I’ve been reading Think Like a Pancreas and realized it’s not normal to go low multiple times a day, every day… Haha. We convince ourselves of silly things, huh? (Still only 20% of the way through, so I’m sure I’ll learn more good things!)
I’m stoked for my next endo appointment. CGM data is changing my life!! My brain was like, “yeah, I don’t go low that often”… I was wrong. I just didn’t always check, because I can almost always feel my lows. A really bad habit that left me with no solid record. How much can my endo help me without info? I’m excited to discuss possible pump basal issues with her.
In the meantime, I still need to fix my approach to lows.
My brain feels lows intensely and hates it. I feel like I’m dying every time, even though I know from experience that I will be fine. As a result, I often overtreat… putting me on the low / high / low / high rollercoaster.
Here’s how I’m working to improve so far. Other tips are always appreciated!
Treat early. Avoid lows if possible.
For example, treat a CGM downward trend at 100 instead of at 70.
Treat small. Eat 5-10 g. at a time. I can always eat more if needed.
This amount may not apply to severe lows or to different bodies. Play it safe, just avoid devouring everything in sight for no reason.
Test often. The CGM lags 5-10 minutes.
My CGM may still show BG dropping. My brain might still feel like it’s “dying,” because glucose takes time to get into body tissues (thus the CGM lag). But a test might confirm that my BG is stabilizing or rising.
Be patient. Carbs may be faster than insulin, but they still take time.
It’s hardest to be patient when I’m going low and need to drive to work, to an appointment, etc. But more carbs doesn’t necessarily mean I’ll rise faster, just that I’ll rise more.
Set a timer if needed. Today I set a 5 minute timer when I had already treated small once. I told my “dying” brain that if I still felt so bad when it went off, I could check and treat small again. By the time it went off, I felt fine, and my blood sugar was rising. Rollercoaster avoided!
All the stuff you are saying sounds like a good plan! A very good way to approach it all and to avoid the rollercoaster.
But I wanted to perhaps put some fears to rest about your brain, because you said that your brain hates low BG. I can understand the feeling.
But your brain is okay! Your brain keeps getting glucose long after everything else is shut off.
The body is cleverly designed. The brain uses the GLUT3 glucose transport. Since GLUT3 is a high-affinity glucose transporter, only a small amount of glucose is needed to saturate it.
Even though you feel it, and you lose some cognitive function, the brain can keep getting glucose until you get to the danger point of below 40. That’s when the glucose is no longer able to get into the brain at the normal rate.
Here is a page from Biochemistry, 5th Edition (Section 30.2):
This one has been helpful for me - and only made possible by the CGM.
The one that’s not on your list that you might consider: don’t over control - you can raise your BG target. Running a little bit high is better than having a daily low, according to my endo’s. So my bolus decisions are biased down (if i think i should bolus 5 or 6, I’ll go with 5). I might run at 120-130 blood glucose (US measures) but I won’t go low during the day.
Thank you! This is a great reminder. I do tend to get frustrated when I go high, and that puts me in the high to low side of the rollercoaster… And that can be needlessly stressful.
Or: Treat big, and take some insulin. Seems counter-intuitive, but it works 9 times out of 10 for me. If I’m having a serious low or a series of lows, my “crash cart” item is a Cadbury’s Creme Egg. I inject for 25 g carb. No roller-coaster.
That is so counterintuitive – but it’s good to know! I think I can see how it works… like a delayed meal bolus sort of, instead of pre-bolusing? The treatment carbs will still hit my BG before the insulin kicks in, and the bolus would keep the BG from spiking so high so fast once it’s moving.
I’ve accidentally been doing that this week when my brain just can’t resist the urge to treat big It’s nice to really think through the method to the madness!
The last week using this low strategy has gone well! I’ve only had one rebound high!
I’ve still had just as many lows, even with no bolus IOB, but the roller coaster isn’t as high and low. I’m 40% into Think Like a Pancreas and slowly trying out basal rate tests.
Wised up and turned off Control IQ (duh!). With my basal rates obviously not being right, it was just worsening the problem. Control IQ would see a “fast rise” from a low treatment and automatically bolus a correction… instead of waiting to see my BG leveling out at 120-130 a couple minutes later, then slowly heading down again. The auto correction was just adding fuel to the next low instead of preventing the spike it was expecting.
@RachelMaraii I think your approach is pretty great! I do similarly, though while I’ve set a mental timer, I’ve not actually set one on my watch and might try that. When treating a low, I do incorporate checking the IOB and sometimes suspend any additional insulin for .5-1 hour in addition to taking 1/2 or 1 or 2 tabs worth (2, 4, or 8 carbs) depending on how fast it seems to be moving down; while I think Loop does that anyway based on projected BG, it at least makes me “think” I’ve done something. What I really dislike is going high following a treatment because i “missed by THAT much!” (Got to love Get Smart!)
Great job!!! I am type 1 for the past 38yrs and sometimes a low hits me before I know it. I went out for a walk the other day and felt fine when I left. My BG was perfect 120. I thought I would walk a little farther and by the time I got home it had dropped down to 37. Thankfully I made it home. My brain was telling me to get home ASAP but my feet felt like they weighed 500lbs. I could barely walk when I got home. Next time I’ll take a snack with me
@jim26 Right, I keep my D go kit (fanning pack) on a hook near the door. I don’t leave home without it. I know that sounds like a credit card commercial but it’s the truth & I feel undressed without it <haha I didn’t say naked)
Ah, that’s always scary!! I’m glad you made it home okay. That low BG exhaustion is no joke.
Tubes for glucose tabs are my favorite. Easily fits in my pocket. I bought 4 tubes years ago and refill them with the cheapest glucose tabs I can find! Each tube fits 10 glucose tabs, which is about 40 grams of carb. I never leave home without a tube, even for a walk around the block!
I also try to keep an Air Head in my testing supplies. I keep my license in my testing supplies too, so I know I will always take it when I’m heading out for the day. If I forget a tube or other low treatment, at least I know I have my emergency one in there!
If so, that is one of the issues with automated pumps. In addition to whatever you are eating to fix the low, your pump is turning off your basal too!
That’s one of the reasons I only use the closed-loop stuff when I am asleep.
I think you are in the same category as me. You were 2nd grade, right? I was 1st grade. We have been doing this much longer than any pump has!
If you are closed-loop during the day, I encourage you to consider just letting it do it’s thing at night, and seeing if your daytime is easier without it.
You’re not wrong, sometimes I know ControlIQ is messing me up. May be worth trying a few weeks without it during the day…
Thinking of writing up my formal complaints for Tandem too. I really have liked the company overall, but sometimes ControlIQ is rough. I’ve been frustrated recently that a doubled ControlIQ basal increase isn’t included in the IOB calculation. Why have internal restrictions on when it can auto-bolus, but not how much it can increase basal to the same effect?
230 and steady now, and just waiting it out. I’m too tired to risk another fast drop.
I think closed-loop requires a totally different mindset and a totally different way of treating.
It isn’t necessarily bad, it just requires us to retrain ourselves. Closed-loop can be super helpful if someone is unable to recognize lows.
But as far as correcting a low with only an adjustment to basal - that takes soooo much longer than just eating something! So I just take care of it myself instead, because I can still feel my lows.
Like everything else diabetes related - try it, and see how it works for you.
Haha. We convince ourselves of silly things, huh? (Still only 20% of the way through, so I’m sure I’ll learn more good things!)
I’m excited to discuss possible pump basal issues with her.
It’s nice to really think through the method to the madness!
Why did 4 hours of nighttime low treatments finally hit all at once?.. Who knows. Get me off this ride!
