Do You Have the Low Blood Sugar Blues?


Recognizing and controlling your blood lows is essential part of successfully managing diabetes

By Richard Rubin, PhD, CDE

My son Stefan had his first low blood sugar reaction about a year after his diabetes was diagnosed. It was a long time ago – almost 25 years, and Stefan was only eight – but even today the whole experience comes back to me in a flash. There he is, shaky, pale, and confused. And there I am, pretty shaky, pale, and confused myself, but somehow managing to get several big squirts of glucose gel – the recommended treatment at the time – into Stefan's mouth. In no time he was back to normal, though it took me longer to recover. Stefan and I got lesson one in low blood sugars that day – they are no fun!

The downside of tight control

Over the years Stefan has had lots of low blood sugars, partly because he works hard to stay as close to normal as possible and sometimes slips a little too low. That's the downside of good control for many people who take insulin, and that's why it's so important to avoid as many lows as possible and to quickly treat the lows you can't avoid. Fortunately, Stefan manages that well, so he's able to stay close to normal without paying a big price in low blood sugars. He's almost always able to recognize when he is going low and get himself back to normal as quick or quicker than we did that day 25 years ago.

But Stefan has had his share of bad lows, mostly when he was younger, lows he couldn't manage himself because he was so out of it. A few times he even passed out and we had to give him glucagon to bring him around. (I'll say more about glucagon later.) Once he was even taken by ambulance to the local hospital emergency room while I was running a race and he was in the care of someone (my brother) who panicked a bit when my son got low and called 911. I crossed the finish line of the race, heard the news, and kept running the 5 blocks to the hospital, where I found my son, perfectly fine. Well, better safe than sorry.

Better safe than sorry

When it comes to low blood sugars, better safe than sorry is a good motto. Any low blood sugar is uncomfortable, and it can be embarrassing, as well. I've heard countless stories, most of them really funny after the fact, about people doing some very unusual things when their blood sugar levels dipped too far below normal. Like the lady who got a little confused, mistook her kitchen for her bathroom, and flipped down the door of her oven and sat down, thinking she was on her toilet. Or the man who made a similar mistake, only the object he mistook for a toilet was a window fan that happened to be on at the time. Fortunately no serious harm was done in either case.

It's not a coincidence that both of these lows happened at night. More than half of all lows and an even bigger proportion of serious lows happen while people are asleep. That's because when you are sleeping you aren't likely to be aware that you are low until you are really low, and then you aren't in the best shape to take care of yourself.

Do you know when you go low?

Some people have trouble recognizing lows even when they are awake. This includes people who have had diabetes for many years, whose bodies gradually stop making the hormones that cause symptoms like sweating and shaking that let them know they are going low. If you have this trouble, it's really important to find some remaining sign. Most people can do this. One man I know said his signal was a little tickle in the back of his throat. He's the only person I've ever known who had this particular sign, but it worked for him. What's your most reliable sign of low blood sugar? Yours could be unusual, just like the man I mentioned.

Even if you generally know you are going low, you can lose that ability for a few days after you have a low. So whenever you do go low, be extra careful the next two or three days to avoid lows, because you might get one without your usual warning.

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Last Modified Date: May 04, 2015

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