Going to Extremes Part I

Think Like a Pancreas: Chapter 9, Your "Going to Extremes" Cheat Guide!   

Part I

You worked out, you ate a glorious breakfast, and in the midst of trying to calculate the many factors that affect your blood sugar, (your workout, your Lantus, your hormones, your stress, what you ate yesterday, the fiber, fat, sugar, carb, g.i. content of your meal, etc.) you calculated wrong—it happens. 

While the results of mis-dosing are obvious (going high or low), it’s important to know the risks and realities of what’s occurring within your body…. or what could occur.

  1. You took too much insulin = low blood sugar (hypoglycemia). Mild forms are easily self-treated (by a rapid acting snack, or lowering dosing), but severe cases may lead to loss of consciousness, seizures, coma, or death. 
  2. You took too little insulin = high blood sugar (hyperglycemia). This is treated with correction insulin in most cases, but if it’s severe enough, your body could enter DKA (diabetic ketoacidosis), which is a life threatening condition. 

The Science Behind Hypoglycemia: 

Low blood sugar affects virtually all systems of the body—but mostly the brain. 

Repeated or prolonged bouts of low blood sugars have the potential to cause permanent mental impairment. I.e. Don’t take it lightly!

Mild Lows—Symptoms generally occur around 70, but they can also occur from a rapid drop from very high towards a more normal level. Adrenaline triggers: rapid heartbeat, sweating, shaking, hunger, and anxiousness. 

Moderate Lows—50’s or 40s the brain begins to lose the ability to function. It’s traditionally accompanied by dizziness, weakness, & slurred speech. 

Severe Lows—An extreme or extended sugar drop can cause you to pass out or seizure. Very severe can cause coma or death. 

Oh…. the joys of Type 1 [insert indifferent face here].

DEVOlution of Symptoms:

In a gist, this means your symptoms do not evolve… they breakdown, devolve over time. 

Also known as “hypoglycemia unawareness”. 

The more lows that you have, the less likely you are to experience the warning signs (symptoms) the next time. Your body essentially adapts!

Treatment of Lows:

There is no one size fits all approach.

Factors in treating include: body size, current blood sugar level, and the rate of change (are you still dropping?)

All carbs aren’t created equal. Some will raise your blood sugar quickly, others not so much. 

Chocolate, ice cream, whole fruit, milk, are not the best choices for treating lows—I think this statement depends on how low you are of course (if you are 40, no, if you are 60, I think it’s fine). 

Higher GI go-to’s like juice, cereal, bread, and dextrose-containing foods will raise your sugars quicker.

Be mindful of over-treating (despite feeling like you want to eat the entire house). Be patient. If you over-eat, be sure to give yourself a few units to cover the excess carbs and avoid a spike.

Preventing Lows:

1. Dose properly. 

  • If you are on low doses (less than 5 units per injection) look for pens that offer half-unit markings.  This will allow for fine-tuning and more precise dosing. 
  • Calculate mindfully—a single incorrect calculation can send your blood sugar spiraling downward…I know, easier said then done--numbers are not my thing. 

2. Wait. 

  • Give your insulin time to work! Rapid acting insulin typically takes 3-5 hours to finish working. Be mindful of active insulin within your body before injecting to correct a high. This will help reduce lows!
  • Calculating your dose for your current meal should be based on the blood sugar 3-4 hours after your last meal. 
  • Stacking your doses and eating back to back will increase the likelihood of lows. 

3. Timing.

Low glycemic foods and high glycemic foods will raise your blood sugars at different rates. Considering the fat, fiber, protein, carb, sugar, content is really important when calculating and timing your dosing. 

4. Discount Fiber.

Always subtract fiber from total carbohydrate before calculating. 

5. Adjust for Exercise & Activity

  • Muscles cells uptake of glucose is increased with and type of activity. 
  • Reduction in basal and bolus is typically necessary for prolonged/strenuous activity. 
  • Following all exercise, you should make adjustment to prevent a delayed blood sugar drop. 

6. Alcohol.

Alcohol can cause a delayed drop in blood sugar by suppressing the liver’s secretion of glucose. Extra snacks, lowering basal, and decreasing your meal-time dose is something to consider based on the amount consumed. 

7. Check Check Check!

How often are you checking your blood sugar? Obviously you don’t want to be too obsessive but frequent blood sugar checks will help you monitor trends and GI of foods you would otherwise not realize spiked you so quickly! 

8. Continous Glucose Monitor

While not necessary, a CGM is a great way to get a picture of trends and high’s and low’s you could be unaware of. The less control you have, opting for a CGM may be just what you need to better your management of blood sugar levels. Alerting you for lows, or even anticipated lows is a great tool to reduce risky/life threatening lows!

Dealing with Postmeal Highs:

……..Stay tuned for next week!