Every few years, my symptoms of low blood sugars morph a bit.

When I was first diagnosed, numb lips and quick tears were my reflex symptom. The emotional uptick would hit first, and I knew things were going south quickly once my mouth and tongue would go numb. This caused a lot of slurred speech during hypoglycemic events, an immediate tell for my parents.

A decade or so later, the numb mouth switched over to excessive sweating and very shaky hands. The tears were still a thing, though.

About twelve years ago, I lost a lot of my hypo symptoms, which left things a little ambiguous until I was already super-low, like in the 30s or 40s, at which time every possible symptom (shaking hands, sweating, crying, fumbling speech, headache) would come slamming into me. I had a lot of panic attacks at this time because my nerves were shot and fear of hypos was real.

Adding a reliable CGM to my diabetes repertoire helped mitigate that mess quite a bit. It also reinstated some confidence in being able to avoid lows, and also catch them more in the 70s and 60s range instead of free falling.

And recently – like within the last month or two – my low symptoms have shifted again. The sweating and crying seems like it’s retired for a bit and has been replaced by a feeling I can only describe as prickly, both physically and emotionally. My skin feels prickly, almost like pins and needles only not specific to a certain area. More all over my arms and shoulders and face, and with that feeling comes this wave of tension and irritability, laced with slow-moving panic that fills the space around every thought.

I felt this new range of symptoms acutely last night as I was writing. Sitting on the couch around 10 pm, I had my laptop open and I was writing when my Dexcom low alarm went off. A few Swedish fish later, I thought I had caught it in time but then the skin prickly feeling came back, along with the panic and the strange waves of discomfort. I felt almost paralyzed on the couch, but my muscles relaxed and responded to commands after minute or so, and even more so after seeing the upward arrow once the sugar did its job.

“How does a low blood sugar feel?” is a question parents of kids with diabetes ask me a lot. And every few years, my answer changes. The learning curve of diabetes is not limited to topics; it’s not like you figure out one aspect of management and then move neatly on to the next. The minutiae changes every decade or so, giving me something else to try to learn and understand and make sense of.