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.

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Don't go swimming right after eating lest you drown. -- Advice to schoolchildren, circa 1970.

When our gradeschool teachers started teaching us the basics of physiology, they taught us that blood brought oxygen and nutrients to our brains, our digestive systems (simplified to "stomachs"), and our limbs, and that these three systems were constantly battling for better allocation of resources.

According to our teachers, our brains always won out because they had to control the rest of our bodies.

Our legs came second, for survival reasons. The concepts of "adrenaline rush" and "fight or flight" were simplified to our grade level.

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Susanne made it through Thanksgiving and then Christmas. She prepared both succulent meals with not even one nibble. Christmas cookies, butternut squash with apples and maple syrup, honey-glazed smoked ham with pears, cranberries and cinnamon. She even joked when our daughter Maeve was setting the table, telling her to set a straw for her instead of a fork and knife.

And now her first birthday with gastroparesis. At least last year she could stick a candle in a gluten-free brownie and make a wish. This year I got her vanilla birthday milkshake and held a single candle in my hand for her to blow out. The kids gathered around the faint yellow glow surrounding the Styrofoam cup like a force field and sang "Happy Birthday." It was mildly pathetic.

She misses food. Misses it very much. I miss having food with her.

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If my online presence has seemed a bit sparse this week, it's because most of my time has been "off the grid".

Without going into the sordid details, we have been without gas and electric for the better part of the past week, and will probably remain so for the next two or three days.

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Several prominent dBloggers have posted this week about issues related to Driving While Low (DWL) and premature death. The subjects of these posts were people with Type 1 diabetes, which is the group with which we normally associate rapid-onset dissociative hypoglycemia. While this sort of hypoglycemia is certainly most common in Type 1 diabetes, it is occasionally seen in insulin-dependent Type 2. Most of the time, these lows would seem to be related to insulin activity peaking early or late -- or at least not in synch with one's food and drink.

Unfortunately, insulin is not always the culprit.

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The problem that I have with Lantus is that one dose just doesn't cut it for me. It claims a 24 hour lifespan, but honestly...it's probably more like 20 hours on a good day. Which means that my blood sugars start spiking towards the end of that injection.

That's exactly why I split my doses however many years ago. It worked, dropping my A1c like a lead balloon. And now that my schedule nearly forced me into either the insane asylum or a once-per-day dose, I'm struggling to find an appropriate time for my Lantus injection.

An evening shot wasn't working because I was having to take such a bulk of insulin that I was dropping way below my safety point by morning. And now I've switched to an early afternoon injection, but I'm afraid that looks like it's bombing as well.

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