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Fifteen Carbs.

At least it's not a glass of pee."It takes more willpower than carbs to properly correct a low blood sugar."

This goes through my head every time my blood sugar is below 65 mg/dL.  I talked about lows with my endocrinologist a few weeks ago, and how when I'm excessively low (the ones that tangle my tongue in my mouth and leave cotton balls in the place where my brain should be), it's very hard to measure out fifteen grams of carbs, then eat, and then sit patiently and wait for my blood sugar to rise.

"Usually, I measure out fifteen hundred grams of carbs, usually in the form of an entire bottle of grape juice, and then consume the whole lot in a matter of seconds.  Then I end up haphazardly bolusing to cover the extra carbs.  Usually, I end up much higher than I was aiming for, mostly because I'm in a freaking panic and treating the low as fast and desperately as I can."

She and I talked about how panicky lows often lead to over-treating, which leads to highs, which leads to rage bolusing, which leads back to panicky lows.

"Fun vicious cycle, that is," I said.  "I do notice that the more stable my blood sugars are, the more stable they remain.  It's once the bounce starts that it becomes gross. My Dexcom graphs start looking like giant letter Ms."

"Not over-treating a low is very important, but I know it's a tough thing to avoid.  That panic drives you to eat until you don't feel low anymore, which can take up to twenty minutes."

"So I need to distract myself while low?"  (Like I'm not already distracted enough at a blood sugar of 40 mg/dL.) 

"Whatever you can do to treat the low without overdoing it, yes.  It can help stop that vicious cycle."

Lows aren't as prevalent now as they were a few months ago, but they do hit every once in a while.  (As irony would have it, I'm writing this blog post while low.  But I only had three small sips of juice.  And now I'm waiting patiently.  PATIENTLY.  SEE HOW PATIENT I AM?!)  I'm trying to be patient while low, and waiting out the panic until blood sugar serenity sets back in.  I thought about crocheting while low, but decided that would be an epic exercise in dropped stitches.  Thought about jumping on Twitter while low to pass the time, but that would end up looking too much like drunk Tweeting. And I can't whistle, or else I would fashion up a low blood sugar tune to pass the time.

So I'll try to sit.  And wait.  And pretend that my brain and my body aren't freaking out while I wait for the glucose to hit my blood stream, the same mantra running through my head while the adrenaline runs amuck in my body:  "More willpower than carbs.  More willpower than carbs."

Comments

It's not cost effective and there is way too much packaging involved, but we buy the 4 oz. juice boxes and use them just for lows. 15 grams perfectly measured out, easy to carry around, easy to keep one at the bedside for those middle-of-the-night lows.

Do you think we could get a discount somewhere if we, as a collective lot, go in and get a tattoo of "It takes more willpower than carbs to properly correct a low blood sugar" somewhere visible on our person??

Love this post- so relatable. Like Deb, above, I've started buying capri suns (I'm 27, but always feel like a child while drinking them) and love the convenience and control they bring to treating lows.

It's hard to be patient. It also seems that the whole 15 carbs every 15 minutes till normal rule we were told doesn't work for my husband. It takes almost 45 minutes for them to hit his system and keep him from spiking. It's really annoying at 1 AM and he has to wake up 3 hours later.

Sometimes I'll follow my 15 carbs of juice with a diet coke. "See brain, it's sweet! I'm feeding you!" It sorta works.

I do exactly what Deb does. Juice boxes work so well for me but that wwwwaaaaaaaaiiiiiiiitttttttt sucks. I usually turn to my iPhone and old school solitaire app to try to pass the time.

Amen to this post! If I'm at home I like to set the timer on the stove to 15 minutes. It forces me to wait until I hear the "beeeeep" of the timer go off to re-test. Otherwise, I'm sitting there thinking, "wait, has it been 5 minutes yet, 10 minutes??" I just recently started using glucose tabs after a 12 year hiatus (I hated the taste) and I am amazed at how much just 4 grams of carb will raise me back up.

I have been using a Dexcom for about 6 months now and had to train myself not to keep eating more carbs each time the low beeper would go off for the same low. Now I tell it to "shut up" and sit patiently and wait until it comes up.

I also use the 4 oz juice boxes. However....sometimes it sure is hard to get that straw into the teeny hole. One time I started jabbing at the box with a corkscrew, which was a futile effort.

So true! When you feel that panic, it is almost impossible to wait those 15 minutes. I'll do anything to feel normal again as quickly as possible. I can't do anything to pass the time other than sit patiently because my brain is mush during those times, ugh.

One of my low symptoms is random, extreme hunger, so that combined with the "OMG LOW LOW MUST HAVE CARBS" panic leads to some pretty nasty highs. And so begins the vicious Dexcom M's cycle.

Try drawing.... then you can laugh at your creation later. :-)

I too took what was probably a 15-year break from glucose (my logic was "hey, why chew on dry powdery glucose if I can have candy instead?"), but I recently re-discovered why glucose is best: your body doesn't need to go through a whole chemical process to break it down - it goes straight into your cells without having to be broken down first. I feel better within 5 minutes. I occasionally slip up and drink juice or have candy instead and because my body is too busy converting it from fructose to glucose, the time lag is long, I still feel low and I end up over-doing it and yo-yo-ing.

Anyway, I also discovered that there's an excellent formula in the Dr. Bernstein book (you may agree or not with his low-carb approach, but there are some jewel tidbits of information throughout that book): if you weigh 50 kg, 4g of glucose (i.e. 1 Dex tab) raises your BG by by 1.1 (Canadian measurements). There's a whole chart in there and it goes according to your weight. It's surprisingly accurate.

So if I'm at 2.8 and I take 2 glucose tabs, my BG will go up to 5.0. And it will do so quickly, so the mad panic doesn't lead me to overdo it. I'm then in control to eat a rational portion of cheese and crackers instead of over-carbing it.

As for the glucose tab dryness, I always crunch down on them with huge gulps of water. It dissolves them quicker and makes them much easier to swallow.

(Again, one of those things that would have been handy to know years ago. Instead of telling me to take glucose without telling me why, the medical people should have explained the logic behind it. If you want me to do something, I have to understand the reasoning behind it. Following orders blindly isn't really me!)

I often knit while low to pass the right amount of time without overtreating, but I try to make sure the project I'm working on is simple, so I don't bungle it.

Thanks for your comment K. I didn't know there was a reason to take glucose tabs instead of candy but I will do that from now on. And you're right..no one ever told me why they are better for you. Do you need to eat 4 though to bring your BG up?

Glucose tabs are great when you feel energetic enough to chew them up (with or without water)
however, I have been awakened in the wee hours of morning, by some wicked lows, accompanied by the whole gamut of symptoms (shaking, sweating, fast heartbeat, and wondering who and where I am)
It is at those time I reach for the easy to open tin with unwrapped york peppermint patties (3 small have 32 g. carbs) and pop 2 or 3, and, my safety and sanity are back shortly after a few swallows
I have mentioned this to my doc, and, of course she points me to glucose tabs, or, as mentioned, 4 oz. juice boxes, which is a much better fix.
Is it just me, when I drop too low, some of the forbidden foods (like mint patties) taste like some kind of supernatural nectar?

I don't mind the waiting so much if I am at home. It is the waiting at the mall or airport or doctors office or before driving the car or before eating dinner at a restaurant. Its that blank stare that I try to conceal from strangers so as not to panic them or cause too much unwarranted commotion.
At home I can take that 15 minutes to close my eyes for a while till things get better. And I do use Glucose tabs exclusively. They work the best.
Christine

The ONLY thing that I find that consistently raises my blood sugar quickly but doesn't spike my sugar is Honest Kids Organic Berry Lemonade juice boxes. They are 10 carbs each. If I have below 60 I drink two in a row and i generally end up around 120-140. If I'm at 70+ then I just drink one and I end up in the same range. They have no high fructose corn syrup and are cane sugar so they aren't horrible plus they are only 40 calories each :)

I used to freak out and totally loose control of what I ate when low, specially when its in the middle of the night but what worked out for me is basically, not getting to the kitchen. I keep juice cans EVERYWHERE, that are 15 carbs and so, as much as I can, I will take one and sit down wherever I am and just..try not to freak out while I wait. I know that if there isnt any juice near and I get to the kitchen..its like open door to indulge on pretty much anything and I end up running super high...
x.x
Its good to know Im not the only one that has this issue!

I didn't know that, K. I will tell my husband - he always eats candy and doesn't measure it out. I'm sure it's not good for him. If I can present him with a good reason to stick to glucose tabs, hopefully he'll move on to those! And the chart you mentioned will be really useful - thanks. I will check it out. Juice doesn't do it for him at all - just seems to go nowhere, get lost in a black hole. He would have to drink at least a litre of it but often feels a bit nauseous when he's low so he won't touch it. Our 5yo T1 Isabel has fruit strips or raisins - one fruit strip is 10g or 12g and a small box of raisins is 10g. Perfect - it works every time, for her, at the moment. Or 10g of apple juice if she is thirsty as well as low.

Kerri - Pinterest while you wait? Excellent distraction.

The problem with me is I don't and never have felt those lows. I will be at 44 and not feel a damned thing. I have gone into a hospital at 35 and never felt the low. Some times it takes hours for 15 grams of carbs to raise me above 60, and I'm a type 2 on metformin. I have been told that metformin won't do that...it does. The aftermath is the worst. It takes me a day to get over the low. Who has a day to laze around like that.

Hi Brenda...1 glucose tab has 4 grams of carb, so if you eat 4 that equals 16 carbs (dang near the recommended 15). I would suggest experimenting to figure out how many you really need to take. If I'm 80ish and want to raise my BG just a smidge I can eat just 1 tab and I'll see my BG go up 10 points (I use a DexCom). If you were below 60-65 I'd start by taking 3-4 and see where it gets you.

Am I the only one who just eats straight white sugar? I know its gross, but we never have juice and its just so easy - and cheap. Only problem is that I usually overdo it. I also like the rolls of mentos, half a roll works nicely for me, and they are easy to stash in your handbag.

Try explaining this to a 2 or 3 year-old T1. Ouch. Fortunately, mine is now 4 and a half, and sort of getting it. It IS hard to wait to come up, though! And it was she who told us that the glucose tabs work faster than juice.

lows must be in the air!! had one today while writing my post LOL! and another one while at work but not a bad one. i treated with sweetarts and then some cheese and crackers instead of the usual sweetarts, and more sweetarts. i stayed level once i came back up instead of dropping again an hour later like i usually do.

Its hard to explain to your shaky, sweaty, heart pounding body at 1am that 15c will do it...so for these horrid extreme lows I just say screw it and eat damn it! :) My bad, I know.

I think the diet Coke mention is what I should try! Good one! How about also eating carb free foods after ingesting the sugar? I might try that too!

I hear ya Kerri...Ive eaten about a box of cereal many times when crazy low. Im sure that totals around fifteen thousand carbs too!

This was such a timely post! Just up in the middle of the night now treating a high that came from over treating a low. Thanks so much for the encouragement in the post and all these comments!

You may hate me for this, but I calculate the number of carbs I need to raise my BG to my own personal target level (90). If my BG is 40, I need to raise it 50 points. One carb raises my BG 3 points, so I divide 50 by 3 and get approximately 17. Four glucose tabs will do the job. This works well for me, unless I have some insulin on board (IOB). With my pump I can always see the IOB and adjust the number of carbs I eat accordingly. I would obviously need more carbs if I have some IOB. I am able to think clearly enough to do these calulations if my BG is 35 or greater. I have been below 35 only once in the past 5 years. With 66 years of type 1 under my belt, I have had lots of practice. What works for me might not work in the same way for you!

I am right there with you. Unfortunately my lows usually hit in the middle of the night. I like to call these "Zombie Lows!"

I raise from my bed like one of the undead looking for brains to eat...I mean carbs. I shamble downstairs in my zombie like fugue state of the low. I head towards the fridge intending to get that one glass of juice. Then I see something tasty in there and think “that might help sate this vicious monster low.” I begin to devour it when I hear more “prey” calling from the pantry.

Before I know it about fifteen to twenty minutes have gone by and I am left feeling better…normal…human once again. I look around and see I am surrounded by the ruminants of that night’s victims (candy wrappers, crumbs from breakfast bars, the empty glass of juice, and other tidbits.) I suddenly feel like the Wolfman or Dr. Jekyll after realizing what it is they have just done as their other selves. I quickly hide all the evidence and scurry back to the safety of my bed.

The next morning though I can no longer hide from the deeds of the prior night. I wake up with that feeling of having just eaten my pillow. The nausea in my gut…the stirring in my head…a quick look at Dex, and finger stick later is all I need to confirm that I am high.

I promise myself, that I will have more control, that I will not let myself get low in the first place, or that if I do I will have just that one glass of juice and let my body do what it should do. I tell myself these things, and I convinced I will do it, be the good patient. I know however that it will only last until the next attack of the “Zombie Lows.”

Monty
@BakersfieldRPG

I've tried to find the Dr. Bernstein table online (fyi, the book is called "Dr. Bernstein's Diabetes Solution" and no, I don't work for him and have no links to him!), but it's copyright protected (fair enough!).

That said, if you're searching, it's table 20-1 in his book (page 235 - though I'm not sure whether that's in the latest edition or the older one). It's a chart along the lines of: if you weigh 100 lbs, 4g glucose (1 tab) will raise your BG by x; if you weigh 110 lbs, 4g of glucose will raise your sugar by y; if you weigh 120 lbs, 4g glucose will raise your sugar by z.

So you just need to figure out how many glucose tabs you personally need to take according to your weight and according to how low you are and according to how high you want to end up. Don't try to do the math when you're low. Figure it out ahead of time and it becomes second nature, like carb counting.

I'm still surprised at the accuracy.

There are explanations elsewhere in the book about the chemical process and why taking glucose vs juice vs a slice of pizza significantly impacts how long it takes your body to break them down, convert the "pieces" to glucose and ultimately deliver that glucose to your cells. It's only once the glucose reaches your cells that you'll feel better.

Quite an eye-opener (without being overly technical or scientific).

I definitely go on the eating warpath when I'm low. And it's so hard to fight, and I'm already feeling so miserable from the low that it's extra torturous. So I usually keep eating, but just steer myself clear of carbs - a stick of string cheese or a handful of nuts or something helps satisfy the intense need to shove food in my mouth, but it won't set me on a rollercoaster path!

Last year I submitted the term "Tsunami" to your book Terms of Endearment.

Tsunami: Defintion to over treat a low in panic and resulting in a higher BS later. Here are my tools to follow the 15 minute rule:

1. Cell phone in front of me. Just in case I am not able to recover from this on my own. Also it is my 15 minute watch.

2.15 grams juice box (lined up next to each other)

3.Meter

4.Sit Down do not move until your brain turns back on.

Just to add to K.'s comment on Dr Bernstein's book. I have also found a chart of Proper treatment for low blood sugar dosing amounts. How many carbs needed in reference to body weight/BG level. It is contained on pg 223 of "think like a pancreas" (Gary Scheiner) which is a great reference book. Worth the investment to add to the Diabetes library.
Christine

Okay, I know this sounds totally weird, but, similar to the Diet Coke approach, I will eat packets of artificial sweetener when I'm panicking. It works surprisingly well to fool my body into thinking I'm doing something meaningful. I just try not to be seen, because it's pretty socially unacceptable...

My son and I both use Airheads. They are 15 grams each, flat so we can keep them in our wallets, testing kit or pocket when we are on the road. They are easy to open.

We also have the small juice boxes on hand at home but it's frustrating to get the straw in the hole when your fingers don't want to cooperate.

i also find that after a low blood sugar

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