A Fine Line
Dealing with the slippery slope of blood sugar lows
February 2014 — When I'm 80 mg/dL, I don't feel low. This is a plus, because I try to keep my blood sugars in-range as much as possible, so it's convenient to not feel terrible when I'm at the lower end of in-range. But there's uncertainty built into seeing a blood sugar of 80 mg/dL, since I immediately picture it on a slippery slope towards hypoglycemia.
"80 becomes 70 pretty quickly. Which can become 60 really fast. Which is really close to 50. Which is a tick away from 40. Which is awful," rattles off the voice in my head, acknowledging the thin line between "fine" and "hypoglycemic," and how quickly a blood sugar can slide.
My low blood sugar symptoms have lost their intensity over the last few years, plunging me into the darkness of hypoglycemia unawareness, where I'm unable to distinguish between in-range and low. I used to feel shaky, and my mouth would become numb, around the 68 mg/dL range, but now it takes a blood sugar in the 50's and 40's before I start to feel the symptoms start to burn. I'm always working to tighten up my blood sugar control, so I think my body got used to running a bit lower at times. It's good for my A1C but very dangerous for my ability to detect blood sugar lows. This is part of why I value having access to a continuous glucose monitor, because that machine can give me a head's up when my blood sugars are starting to tank.
But even with a CGM, there can be really scary low blood sugars that shake my self-care confidence. A few years ago, when I was traveling for business, I had a very rough low blood sugar while I was alone in my hotel room. I remember counting the glucose tabs as I chewed them, hoping my body wouldn't give in to the waves of confusion that were lapping at my mental shores. Those kinds of blood sugar lows stick with you and can make even 80 mg/dL feel too low for comfort … at least until your confidence reboots.
It amazes me, the difference in my body's response to everything, between blood sugars that are "fine" and that are "low." Even though it might just be the difference of a few points, I can function properly at 70 mg/dL, but I'm weak and shaky at 58 mg/dL. What also amazes me is how little glucose I need to pop back up into range. Two or three glucose tabs can correct a low back into range, but it requires restraint I don't possess in order to not drink an entire bottle of grape juice in one gulp when I'm low. My body's response to a wicked low is to open the fridge and inhale the contents – condiments, leftovers, and even the weird smelling tomato in the produce drawer – without blinking. Sometimes I literally sit on my hands in order to find my hypoglycemic willpower, knowing that over-treating a low blood sugar usually results in a follow-up high blood sugar, which can start the low-to-high cycle all over again.
I'm constantly humbled by what hangs in the balance of a single glucose tab, or a sip of juice. The challenge is continuing to walk that fine line.
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dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
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Lows are really nothing new to me. In the past (almost) 22 years, I've experienced every variety of low blood sugar. Two seizures, multiple black outs, the "I'm fine" at 32, the nauseating 85, and everything in between. That certainly doesn't mean that I'm used to them or that each low doesn't feel like a new and treacherous journey. They still scare me. They still annoy me. And they still overrun my life at times. Since I've hit the gym and the calorie counting on an aggressive...