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The Return of Low Blood Sugars.

For a good, long time, I ran higher than usual on purpose because of my focus on the baby and my fear of low blood sugars while I was responsible for her care.  In the last few months, I've started to lower my blood sugar goals to reclaim a little more control and tighten up that freaking standard deviation.

Which also means that my sensitivity to low blood sugars is tossed out the window once again, along with any whisper of a symptom.  ("Pssssst.  You're low.")

So these lows are starting to creep back into rotation.  For a few weeks, it was the 60 mg/dL range that had me sweating and shaking and reaching for juice before bothering with my meter, because the symptoms of the low were so intense.  Those lows were weird because I wanted to drown myself in grape juice, even though I really only needed a few sips to bring me back into range.

But now, with my control slightly better and my meter average down a smidge, I'm back to the Symptom-Free Zone, where lows are caught more by the Dexcom and less by my actual body.  In the last week alone, I had:

  • a 48 mg/dL at 4:30 in the morning (wherein I started texting people back about random things, in my low stupor, and when I woke up, I had to ask people if I really had a text conversation, or if it was something I dreamt);
  • a 44 mg/dL which had me so disoriented that I fed the cats before getting my own juice (see also: casual low);
  • a 39 mg/dL after sleeping-in one morning, where my only symptom was confusion about who I was.  (I had to remind myself: "I'm a person.  I'm a person named Kerri.  Hello, Kerri!  Those are glucose tabs.  Eat them?")
Lows bug me out.  They are unnerving moments in my diabetes management when, even after all this time, this disease can grab me and shake the leaves off my mental tree.  And the lack of symptoms seems to be a strange reward for achieving tighter control, which is so counterproductive that it makes my liver throw its hands up in frustrated disgust.  ("Seriously?  Now I work harder?" while my pancreas happily sips on a mango margarita and plays soduku.)

I want that middle ground.  That place where lows aren't so dramatically low (I'd love a good 65 mg/dL as a trade for these 30's) and the rebound highs are so sticky.  Where troubles melt like lemondrops, and my blood sugar is 130, tops  ... something something. 

For now, I'm testing a freaking ton and relying heavily on the Dexcom as I make adjustments to my basal rates.  And I'm keeping my phone in another room while I sleep, to keep the 'texting while low' at bay.  ;)

Comments

Scary stuff dude! Treat then tweet. I have to remember that one too!

I was 40 mg/dl upon waking this morning - my Dexcom had been buzzing and singing for hours and I was just happily snoozing away - and not a symptom to be found. AND the cats got fed before I did, so I can totally relate!

(And btw, I love the image that I have now of my pancreas sitting on a beach and sipping an umbrella drink, pencil in hand....!)

I can imagine the frustration. And I'm thinking if drunk texting is a bad idea, so is low texting. ;-)

I was 55 just now. No symptoms. Only tested because my CGM alarmed predicted low.

Lows send my mood through the roof. I often get depressed and angry, as well as frustrated at how intrusive they are (all the times I'm in the middle of something important and have to 'stop down' for a few - like a photo shoot with clients! or in the middle of a workout that I don't have much time for). And if I have a day that's out of whack with a lot of lows, I get angry that I have to keep eating so much. Lows make me feel out of control of my life. Yes, tighter control means more of them and that's hard to deal with.

So true Kerri! I'm so glad you're posting about this, especially the feeding the cats first. I think that's the scariest part of the lows is that you might not figure out what the heck to do to fix the low! I have had 40's where I'm still cleaning, fixing food, etc. and I even check my sugar and SEE the 40, but it takes me 10 minutes to figure out, "Oh yeah, I should get some glucose tablets." All we can do is keep lots of sugar around, and just try to always focus on getting that sugar as best as we can.

Living alone, I unfortunately try to insure that my BGs are in the 130 range upon waking. This past week I awoke at 4:30 to a 47 which scares the heck out of me. Fortunately my body responds very quickly with symptoms and somehow my sleep was light enough to awaken me. Also this past week I was shocked into the reality of how dangerous lows can be when there are no symptoms when I received word that the nephew of one of my best friends, a T1, was found dead on his parents living room floor from severe hypoglycemia. He was housesitting alone and had a history of not being able to sense his lows. Not to be the voice of doom here, but these are the realities of the seriousness of this.

I have been living with symptom-free hypos for about 15 years (for about the same amount of time pharma began selling biosynthetic insulin varieties exclusively), and I can tell you they really do suck, but consider yourself lucky to have a continuous monitor to assist, as many aren't so fortunate. Part of the issue is that the autonomic response that we rely upon to generate "symptoms" becomes muted the longer patients live with diabetes, which I think explains why the JDRF in September started a campaign for glucose-responsive insulin. SmartCells, which was acquired by Merck is also pursuing this, but just having big pharma's money doesn't guarantee its success, so the organization is hedging it's bets by trying to lure others into this space, which I support. Without delving too far off topic, this can be scary, but we have bright people working on it!

Well said, those "no symptom" lows are The Freaking Worst!! (And yes, way to reward us for tightening up our control, right?) I had a middle of the night 30 last week that left me in a state of major confusion. (I'm eating these glucose tabs but I don't know why . . . ) And also, a high 30s during the day that had no symptoms. Not a single one - except I felt tired. My endo actually suggested running myself a little higher for a while to bring back the symptoms . . .

Your pancreas is classy even if it is in permanent malfunction mode. Now you've got me thinking about what kind of cocktail mine prefers...

I love your blog, thank you for sharing all of your unique and open perspectives into the moment to moment life. I have been diagnosed LADA and now on insulin but feel like I am on a total roller coaster of more highs and some lows. I am contemplating a Dexcom as I am an active mom and speech therapist...I want to know what is happening and I want to achieve greater control....hoping my doctor will listen as this has been a long road to the correct treatment.

Your blog today was very appropriate for what I have been experiencing the last few days. I have had symptom free (until I check my BG) lows the past few days. One was as low as 28 and then a few 36's. I am in the process of switching from a Medtronic CGM to a Dexcom and it can't get here soon enough!

I feel like since I had our 2nd child, Caleb in June, that I don't realize I am having symptoms until its too late & my husband springs into action like a superhero! Could be sleep deprivation:) I just got my Dexcom in the mail & am anxious for my appt to learn how to use it!

Its difficult bc you want to be on the lower side without the slurred speech or my fave, double vision, or low texting:)

Thanks for your posts!

As a teenager, I had some really frightening early AM lows that involved hallucinating, parents holding me down, screaming, and a lot of patience from my parents. Kind of amazing I made it through? Getting away from NPH was the best thing I ever did.

I always tell people that when my blood sugar is low, I can forget my mother's name. But you blew that out of the water! Identity crisis.

It's actually gotten to the point where I sometimes go to test just because I can't remember something obvious! Like the number to my house . . . .

Who texts while Low?

*raises hand, and runs away to find my phone and blood meter to test (& text)...*

No symptom Lows aren't fun at all. Hope you find that balanced middle ground, Kerri.

Lows suck. They really do. My low symptoms have changed recently to a dull feeling only, which could be a symptom of basically everything - a cold, being tired, beginning headache - so I lately caught a low when I was already down to 38. Well, I hope I will get the hang of this peculiar symptom ere long.

Appreciate this post so much! I've been struggling lately with middle of the night lows that I don't wake up to treat and then waking up in the 200s as a rebound. Then I treat the high, rush off to drop off my son at school, get to work, and by the time I arrive, I'm in the 40s and 50s again. I am also awaiting the arrival of my Dexcom and cannot wait to get started on it! Trying to get sorted out to TTC (trying to conceive) and know there will be a battle of lows on the horizon!

Lows are just super sucky. I really hate the symptomless lows too because often I have symptoms, but they are vague and confusing (not the standard shaky-sweaty-nauseous symptoms that make you run for the juice). Like spontaneous depression/crying. Nothing is more lovely than bursting into tears for no apparent reason. And then checking your BG and discovering it's like 40. Fun times. I also love your description of "casual lows" because I get those too. My BG can be 50 and, because of the confusion, I can decide to do something really irrational, like first take the dog out to pee. Totally rational.

Kerri - I read this yesterday and commented and then last night I had a very vivid dream in which your doctor (her name was Kathy McDonald in my dream!) posted a comment and said, 'Kerri, get back to me ASAP! I need to talk to you about how you're dealing with this. Some low blood sugars are different than others. It depends on how much insulin you still have on board.' Huh?! So weird and random!

Kerri,

I just want to thank you for this post, your putting words to a struggle that I think a lot of us have. I couldn't have explain it better myself, in fact it makes me feel better knowing that I am not the only one going through these things. I want that middle ground too!!!! Thanks, Ben

"something something" = "that's wh..ere you'll fi...nd me!"

Yet another excellent allusion.

Somehow you failed to mention that you take pictures of your meter when you're that low, too.

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