I’ve been having more lows recently with the hot weather.
I think the ongoing heatwave coupled with my period ending has got my blood sugar thoroughly confused. Some days I need double the insulin at one meal, then the next meal I’ll need just half. It’s my first summer with diabetes, so it’s been a bit of a rollercoaster.
But… that means I’ve worked my way through some glucose tabs I had open and get to crack open some new packs.
My usual go-to flavors are cherry and black currant Dextro Energy tabs, both of which are 1.3g carbs each. They work fine, but I was ready for something different.
These are dual-flavor tabs and they’re 2.2g carbs each and they’re delicious.
From left to right, we have:
Mango and passion fruit (the best!)
Raspberry and apple (good)
Cherry and banana (not my fave, but DH thought I liked them last time I bought them so he bought me another box)
I decant my tabs into small tubs that I can keep around the house, beside the bed, in bags and in my pockets. Tabs seem to all come in boxes here in Germany, so the plastic tubs are more convenient, less likely to open in my bag, and waterproof. I usually use the small tubs when I go for walks (they’re the perfect pocket size) and then refill them from the big tubs when I get home.
Summer can be a tricky time with type 1. I’ve been type 1 for 47 years, and the one mystery that I always had was why am I so prone
to low BG when it’s warm out? I finally found one Emergency room doc that gave me the clue. The reason maybe because when it is warm out, your capillaries dilate when you get warm to cool your body, and that may allow your insulin to be absorbed at a faster than normal rate.
I have brought this point up with every endo I’ve had over the years and they tell me that it doesn’t work like that.
That being said, I have figured out all the numbers, and I can make my blood sugar work better but not perfect in the heat. Spring and fall can be more tricky with the sudden change from warm one day and cold the next.
Talk to your endo, and bring up the point about capillary dilation when it’s warm. They might be able to help with the numbers. If not, remind them that it is a combination of both anatomy and physics. When the human body (a.k.a. the patient) gets warm, blood is pumped closer to the surface where our pump and/or Multiple Daily Injections (MDI) place the insulin into our bodies. Your endocrinologist knows a lot, but sometime they don’t think about the simple things.
I hope this helps. If you have trouble getting your endo on board, let me know and I can give you some tips about how to talk your endo thru the simple physics.
This is pretty much exactly the sort of thing I was looking for when I was diagnosed. Then I found these small tubs and they work pretty well.
My keychain consists of a house key and a mailbox key, so it’s small and usually tucked away somewhere safe in my bag. My pockets, with one of these small tubs, is easier to get to, but I’ll look these up if I ever want to change.
I’m not sure how well they’d fit German glucose tabs, though. Ours sound like they’re smaller than the ones they say fit - I haven’t taken measurements, but my round tabs are 2.2g carb each and my square ones are 1.3g carbs each. It sounds like glucose tabs in the US are 4g carbs each. Is that right?
I’ll definitely be bringing this up at my next appointment. It seems really variable right now - I had a bunch of lows over a week, then changed my factors and had 2.5 full days where I was 100% in range (70-150) and now I’ve spent most of the last few days frustratingly hovering around 165 with a few random drops off cliff edges.
The highs were unexpected, especially after my 2.5 days in range and I’ve been trying to figure out the reason -
Covid test was negative
Ketone blood test showed .1 last night - this isn’t anything to worry about, right?
Maybe it’s my honeymoon period (I was diagnosed almost exactly a year ago)
CGM seems relatively accurate
The weather’s been pretty consistent with slightly cooler mornings, but still in the 90s most of the day
Pens didn’t get hot or cold
The start of the highs seem to line up with a long walk we did - 2+ hours out in 90F sun, with a hat, but we could have brought more water, so maybe my highs started with dehydration from that
We bought some mirabelle (small yellow plums) from a farm on our walk and they are much sweeter than the ones we’ve been getting. It’s possible my usual carb estimation is a bit low for these super sweet ones
Anything else I could consider?
Here’s my last 24 hours. The drop off is after dinner and the following rise is 10g carb treatment for the pending low (I was 82 straight down at one point), plus the food still working its way into my system even though for dinner I bolus 20-30 minutes after I start eating.
I usually have a few different speeds of glucose on me. Tabs for when I need something fast, granola bars if I need something slower and long lasting, and Skittles or Haribo if need something in between. And if we’re going out for a walk and I know there will be benches, I usually bring some fruit.
What are your low treatments of choice? Maybe it’ll inspire me to find some new options.
In Germany, they just tell us to treat with 1 KE of fast sugar, which is 10g of carbs. I can usually get away with less unless I’m really crashing hard, which seems to be happening more often these days.
It is a method to treat a hypo in a measured way to prevent over treating result in a high rise of blood glucose.
Test
If low consume 15g of glucose
Wait 15 minutes and retest
If BG is in the normal range, eat a small snack that is a mix of carbs, fiber, protein and fat to stabilize.
If still low repeat with 15g glucose and retest.
I seldom consume the whole 15g, sometimes only half a tablet which is 2g. Often I can wait a bit because my pump will drop basal to near zero, and my Alpha cells will cause a release of glucose from the liver.
When I was on MDI and before just on a long insulin I could experience some bad hypos. Before I lesrytje 15/15 method I was prone to eating whatever until I felt better. This always caused a huge spike in BG.
Thanks. I guess that means Germany’s is actually a 10/15 rule - 10g of fast-acting carbs, then retest after 15 minutes, but no snack after. If still low, repeat the process.
I also usually get away with fewer carbs when treating lows. No point in 10g and ending up high when just 2-3g will get me to a reasonable level.
I just look for something sweet in the house. It just depends on what we have. It could be cookies, pastry, chocolate milk, donuts, juice, chocolate, or whatever we have.
Most Saturdays we walk to the next town over, about 45 min walk each way. There’s a nice bakery and if I see I’m going low as we near town, I’ll try and hold out, or microdose glucose tabs (I have some that are .2g carbs each, so 5 is 1g carb… basically a placebo), so I can get a Schokocroissant (German pain au chocolat) at the bakery to share with my husband.
It’s been a while since this happened—I avoid going out in the heat—so I don’t remember how long. I do remember that I needed water, salt, and insulin to get back on track.
and now I’ve spent most of the last few days frustratingly hovering around 165 with a few random drops off cliff edges.
