Going low on the road with prediabetes



Randy Ritchie has never shied away from taking charge of managing her health. That’s not a small task since Ritchie, 70, lives with multiple chronic conditions.

When Ritchie was first diagnosed with prediabetes in 2006, her healthcare provider suggested some lifestyle interventions. Otherwise, she didn’t get much diabetes education, despite a family history of type 2.

Ritchie had seen her mother, uncle and two siblings live with T2D. Yet, after her prediabetes diagnosis, she realized she didn’t know much about diabetes or diabetes management.


Ritchie is a natural researcher. She went to her insurance to ask to be paired with a nutritionist or certified diabetes educator.

“I was told I could have one visit per lifetime,” she said. So she hesitated.

“I was afraid I was gonna need it later,” Ritchie said. “I mean, how do you throw that away and then all of a sudden you’re insulin-dependent and possibly have other health issues?”

The bulk of the information she was finding online was focused on T2D, not prediabetes, and sometimes didn’t feel specific to her circumstances or needs.

Ritchie poured over online forums, which were more scarce 15 years ago than they are today—where there’s a thriving, connected community on platforms like Beyond Type 2.

“It was the practical experience” shared by others that really helped Ritchie, she recalled. She learned when to check her blood glucose to make the most of her test strips, and was told about the dawn effect.


Ritchie lives with a number of chronic health conditions, including lung and kidney disease. Changes in how she manages one of those conditions often affect another, like her prediabetes.

Sometimes she’d have to argue her case for changing or discontinuing treatment to a doctor who wasn’t treating her diabetes because of how it was affecting her blood glucose.

At one point while taking a steroid medication for a lung condition, her A1c rose into the sevens. “My fasting blood sugar was up in the diagnostic range for type 2,” she said. Despite this, she was never formally diagnosed with type 2 diabetes.

Looking back, she thinks her healthcare team was focused on her lung disease and wonders if her diabetes deserved more attention. After discontinuing the treatment, her A1c dropped again.

Certain medications can increase your risk for severe hypoglycemia. If you are experiencing lows, speak up to your healthcare team. It’s important to always advocate for yourself and that your concerns are addressed.


Despite her lower A1c results, Ritchie experiences big swings in her blood sugar levels. Her levels are often high in the mornings and she also has to watch for signs of low blood sugar, or hypoglycemia.

Hypoglycemia is when your blood sugar level drops below 70 mg/dL. Severe hypoglycemia is when your blood sugar level drops below 54 mg/dL. Having low blood sugar is dangerous and needs to be treated right away. Left untreated, hypoglycemia can lead to unconsciousness, seizures, and though rarely, death. It’s important that people around you know how to help.

Looking back, Ritchie can remember episodes consistent with hypoglycemia in the years before she understood what it was.

“I’d come in from gardening and I would just be sweating and shaking,” she said. Back then, she attributed the symptoms to another medication because she’d never been educated on what to look out for and how to treat low blood sugars.

As someone with prediabetes, she wasn’t warned that she may be at risk until she had blood glucose readings that showed she was, in fact, going low.


Ritchie and her husband moved away from Ohio for her husband’s job in 2000. Over the last two decades, she’s made regular trips back to Ohio to see family, including her grandchildren. She became used to making the 15 to 17-hour drive from Georgia or Florida back home by herself.

After a while, she found herself frequently experiencing low blood sugar while on the road. There would be times when “all of a sudden, I’d have to pull over. I felt like I was going to pass out,” she said. “I would start to get the narrow tunnel vision and sweat and shaking, palpitations and sure enough, I take my blood sugar and it would just be horrific.”

So Ritchie started to plan ahead. She’d load up her car with snacks and make hourly stops to check her blood sugar levels.

“I would keep it a little bit high when I traveled so that I wouldn’t go too low. If I was starting to skate down around 100ml/dL I would snack while I drove,” she remembered.

Nonetheless, blood sugar would sometimes drop into the low 40s.

“I got stuck at the side of the road at night more than once. I almost blacked out and I thought, can’t do this, it’s just way too dangerous.”


Her husband and children often don’t take these low blood sugar episodes seriously, even when it takes her one or two days to regain her strength.

“I feel very weak. Like I have the flu—vomiting and fever,” Ritchie said. “It’s like a malaise. I don’t feel safe to get in the car and even go buy myself a cup of coffee.”

Severe low blood sugar is hard on your body—it can take up to a day and a half to recover from the impact on your mood, mental state and cognitive function.

Even when corrected quickly, hypoglycemia has lasting effects. Research shows low blood sugar events can trigger inflammation in the body that can last up to a week—regardless of if you have diabetes or not.

When this happens, Ritchie focuses on resting and reestablishing the day-to-day routines that help her manage her prediabetes.


For Ritchie, making the long trips is no longer worth the risks. Staying close to home means her diabetes and health feel more manageable, though she misses her grandchildren.

“All you need to do is find yourself on some Georgia back road after you’ve gotten off of a highway and you haven’t got a clue where you are because you’re so stinking confused and dizzy—It doesn’t take much to scare the bejesus out of you,” she said.

Managing multiple chronic conditions can have a big impact on your daily life. You are your own best expert on understanding your specific needs and knowing what is best for your wellbeing. Your health and safety should always come first. Making those tough decisions isn’t easy, be proud that you’re doing your best to live with prediabetes or diabetes!

Editor’s note: Educational content related to severe hypoglycemia is made possible with support from ​Lilly Diabetes. ​Editorial control rests solely on Beyond Type 2.

This content mentions Lilly, an active partner of Beyond Type 1.


A person cannot simultaneously be pre-diabetic and have diabetes. No PCP or specialist other than an endocrinologist can be expected to be knowledgeable about the diagnosis and treatment options for diabetes today.

If a person’s A1C has been in the 7’s their BG was chronically elevated. They aren’t pre-diabetic. They are either marginally type two or in early stages of LADA. A proper differential diagnosis requires testing with no preconceptions.

So with multiple health conditions and elevated BG, rather than ask for a referral to a nutritionist it should be to an endocrinologist.

If your BG was chronically high, your body needed more insulin. That could have been produced in greater amounts by your body in response to drugs like metformin.

Uncontrolled, unmonitored high BG is as dangerous as uncontrolled, unmonitored low BG. With an A1C of 7, that means half the time yours was higher. You have no way of knowing how high it was unless you tested it when it is high, and no way to know when it was high.

As far as diet, treatments for health conditions other than diabetes can effect digestion and raise or lower BG. Medications might possibly put restrictions on what a person could eat while symptoms of other conditions might effect what a person was able to eat and whether they can tolerate it.

None of that changes basic biology.

When your BG is low you need to raise it with carbs. To prevent that you need to 1) know what your BG is, 2) eat wisely, and 3) have testing equipment and a source of carbs and water with you. A basic OTC BGM can be used to check before driving to see if you need to eat something. A container of glucose tablets, a package of granola bars, packaged cheese/peanut butter and crackers, and several bottles of water kept in the car can provide enough carbs to prevent, deter or reverse hypoglycemia and provide enough protein and fat until a proper meal can be obtained.

Most of the many books written for persons with type two or type 1 diabetes have sections on basic nutrition and a balanced diet that are applicable to anyone. The same is true of books written for persons with other specific health conditions. They virtually all advocate a diet of moderation with one or two components watched more carefully than others.

imo, A good starting diet would be one suitable for someone with type 1 diabetes. As a chronic disease that is degenerative, most people who have it eventually develop other chronic conditions. They need to learn to manage their BG in spite of whatever else happens to them. The basic diet is healthy, balanced. If measured and documented they can develop an acute awareness of how what they eat effects them and make changes to it as they learn from their experiences.

One thing to note is that carbohydrates are the component that is watched most carefully in a diet for persons with diabetes. Simple carb snacks for a low can cause BG to skyrocket and then crash. The rapid drop can produce symptoms of hypo while BG is still at “normal” level.

I’ve experienced a lot of lows and have a strategy for responding that might work for you.
I found that simple carbs will raise my BG by 3 ml/DL/gram. I want to stop dropping below 70. When I test, if below 100 I test twice at 5 minute intervals.
If above 70 and dropping I take 3 tabs (12 gram), if below I take 4. I drink water, wait while sitting erect for 15 then wash my finger with water and retest.
If my BG is then rising, I wait another 15. If still dropping I take 2 tabs and repeat at 15 until it rises.
Once above 70, I “correct” to 110 md/Dl with cheese(peanut butter) and crackers. The packaged crackers product has enough fat and protein to slow down absorption.

Pre diabetes is diabetes. It’s just on a continuum.
This way you might hold off the disease by making healthier life choices or keeping an eye on it in case it gets worse.
So you can add insulin or other meds.

An A1c over 6.5 means for certain your sugars are spiking over the 180 spill point at least some of the time.

That 180 wasn’t just made up, it’s in our genes.
It’s also where glucose starts to damage our bodies.

So if someone says you are pre diabetic, it means you are diabetic but not bad enough to cause long term complications.

If you are diagnosed as having diabetes, it means you are in the range where you are damaging your body unless you make some kind of changes.

Just because you lose weight and eat better and your glucose comes into range, doesn’t mean you are no longer diabetic. You are, you are only managing it.

Just like when a type 1 gets into range, we aren’t non diabetic. We are taking insulin to manage it.


I’ve read many stories of T2Ds who go low carb, restore normal blood glucose, stop all or almost all diabetes medications long term, including insulin. If they return to their former high-carb, high-fat way of eating, however, their glucose control erodes. It’s as if their diabetes is placed into remission – it’s not cured.


Pre-diabetes and diabetes have different diagnostic criteria. Prediabetes is defined with numbers that correspond to high normal blood glucose levels with impaired response to load that can be managed with lifestyle changes. Diabetes is defined as a response that requires management with medication or insulin supplementation.

Diabetes itself is not one disease with a “spectrum”. The only spectrum is the degree of one SYMPTOM - glucose level in the bloodstream. Pre-diabetes does not always invariably progress to diabetes if the organic cause (there are several) can be addressed.

Insulin deficiency and insulin resistance are associated, but it is possible to be insulin resistant, to have an alpha cell imbalance, a liver that is being overstimulated to release glucose, or malfunction or cancer of one of the several organs involved in metabolism without having an absolute insulin deficiency.