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Half a Juice Box.

Turn on the light.

Fall back asleep.

Press the button on the CGM to make it stop BEEP!ing.

Fall back asleep.

Unzip the meter case and take out my glucose meter.

Lapse back into sleep again; was it sleep or was I passed out and what’s the difference when it’s 4 am and your blood sugar is under 40 mg/dL?

Opting for a juice box instead of the open jar of glucose tabs on my bedside table, I fumbled with the straw and once it hit the foil-covered mark, I drank as though my life depended on it.  Because it felt, in that moment, like it did.

I was 98% sure I would be completely fine in a few minutes, with no lasting effect of the severe low except maybe a hypoglycemia hangover.  But until the juice hit my system and my brain stopped panicking, the remaining 2% of doubt invaded every bit of me.

“I wasn’t afraid I was going to die,” I told Chris, explaining the next morning why I was so tired.  “It was more like I was really aware of how close I was to a dangerous physical state, and I needed to make sure I didn’t cross the threshold, whatever that might be.”

“I wish I had heard the alarm.  We need to do something about that – you need to keep it in a glass even when I’m home, so I can hear it when you don’t.  I need to be able to hear it, too,” he said, giving my shoulders a squeeze.

“Yeah, but what’s weird is that all I could think about, as I was waiting to come up and feeling pretty awful, I kept debating whether or not to drink the rest of the juice box instead of just drinking half.  I wanted to drink the whole thing, and then fifteen other juice boxes and maybe a sandwich, for good measure.  But instead, I was sweating and shaking and confused and at the bottom of the well, you know?  And the only moment of clarity I had was limiting myself to half of a juice box, knowing it would bring me up just enough and not too much.”

Having the first half saves my life, and having the wherewithal to not drink the second half saves me high blood sugars when I wake up.  It’s a humbling moment, realizing what hangs in the balance of half a juice box.

31 Comments Post a comment
  1. Jessie #

    I think that this perfectly captures the essence of diabetes management and describes something that people who don’t worry about insulin don’t often get. There is such a fine line that is toed, so that often, many days, it feels like you are a tightrope walker teetering to one side or the other, when as much as half a juice box can tip you over the edge. Thank you for sharing.

    01/3/14; 10:07 am
  2. Deb #

    Ah, yes, the half-box problem. This is why I buy the toddler-sized 4 oz. boxes for a 23 year-old!

    01/3/14; 10:10 am
  3. I use the itty bitty ones that are 14g carbs. Perfect amount and I can feel like a giant when I drink them. 🙂

    01/3/14; 10:51 am
  4. Walter #

    Definitely been there way too many times, but I use granola bars and glucose pills instead. Did that at work yesterday, got a little loopy (sorry, Loopy, but it’s the word I use for some lows now), quartered a granola bar til I could slow down and test. Don’t think an open or sealed juice box would have fit in my pocket…and any juice on a white dress shirt would probably not have been cool.

    01/3/14; 10:52 am
  5. Brenda #

    Speaking of white dress shirts (I don’t wear them, but ^he^ mentioned them)….am I the only one who only buys apple juice boxes because of the lighter stain value?

    Tightrope…….loved that!

    01/3/14; 11:49 am
    • Bryon Clough #

      I only by apple juice now for multiple reasons. One is the stain factor. I can’t tell you how many shirts I had to throw out because of OJ stains. Another thing is the fact that I can’t stand to even smell OJ anymore. I have gotten sick and spilled so much of it that it makes me ill to even smell it. Plus apple juice is not as sticky when it spills and dries.

      02/13/16; 7:58 pm
  6. A familiar thought process — having overtreated so often that now my priority when low is NOT to overtreat!

    Lately, my typical M.O. has to been to overtreat a low, then Square-Wave a bolus for the amount of which I overtreated — over 30 minutes. This way the overtreatment brings me up faster, and the delayed bolus takes care of the resulting high.

    In theory, anyway. It doesn’t always work out as planned.

    01/3/14; 12:37 pm
  7. Gotta tell ya… I totally would have gone for the other half of the juice box. Kudos on your control.

    When I talk about diabetes to people who don’t have diabetes, I try to explain how I have to do the math every time I put something in my mouth. Lately, I’ve started to add “and that includes when I’m really low and my brain has trouble functioning properly”.

    01/3/14; 1:17 pm
  8. Jen #

    Been there. Many times. But those little four oz. glasses are a god-send.

    01/3/14; 1:31 pm
  9. Connie #

    Thanks for the “put the CGM in a glass” suggestion! We will try that! I hear it across the house, but ds sleeps right through it!

    01/3/14; 1:58 pm
  10. Angela Harlow #

    I try to explain this very thing to my husband, family, etc. it can literally create a vicious cycle. When I’m “loopy low”, my husband will try to pour a gallon of OJ in me, then when my sugar spikes to 300, doesn’t understand why or how….500 glucose tabs later;)

    I had a BAD hypo attack Saturday & after 3 whole juice boxes, I was 88, so Lord knows how low it was to start. I hate having to analyze so hard over it. Perfect post after the weekend I had! God bless my 3 yr old for calling for help bc I was home alone with her. We live a life with decisions that never even enter someone’s mind

    01/3/14; 2:24 pm
  11. Megan S #

    This is extremely well stated. This is also a reason why I have purchased the smaller Juicy Juice boxes that only contain enough juice for 15g. This way I don’t even have to guess what is half of the box when things are going downhill quickly.

    01/3/14; 2:27 pm
  12. The small juice boxes give me the ability to finish it without worrying I’ve over treated. I’m with you. I hate middle of the night lows.

    01/3/14; 2:50 pm
  13. June S. #

    You’ve explained, so very well, how confused one is when one’s BG is VERY low. I am guessing you use juice boxes that contain more than 4 oz. of juice. I only ever buy the 4 oz. ones. For me, however, I would likely have taken more than just one 4 oz. juice box, with a BG of 40.

    01/3/14; 3:17 pm
  14. lap #

    trying not to overtreat (and convincing those caring, well-intentioned people around me that yes, I know I am a sweaty incoherent mumbling mess, but the one thing you should trust me on is that I should NOT have a whole bag of skittles) is so tough.

    Since I found them maybe a year and a half ago I’ve really liked the quick sticks powdered glucose – no stains, 10g of carbs, no chewing. I use them a lot at night and when I’m out running. Plus I think the watermelon flavor tastes like watermelon nerds 🙂

    01/3/14; 5:02 pm
  15. Larry Here #

    So… the Dex isn’t loud enough. Perhaps, and I am not kidding, someone needs to rig up an AMPLIFIER for it, for nighttime…

    01/3/14; 5:29 pm
  16. Kristin #

    I can totally relate to this. I treat lows with shot glasses of juice or an OXO 1/4 cup measuring cup. For a severe low, I even get two shots, which somehow is much more gratifying than drinking half of something 🙂 I have never used juice boxes because even if I do have the will power to stop half way through, how does one know when they are half way done??? Away from home, I do use glucose tabs.

    01/3/14; 5:31 pm
  17. Yes, I too am concerned about over treating, but if I didn’t spill it all over myself and the sheets before getting in my mouth, I’d drink the whole amount. Guess I don’t function as well as you do when I’m both half asleep and low. I also have yet to convince my partner that it really doesn’t take 6 oz. of Coke to get me out of a low.

    01/3/14; 5:46 pm
  18. Emily #

    Yes. I can only trust myself with the bitty boxes.

    01/3/14; 5:56 pm
  19. Laddie #

    One thing that you should feel good about is that you still have strong hypo symptoms after so many years of Type 1. Those symptoms that make you feel so bad are also helping to keep you safe.

    Like others, I find those 4 oz Juice boxes to be perfect. I don’t know why I only use them when hiking and haven’t incorporated them into my daily life. They seem to work much faster than glucose tabs and are definitely quantity-controlled.

    The one advantage of my mostly hypo unawareness is that I very rarely am tempted to over-treat. No more multiple bowls of Frosted Flakes at 3:00AM. Thank heavens for my Dexcom which vibrates and beeps until I finally wake up.

    01/3/14; 10:42 pm
  20. I was going to say “wow, you are far more carb sensitive than I am” thinking that you are using the same 15 g boxes that I do (it’s hard to tell from the drawing). Then I read the other comments and now I’m not so sure. Each gram of carb raises me about 4 points so a 15 carb box is perfect for those 50 mg/dL lows (like last night).

    01/4/14; 3:27 pm
    • What, the drawing wasn’t precise enough? 😉 The ones I bought this time were slightly bigger, the tallish ones (Monsters Inc themed for this round) that are 24 grams per box.

      01/4/14; 11:07 pm
  21. ria #

    when I am visiting my daughter she always has clever inventions to wake her when I drop low so she hears me from the other room.
    Last one was a spoon in a glass, ( I guess I was supposed to use it as a noise maker)previous have been a “cow” bell, and last but most recent, a whistle purchased at a local sporting goods store to alert fellow hunters to an emergency.
    so far I haven,t had to use any, but am soooo wanting to blow that whistle at 2 a.m.
    (payback for the sleepless nights when she was a wild child teenager and would wander in wayyy past her curfew) =)

    01/4/14; 6:58 pm
  22. I just had this conversation about juice boxes with a type 1 friend who struggles with the same dilema of overcorrecting with juice boxes. I will forward your article to her. Oh, and your little trick about putting your Dexcom in a glass to amplify it’s sound when it vibrates is just brilliant! My Dex was so low last week while I slept that it literally said “LOW” on the display when it finally woke me up. I had been that low for 4 hours!

    01/5/14; 5:07 pm
  23. Veronica #

    It’s funny how Rich and I were just having this conversation. I don’t have as much self control as you when it comes to drinking half the juice box instead of the whole thing. I will try next time though!

    01/5/14; 5:41 pm
  24. Theodora #

    The companies that make CGMs should be sued. They make a product that they claim will save our lives if we go low but they make the alarms so soft that we can’t hear them. (I can’t hear mine if I am driving and my pump is tucked behind me, or if I’m in the supermarket, and I never hear it if I’m asleep.)

    Why is it that I can hear my mobile phone at 2 am when someone texts me with some inane piece of information/gossip but I can’t hear a device that is supposed to save my life?

    It’s about time we get together to come up with a plan. Class action? Complaints to the FDA? WE NEED TO DO SOMETHING BEFORE SOMEONE DIES.

    01/6/14; 10:59 am
  25. Allison #

    I showed this post to my husband and he said, “It sounds like you wrote that post.” I’m in my 9th year of T1D, and my mental interpretation of lows has substantially changed in the last three years. I think in the first six years of T1D I didn’t know what I didn’t know. In other words, I’d had some severe lows but I was always able to treat them myself so they just seemed like part of the landscape of avoiding complication-inducing highs. But having gotten close enough to the edge to see what COULD happen with a bad enough low, I’ve shifted my target range to feel (and be, for me) safer. That 2% of doubt you mention hits the nail on the head. And my 2% screams pretty loudly these days. I’m working on not overtreating lows. Diabetes always has a project waiting for me! 🙂

    01/6/14; 9:44 pm
  26. Roger #

    This is what I love about T1D people. Of the comments on this article, about 60% are designed sympathetic to the author (40 of that 60% remark/advise that you can avoid the temptation of the other half of the juicebox by switching to smaller juiceboxes — a little precious, but certainly well-intentioned). The other 40% are either compliments, or commiserations from people licking wounds about the quiet-alarm-dexcom problem. Such an awesome community.

    Nobody complains. You could complain about how a hypo attack nearly wasted your brain; you could complain about how regular-sized juiceboxes (designed for children) are too sweet for diabetics to put to use. We could complain about how we live in a market society more preoccupied with finding new products to package all the sugar we have to dispose of — yet I see zero complaints. Not one.

    Love you guys. If T1s ran the world, we’d all ride hover-boards and velociraptors to work, the homeless would live in mushroom palaces, and the only chocolate available at markets would be 80% cacao (or higher).

    I’ll now try and add something helpful.
    An algorithm for self-treatment of hypoglycemia exists. If you don’t love it, reject it, but you should still know about it.

    It is:
    (1)Test Glucose; if Low, do -> (2)
    (2)Dose 15 Carbs
    (3) Wait 15 Minutes
    (4) do -> (1)

    02/10/16; 4:07 am
  27. Bryon C #

    I hate to say that I have the opposite problem with my MiniMed CGM. I wish it would give me a chance to treat before setting off that annoying loud alarm again. What’s worse is that I just got the uploader to warn my wife when it is too low and now she thinks I am doing it on purpose. How about if we get a way to tell the CGM, “Hey! I’m working on it. Give me 15 minutes.”?

    02/13/16; 8:12 pm

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