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October 25, 2016
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Why Low?

In most people with diabetes, lows occur either because we've overcalculated the amount of insulin we need, or because of an impaired, inhibited, or insufficient glycogen response. While this is obviously an oversimplification, I remember reading that either autoimmunity or modern insulins did weird things to the glycogen response in people with type 1 diabetes, and I know that at least one class of oral diabetes drugs works by inhibiting, if not completely blocking, that response. Then there's the issue of undereating, or not eating sufficiently, for there to be glycogen stores that can be easily converted to fuel our bodies and, of course, drugs such as glipizide which work by stimulating additional insulin release.


But for most of us whose diabetes is controlled by diet and exercise, there should be no reason to experience lows or near-lows. Mostly, the exceptions are those of us who are neither overweight nor obese (or who have below "normal" levels of body fat, regardless of weight), those of us who are fasting for whatever reason, and those of us who are serious athletes. I fit into none of these groups.


So why have I been dealing with lows at work, or while in Queens working with my sister on stuff related to Mom's passing?


For what it's worth, as someone who is not on insulin, I don't have the ultra-low, debilitating, soak-the-sheets-and-leave-you-wrung-out-to-dry-for-days types of lows. When I experience them, they're more on the headache-bad attitude-dizziness-mind-out-to-lunch axis, and at blood glucose levels in the 70s and 80s. And I don't always feel low at that level, but since it's not dangerous at those levels, I'm generally not concerned about about it. The times I am concerned is if I test under 100 mg/dl before or during a bike ride, or before a shift at work, when I know I won't have access to caloric intake for a period of time. That said, I will test if I feel, or sense myself acting, "off".


What I have been finding are numbers in the 70s and 80s that I haven't been feeling, or that shouldn't be there, based on what (crap) I've been eating. Numbers that make no sense. Worse, I've had two or three incidents at work where I've gone into the 70s-and-feeling-lightheaded range, when my food intake suggested I should have been in the 110's (if not higher). In some ways, I'm not sure what to believe, since the cold weather and repetitive stress have been aggravating the Raynaud's to the point where I'm dealing with swollen and/or tingly fingers and hands when I lie down to sleep at night and I know better than to trust fingertip readings when my fingers are cold. That said, even my forearm readings are, for the most part, lower than I would expect based on my diet and activity levels.


One might suggest more frequent testing, during my shift at work. That's easier said than done when there's more work to be done than there are hands to do it, and each step up the store-management food chain has expectations more realistic than those of the rung below it. It's also less than practical when our shifts are kept short enough to avoid having to give us any sort of break, or when there's so much work that taking a break to which I am entitled is impractical at best.


I suspect that, like everything else with diabetes, this is a phase that I'll run through and run out of hopefully before I've gained any significant amount of weight. But that said and done, there's no reason for me to be low, and the fact that I've had these unexplainable lows is... puzzling at best. Perhaps I need to look at doing some every-fifteen-minute testing to see what's going on. On a day I'm not at work, not doing errands, not traveling to and from Queens, and not waiting around for lawyers' calls.

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