my breathing started to run a bit ragged – almost like I was having a panic attack. Between the breathing and the numbness, I knew something was very wrong.

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What would you have done in this situation?

So I bolted upright in bed and grabbed my meter and kit to do a blood sugar check. And that’s when the number 34 popped up on the screen. I swore out loud, and almost immediately began sweating profusely. As beads formed around my hairline and streams trickled down my back, I reached for my bottle of glucose tablets as well as my phone. I ate three more tablets – wondering why the three I’d eaten 15 or so minutes ago seemed to have no affect – and contemplated dialing 911. After all, I was completely alone and there was no telling whether I’d pass out or need assistance from someone. In that moment in time, I craved talking to someone, anyone, who might be able to stay on the phone with me while I waited for my blood sugar to come back up.

Like a complete idiot, though, I decided not to call 911 and instead took to Twitter…*insert face palm here*. I know what you’re thinking, why the eff did I do that? Two reasons: 1) I wasn’t exactly thinking clearly and 2) I knew that someone, somewhere, within my diabetes online community would be awake and possibly willing to talk to me.

Thank goodness my intuition was right…my sweet friend, Heather, who I had the pleasure of meeting IRL five years ago, responded to my tweet a few minutes after I posted it. She offered to call, but by this point in time, I had made it downstairs and into the kitchen just fine and was helping myself to a cupcake I’d baked earlier in the day (oh, how convenient my passion for baking can be…sometimes). I exchanged a few tweets with her back and forth, and before I knew it, 45 minutes passed from the onset of my scary low blood sugar symptoms. I ambled back upstairs to my bed and checked my blood sugar before getting settled back into it. I was surprised to see I was only 72; after all, I’d consumed about 50 grams of carbohydrates in the last hour, and for me, that’s a lot! Most of my meals don’t even contain that many carbs!

Bemused and exhausted, I slumped against my bed frame and distracted myself by scrolling aimlessly through social media channels. My body and my mind craved rest. Much to the relief of both, I was able to get it before long, once I got confirmation from my CGM and my meter that I was finally above the 100 mark. I knew that I’d likely go up much higher (and I certainly did, waking up at 289 the next morning), but at the time, I just didn’t care. All that mattered was that I was going to be okay.

I’ve been reflecting on the incident on and off the last few days. I’m trying to process what happened and how it happened – was it my new Metformin that triggered it? Was it stress that I had experienced earlier in the day manifesting itself? I drank one beer before I went to bed, could that have done it? Did I take too much insulin before bed, even though I was certain I hadn’t? Lord knows that it could’ve been any combination of those factors, or none of them…but I can tell you this: I haven’t taken Metformin since it happened out of fear. I’ll talk to my endocrinologist soon and revisit my dosing plan with her. I can also tell you that, even as I continue to process the entire ordeal, I’m feeling so lucky that I was lucid enough to take proper care of myself. I know there are many other T1Ds who can’t say the same and have experienced much more awful low blood sugar incidents, so I’m simply counting my blessings right now.

What would you have done, had you been in my shoes? Would you have called 911, a family member, a friend? Would you have waited it out?

That Time Low BG Made Me Mad at the Moon

Low blood sugars in the middle of the night are far from pleasant. But they’re especially grating when you’re just trying to have a sleepover with your best friends and your CGM alarms loudly and urgently, rousing more than just me from a peaceful slumber.

Dammit, diabetes…you’ve done it again.

I don’t know how or why the low happened. I went to bed around 1 A.M. – we had stayed up late talking, drinking wine, and eating snacks – and at that time, my blood sugar was 156. You can’t get much better than that, and it felt even sweeter because we’d eaten pizza for dinner earlier in the evening.

I thought I’d be fine overnight. I might come down a smidgen due to the unit and a half I took to cover a slice of fabulous flour-less chocolate cake (utterly heavenly), but I made the assumption that I wouldn’t come crashing down.

I should know by now…never assume with diabetes.

So it happened at about a quarter of four in the morning – a witching hour, in my mind. I woke to the frantic buzz buzz buzzing of my CGM and quickly acknowledged it, then reached for my tube of glucose tablets. I did it as silently as I could, seeing as I was sharing the room space with my three gal pals. From what I could tell, my super slow glucose tablet chewing didn’t even cause my friends to stir. It seemed that I’d successfully managed to avoid waking anyone up, thank goodness.

I was just starting to fall back into a doze when the frantic low CGM alarm blared – BEEP beep BEEP beep BEEEEEEEEEEEP. Ugh! Upon hearing the first beep I snatched up my receiver, silenced the alarm, and scooped up my test kit and my phone. I tiptoed out of the bedroom from which we were all nesting to the living room, where I searched through my backpack for the Skittles I’d purchased earlier in the day…because that’s right, this 3:45 low blood sugar hadn’t been my first in the last twelve-hour window of time.

Digital Imaging Specialist
Low blood sugar in the middle of the night can make you feel weird things…such as anger towards the moon.

I plopped myself on the couch and started furiously chewing Skittles. I remember looking out to the sliding glass doors and to the balcony and to the parking lot and then finally up to the sky to see the moon shining brightly at me. It was positively dazzling, yet infuriating with its cheerful gleam. I wanted to yell at it to stop looking so happy. I muttered to myself, “this sucks,” and reclined a bit on the couch while I waited to come up from the low.

Everything was fine within 15 minutes. I was on my way up and could safely go back to bed. And again, I congratulated myself for not waking anyone up.

Or so I thought.

“Did anyone hear my CGM go off in the middle of the night?” I asked my girlfriends, approximately six hours after the incident when we were all awake and about to head out to breakfast.

“Yes! I was wondering what that loud, aggressive noise was,” said one. I cringed, an apology lingering on the tip of my tongue, when she continued with an “are you okay? Don’t worry about the noise, I fell back asleep soon after.”

I was grateful for her reassurance, but also for her concern. It felt good to know that ultimately, she didn’t give (apologies for language) two shits about the actual sound that my low blood sugar caused, she was just worried that I recovered from it okay and could get back to sleep soon after.

I smiled to myself. Hours before, I’d been cursing the moon for merely existing and dealing with an annoying, random low blood sugar. But now, I was cruising at a great morning BG and I was on my way to get a delicious breakfast with my gal pals. Diabetes has its moments, but I sure as heck appreciate it when it cooperates during the ones that matter most. So in hindsight, the 3:45 A.M. low was nothing more than a temporary annoyance, and I was just glad that the worst thing it did was interrupt my sleep (and mine alone) for 10 minutes rather than ruin actual precious time spent with my friends.

Hypo and Tongue-Tied: My Woes at Work

“Okay,” I thought to myself as I sat down for my 90 minute meeting, “My blood sugar’s sitting pretty around 100 or so. I should be able to make it the whole meeting without experiencing a drop, since the last time I gave myself insulin was about three hours ago…”

The fact that I had the audacity to think that my body/blood sugar wouldn’t play any tricks on me is laughable.

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This was my recent struggle at work. Usually, diabetes doesn’t interfere with my work whatsoever. I’m sitting, somewhat stationary, at a desk for eight hours every Monday through Friday. There was an adjustment period to the sedentary life when I first started working at my job, but it’s been more than four years now, so my body and my blood sugars are used to it. Plus, throughout the workday, I go out of my way to fit in extra steps, whether it’s using a restroom on a different floor or parking my car far away from my building’s entrance. Combined with my higher activity levels before/after work and regular workweek eating habits, I’d say that I’ve struck a balance in terms of physicality and diet that makes for an optimal environment for my diabetes to function normally/predictably.

So when I DO experience a high or low when I’m at work, it throws me off…but only for a relatively short amount of time. I’m talking like 15 minutes or so here. That’s right about the amount of time I need to come up from a low. If it’s a high blood sugar, I need even less time to rebound. I simply bolus, drink plenty of water, and move on to my next task. (Only in cases of 300+ blood sugars do I get really nervous – it’s only happened a couple of times, but I’ve had to leave work when that happens either due to feeling sick or needing to go home to deal with it.)

But things were different the other day when I was in the middle of a meeting with a colleague and I could feel the slow and steady drop of my blood sugar. Despite having monitored it closely prior to the start of the meeting, it started to coast down. Here’s the real kicker, though – I’m pretty in-tune with my body and could feel that this was not an urgent low. I figured my blood sugar was somewhere between 65 and 75. I didn’t have my CGM or meter to confirm, and I felt like I could keep the meeting going…so I didn’t do anything about it.

And in hindsight – even if it is 20/20 – I wish I had done something.

Why? Mainly because I felt that I was virtually useless in my meeting. As I reviewed each page of the 80+ slide PowerPoint, I could feel my thinking start to deteriorate. Words were tumbling out too quickly and nonsensically. I wasn’t sure if I was making a whole lot of sense to my colleague. And that’s a feeling that I can’t stand. I don’t like thinking that I may have wasted her time due to my determination to “power through” a low. It’s a perfect example of low blood sugar causing a symptom other than shakiness, sweating, or sluggishness: In this case, it also caused stubbornness.

When I finally made it back to my cubicle, I slumped down into my chair and grabbed a juice box from my low supply stash while my CGM buzzed over and over, letting me know that I was indeed low. Within approximately 8 seconds, the juice box was crushed, and I couldn’t help but think how next time I had a meeting, I’d bring one with me…just in case.