Ask D’Mine: On Overtreating Lows, Control-Freak Loved Ones

Do you sometimes freak out when your blood sugar plummets? Have a loved one who freaks out with worry over these situations?

You will not want to miss this week’s edition of our diabetes advice column, Ask D’Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois. Read on…

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

Lou from Florida, type 1, writes: Lows are so scary. There’s that moment when you feel totally out of control and are stuffing things in your mouth to avoid passing out. But then later, your doctor scolds you for “over-treating” lows. In that scary moment, I can’t help myself. Do you have any tips on how to avoid over-treating?

Wil@Ask D’Mine answers: Lows are an unavoidable side effect of diabetes treatment with insulin, and with some diabetes pills as well. But opening the background dossier on type 1 hypos, I see that not all low blood sugars are created equal. Insulin hypos tend to be more aggressive, faster, and deeper than pill-triggered hypos. Also, hypos from fast-acting insulins tend to be more wicked than those from basal insulin. Both type 1s and 2s can get hypos, but as the body’s built-in protections against lows are broken in T1s, our lows tend to be more dangerous.

I think that about covers everything, background wise. Oh, wait a minute. I forgot one little, itsy, teeny, tiny fact. Your brain runs on sugar and it doesn’t run very well in the absence of sugar. As your blood sugar drops, so too, does your IQ.

And I’m not just being cute when I say lows are dangerous. They can actually kill you dead. So there’s plenty of reason to be scared when you feel the  insulin hit the fan. Plus, as I said, your IQ is dropping.

Fear + stupidity = the classic caveman low where you lose all control to your primal survival urges and feed your face until you barf. At least metaphorically. What usually happens is that after 20 to 30 minutes of feasting, your blood sugar rises enough that your brain fires back up and the guilt nodes turn on. There you are in your kitchen, surrounded by empty cereal boxes, candy bar wrappers, and half-empty tubs of Häagen-Dazs, with assorted crumbs scattered down your front and across the floor. You blink once. Twice. Who am I? Where am I? What the hell just happened? And then, of course, it all comes back to you and you feel guilt, anger, and shame all at the same time.

Now on the medical side, your doc has two legitimate concerns (neither one of which justifies a “scolding”). First and foremost, over-correcting triggers what’s called a rebound excursion. No, it’s not a tropical cruise after a breakup. This isn’t an excursion you want to take. What happens is, you yo-yo from dangerously low blood sugar to dangerously high blood sugar. The level of the high can be perilous and the speed which it happens can be damaging. Secondarily, if you have weight issues, you just added an extra meal’s worth of calories to your day. No shit, frequent lows can make you fat.

Of course, any non-diabetic medical professional will tell you that to treat a low, all you need to do is ingest 15 fast-acting carbs, calmly wait fifteen minutes and then retest. If your number is lower or flat, ingest another 15 carbs. Wash. Rinse. Repeat. Once you have a rise started, even if you’re still very low, you’re to stop eating. Like the economy, once stimulated, it will recover. Eventually.

But any non-diabetic medical professional has never had a caveman trapped inside, fighting to get out. Sometimes I can keep my head when I’m low and do it “right.” Other times my life and the lives of my loved-ones-without-me flash before my eyes and I lose it, grab my spear, and go kill me a mammoth.

So what to do? Do I have a tip? Of course I have a tip—but it’s more like a parachute than a tip for avoiding the plane crash in the first place. Once the caveman is loose, there’s no stopping him. But you can do something about the excursion. As soon as your wits return, you need to survey the damage. What did you eat? Be honest, 15 carbs doesn’t generate that much wreckage in the kitchen! I don’t think anyone has studied it yet, but I’d wager the typical response to a bad hypo is 100 carbs. Hell, a decent sized hypo-serving is Fruity Pebbles alone is 50 carbs, and that doesn’t count the milk or the fact that no caveman stops at one bowl!

80-100-125 carbs. Whatever it was, be honest. Now, bolus for it.

You heard me.

Yes. I know your blood sugar is still only 70. But you just ate a wooly mammoth. You just stepped on the excursion elevator. Taking insulin when you’re still low is a hard thing to do, but it’s the right thing to do. As your blood sugar rises you’ll evolve from caveman to modern man.

Look, today’s “fast-acting” insulin arrives on the job in about 20 minutes, but it won’t peak for two hours, so it’s actually safe to take fast-acting insulin when you’re very low if you just ate a ton of crap. The carbs will out-pace the action time on the insulin. In this situation, taking insulin when you are low won’t make you go lower.

So take your medicine and call the doctor in the morning. Or maybe you won’t need to call him. If you can cover the caveman carbs right away, you might stop the glucose excursion in its tracks. When your doc sees the low and the modest rebound on your meter download, he’ll assume you did the whole 15 carb thing and give you an atta-boy.

He doesn’t need to know about that whole Thanksgiving dinner you scarfed down at 2 am. And we won’t tell him either.

Hailey from Kansas, type 1, writes: My boyfriend constantly thinks I’ve died if I don’t respond to his calls/texts within 10 minutes. It’s getting really frustrating because I reassure him that I set alarms and check really often, but he still freaks out. Any advice?

Wil@Ask D’Mine answers: Now… let me see… you are frustrated and he is freaked out. This is classic F&F, which can lead to an F’d up relationship. Well, at least it’s clear he loves you. And at least he cares enough about you to learn the fact that your diabetes, in theory, could kill you. So I’m liking him already.

Still, some balance is in order and you’ll need to set some new ground rules. But before I get there, let’s cover some basic insurance for avoiding the whole dying thing.

Number one: do you wear a medic alert ID? If you do, you can reassure him that, worst-case scenario, if you pass out somewhere, you have this extra level of insurance. If you don’t wear one, when was the last time this boy bought you something pretty?

Number two: well, hell, I can’t think of a second thing.

Clearly, some more education for your boyfriend is in order. Help him to understand when your high-risk times for lows are. Lows are more likely 3-4 hours after a meal, in general. Or at the gym. Your mileage will vary, but you probably know when you are more likely to go low and when you are very unlikely to go low. I think helping him understand that might at least let him focus on when to worry, and when not to.

Of course, I don’t know what your work situation is like, but I think it’s fair for a loved one to worry a little more when they know you’re alone, rather than when you’re surrounded by other people.

Now, you told me you set alarms and test often. How would you feel about texting the numbers or a “I tested and I’m OK” message to your BF regularly? Is that too invasive for you? It might be reassuring for him. Maybe you could offer that in exchange for an agreement that you’ll respond to calls and texts when you can, but that he shouldn’t expect instant responses.

Oh dear.

I just heard the sound of 100 matches being lit by your diabetic sisters, preparing to flame me for even suggesting that you keep him in the loop with your testing. I can hear the arguments already. She’s not a little girl! He isn’t her father! Her blood sugar is none of his businesses!

Calm down and let me share a secret with you: Her blood sugars are his business. You think having diabetes is hard? Just try loving one of us! Put yourself in their shoes for a moment. All the same worries we have, but none of the control. Wow. Now, that’s a tough job.

So what I’m advocating for is a third “F” to go between the Frustration and the Freaking out. I’m thinking some Facts will help the relationship Function better.

Then you can both have more Fun.

Thanks for writing!

Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.