I love roller-coasters. Since childhood, I’ve always enjoyed the thrill of holding on for dear life while being thrust in 37 different directions racing on a track high above the ground. What I don’t like are blood-sugar-roller-coasters. Those days when the sugar and the insulin can’t seem to balance….and it feels like someone spiked your drink with Red Bull and Vodka, then handed you a math test.
I’ve had many of those days. And the worst part: I caused most of them. There are a number of things that can set off a blood-sugar-roller-coaster, but here I will focus exclusively on hypoglycemia. Below are the guidelines from the American Diabetes Association’s website on the management of hypoglycemia. The ADA defines general hypoglycemia as below 70 mg/dL, but acknowledges that symptoms may occur at a range of numbers. Here’s the protocol:
- Consume 15-20 grams of glucose or simple carbohydrates
- Recheck your blood glucose after 15 minutes
- If hypoglycemia continues, repeat.
- Once blood glucose returns to normal, eat a small snack if your next planned meal or snack is more than an hour or two away
This protocol will unmistakably correct mild to moderate hypoglycemia 100% of the time. However, it will also cause (I’m going old school here) “rebound hyperglycemia” much of the time. In other words: blood sugar low -> treat…..1 hour later: blood sugar high -> treat. If it stops there, you’re good. But many times it doesn’t. Hence, the blood-sugar-roller-coaster.
Now let’s be clear; hypoglycemia can be very dangerous, and is certainly nothing to ignore. But the blood-sugar-roller-coaster can ruin your day as well. So what gives?
It’s helpful to think of corrective glucose as if it were a medication that reverses the action of insulin. Let’s say you’ve determined that a blood sugar of 195 mg/dL requires about 2 units of insulin to return to normal range. But 250 mg/dL requires about 3.5 units. In essence, it takes a ratio of insulin to blood glucose to affect a desired change. But have you ever used glucose in this way to treat hypoglycemia? I’m sure you have at some point, without even thinking about it. Sometimes the lows hit hard and we eat the kitchen. But what if your reading is 65 mg/dL? Do you treat it the same as if it were 60 mg/dL? Or 58 mg/dL? Do you take into account situational circumstances, such as activity level or insulin/food on board?
Each person’s metabolism will react differently to sugar, so there’s no standard “sliding scale.” You’ll have to put in the work of very carefully tracking hypoglycemia treatment and post-hypo blood sugars to establish a baseline. The following are 2 personal real-world examples of hypo treatment that have worked well for me in the past month:
Scenario 1: Simple Dip
Setting – typical workday (sedentary job) about 10am. Nothing out of the ordinary happening. Felt hypo coming on.
CBG Reading – 67 mg/dL.
Treatment – 1 peppermint (approximately 4-5g carb).
Results – Symptoms subsided within 10 minutes.
Post-Hypo CBG – 79 mg/dL after 1 hour. 82 mg/dL after 2 hours. No rebound hyperglycemia.
Scenario 2: Active Insight
Setting – ADA Tour de Cure 50 mile bike ride; mile 24 rest stop (26 miles still left to ride).
CGB Reading – 56 mg/dL.
Treatment – 10 minute break. 1/2 banana (approx. 15g carb), 1/4 cup peanuts (approx. 5g carb), 1/2 pb&j sandwich (approx. 30g carb). Total carb intake = 50g. 2 hour extended bolus for 20g carb excess (bread and peanut butter on sandwich). Net correction glucose = 30g carb.
Results – No problems finishing the ride.
Post-Hypo CBG – 74 mg/dL at mile 37. 88 mg/dL post ride. No rebound hyperglycemia.
I once heard someone say that you must be smart to be diabetic. I would say that’s not entirely true. Anyone can be diabetic. But if you want to enjoy life, you must become a student of biology, nutrition, math, and your own body.
I hope this post gives some insight on treating hypoglycemia and avoiding the blood-sugar-roller-coaster. Leave me a comment about your most recent low and how you handled it. ‘Til next time; let’s be less than 7, greater than low!