Massive problems with low blood sugars

I’m a type 1, have been for 15, 16 years or so, since I was a kid. I’ve been on many different kinds of insulin in that time.

And I have a somewhat uncommon problem for diabetics. Most diabetics I know tend to have high blood sugars too often. I don’t. I’m terrified of high blood sugars, so I get low. A lot. My last hbA1C was 4.6. Immediately afterward, my doctor called me up and told me to stop getting low so much. At least 2 or 3 times a week, I trash my apartment after having a seizure because of massive low blood sugars. I pass out at work a few times a month. I get low (below 50) at least 4 or 5 times a day. I know this completely unhealthy. My coordination is not as good as it used to be, and I’m getting dumber (seriously, I’m not as fast on the uptake as I was a few years ago…though maybe that’s just age).

Anyway, I’ve talked to doctors, and they just tell me to give myself less insulin. And I’m like, yeah, no ^#$%. But I still give myself too much. I just wanted to post here and ask if anyone had a similar problem or if they knew of someone who’d done something that helped? Or of any books that might be useful. I know there are the continuous testing meters, but my insurance won’t cover it. So, basically, any help you can provide or any ideas, I’d appreciate it.

Aren’t you worried that one of these lows will happen when you are alone or driving?

Hi Anna, I think it would be helpfull to know the insulins that you are using right now.

Elaine, it often happens when I’m alone. So far, I’ve always come to…though usually I’m shaky and out of it for a while afterward. And I don’t have a car…it happened once when I was driving, and I haven’t driven since.

As to insulins, I recently got off the pump. Now I’m on humalog (or novolog) and lantus. But type of insulin doesn’t really seem to matter. I had the problem on the pump and I had it before when I was on lente…

Anna,are you thinking that the problem is in not knowing how much to properly dose, or is it that you cant stop yourself from giving yourself too much for some unknown reason?

Mostly I know I’m giving myself too much, but I do NOT want to be high, so I give myself way too much, to make sure my sugars won’t be high. I know it’s unhealthy, but…well, I don’t want high blood sugars.


I went through a period where I was giving myself too much insulin, just to avoid the highs (because as a child I was constantly told by my doctors that I was “cheating” because of my high numbers - and I wasn’t - so as a teen I overdid it - just to get that good HbA1C), but it doesn’t help you. Low blood sugars can kill you or kill your brain. Where would you be then? I think you need to test yourself more - do you have a regular blood sugar meter??? Test yourself as much as possible. I test myself over ten times a day now. I hate the highs, I hate the lows too. You need to take care of yourself. That way, you can tell if you are going low and eat something. You know that you get the rebound highs when you are too low, don’t you??? So, if you are going too low you are going to go too high as your liver tries to get you out of your hypo. I think your answer is to test and regulate your insulin. Otherwise you are going to kill yourself doing what you are doing.

Oh, please. I test a least 20 times a day. I go through a box of strips in about 5 days. And I give myself enough insulin that I don’t get high after a rebound…

Not really sure. When I first got diabetes, I was in a coma for 4 or 5 days with blood sugars of 1900. That’s probably part of it. Plus my doctors always focused on the negatives of high blood sugars, and they never really warned me about the dangers of lows. I know there are a lot of dangers to low blood sugars, but it doesn’t really stop me from giving myself too much insulin.

Anna, it sounds like your problem is this debilitating fear of highs. We all hate highs and lows (I’ve had type 1 for 18 years), but it shouldn’t be crippling you or bringing you to a state of panic or this overdosing. My suggestion would be to contact the Behavioral Diabetes Institute. They are a critical resource for diabetics who are having trouble dealing with the emotional aspects of the condition. Several of our members here have received genuine help from their staff there.

In lieu of that, I would suggest seeing if your doctor can set up a visit with either a CDE (certified diabetes educator) or a social worker trained in diabetes care. They could help you set up guidelines for how to deal with your response to your hyperglycemia fears.

How often do you test? I tested 12 times a day before I got a CGMS. If you know you’re overdosing, you should be testing at 2 hours and 3 hours after you take insulin so you can correct the lows before they reach the point of brain damaging hypo seizures. Do you keep glucagon handy?

I understand, but I am right the opposite. I tend to be very fearful of the lows. Of course, I am home alone with 2 small children a lot and I definitely do not want to pass out with them. I tend to stay on the higher side because I don’t want to overdo my insulin and pass out. I hope you find help, though because this is very dangerous. MelissaBL’s advice about the Behavioral Diabetes Institue is something you should really look into. Try anything that might help. You are in my prayers.

Anna please be careful. I have brain damage because of so many lows and trying to get that great A1C along with fears about the long effects of highs. What know one tells you is high BG kills you over time (no dka) low can kill you in minutes.
Let me tell you some of what I have lost
I know longer can write kind and respectful apologetics that helped people on 2 sides of 1 issue come to common ground.
Certain memories are gone including I no longer can recall how my youngest looked the moment she was born.
It is so hard for me to type and some times I can not so I don’t get to say what I want.
If I lose my phone book I can not call anyone I love because I can no longer remember phone numbers.
Sometimes I get so confused I have no idea how to proceed to the next step my mind becomes vacant.
I can’t remember birthdays anymore.
I could go on and on… The low BG’s also stole any logical trust I had in insulin and now I am scared to death to even take what I need to live to the point a couple of years ago I just choose to stop eating.

Lows are not good for your mind. Lows are not good for your body but they steal your mind first. I think it is great you do not want high blood sugars but you might want to think of it this way.
A person who is starving has low cholesterol numbers but it won’t matter over time what gave them great cholesterol numbers will kill them anyway. I think it is awesome your putting yourself out there. Keep learning. We are our minds it is what makes each of us who we are. Don’t weaken who you are with low’s try to get to a better balance because you have value.

Be loved

(long suggestion. I think that THIS is the post you’re looking for.)

Anna, I think that you should aggressively pursue a particular kind of psychotherapy: “Cognitive Behavioral Therapy”. Ask for it by name! What should happen is: Instead of a lot of general “fishing around” about how you feel, the therapist should do something like this:

THP: “OK, you’re afraid of going high, even a little bit. Now suppose that you did, right now, screw up and measure 250 mg/dL – what’s the WORST thing which could happen?”

Your turn: You’ll probably explain that you’re gonna get REALLY upset, angry at having made a huge mistake, angry that it’ll cause your A1c to go up, and you’d do a bolus fix-up shot, but you’ll be pissed off for the next 3 hours because the bolus will take that long to work. You HATE being abnormal, even if no one else sees it. You can FEEL your high bG, you’re not thinking as clearly, and you’re even running to the bathroom to ■■■■ away some excess sugar, it’s such a mess that even your kidneys are trying to clean up this GD mess you’ve made (or something like that…)

THP should then investigate EVERY SINGLE ONE of these “the worst that could possibly happen” items. For example, starting with the first one:

THP: “Now tell me about how you’re getting upset. What exactly are you going to do in the most UPSET ABOUT THIS state you can imagine, what’s the WORST THING which could happen, exactly how are you feeling infuriated, and what are you saying to yourself RIGHT NOW…”

Then he should follow each one of those things, as far as they go, and investigate THE WORST THAT COULD HAPPEN for every single one of them.

in a few sessions of actually following all of these “worst thing that can possibly happen” alternatives, and seeing that they basically lead to nothing seriously bad at all, you will probably rationally conclude, YOURSELF, without lectures from know-it-all’s like me, that ALL the “worst things which could possibly happen” from running a bit too high for a few hours a week aren’t really so bad. In fact, they’re way better than the things you go through now. :))

A skilled therapist will ask questions which get to the heart of the matter quickly, helping you expose fears which you might not be willing to present to yourself without help. This is why CBT doesn’t really work from just reading a book and trying to do it on yourself, you need someone ELSE to challenge your ego.

For a large number of major and minor psychiatric diagnoses, CBT has been shown highly effective. You’re obviously an expert on the medical part already, and you already realize that it’s a psychological problem-- so don’t waste time and copays with diabetes MDs re-instructing you, for about the 50th time, on insulin dosage calculations and testing protocols, that appears to have NOTHING to do with your behaviors. I’m a CGMS user myself, but I think you need CBT, not CGMS. I need both. :))

I hope that what I’ve said rings true. If so, go after it! I’m guessing that guilt about “misbehaving”, of which you’ve already got MORE than enough, probably strengthens your deep-seated fears of relaxing your sugar a bit: When your Doctor called you, you went into a irrational tizzy about being “bad”, but nearly everything you’ve EVER read about misbehaving T2s and teenagers in the popular press says “I was bad, my A1c was 13.9, it needed to come down, it was an emergency…” And your condition confuses the one badness with the other, even though you rationally know what you should be doing, you keep responding backwards (trying to push your A1c lower, lower, lower, at any cost).

You need to have this confusion challenged and exposed for what it is-- a lot of baggage from long ago, fearing a set of “terrible” outcomes which, when actually reviewed, will be much less bad than what happens now. Your target is an A1c of five and half, not thirteen. But your mind treats any attempt at relaxing your target of “always below 100” as this:
“I’m headed straight for an A1c of eighteen, I’ll go blind, then they’ll have to chop off my gangrenous legs, and I won’t even be able to read my meter anymore, I’ll get even worse, my A1c will reach twenty-five, then I’ll have a massive coronary from all the sugary dreck clogging my arteries and die a miserable death, and everyone at my funeral will say IT WAS HER OWN FAULT, SHE KEPT BREAKING THE RULES AND LET HER A1C FLY WILD…”

That’s what’s going on. really. BTW, I don’t think you’re getting stupid, you seem to be suddenly getting a lot smarter in a different way. Thanks for the post, it’s REALLY inspiring to me personally, I’m still doing the same thing as you are. (I’ve got more lows than highs too, and just like you, I get MORE angry at the highs. It doesn’t make sense, the lows are really much worse for me and everyone/everything in the vicinity, and for my work.)

So I’m gonna think about this post myself, and maybe ask DW to challenge me with some good CBT this weekend. (She’s Board-Certified MD in that area, more focused on drugs than therapy, but really good on both sides.)

Hope this suggestion might be helpful. I had a problem with rapid acting (Apidra) being too fast. I’d drop like a rock. I’m now on Humulin R. For me, it keeps BG more stable without so many lows. Of course, you can’t be taking too much of this either!

My doctor’s office purchased a CGM to loan patients. I haven’t borrowed one yet, but perhaps this type of arrangement might be covered by insurance if your doctor has one.

Hope you will you take the advice of the others. Knowing your ratios will put in better control so you can dose accordingly. Hoping that feeling more in control, will help you get over your fear of highs, You can’t keep overdosing yourself!

After each low it takes the brain about an hour to recover to it’s normal function. I think if you go research the internet on hypo’s you will find that it slowly breaks down the grey matter of your brain. (I’ve read it in some research but do not know where - some medical research site)

Hi Anna! I think that you have gotten some useful advice here… so I don’t have much to add.

I just wanted to let you know that I share your fear of highs. I would rather be low than high any time!! Perhaps I need to re-think this as well.

One thing that actually helped this was when I started giving my insulin 15-30 minutes before eating. I HATE post-meal highs-- not just because of the effect on my A1c, but also because they make me feel lousy. In order to avoid the post meal highs, I gave WAY too much insulin, then ended up treating lows, but I thought this gave me better control. The truth is that I have now found a better way to even better control. I take my meal bolus about 25 minutes before eating. Then I avoid post-meal highs (I don’t tend to go above 160 after meals) and I don’t drop low later. You might try giving LESS insulin with the meals, but giving it early. When you do this, make sure that you test often!!

Also, another question, are your lows generally around the same time of the day or spread through out the day? Do you tend to have lows at night as well?

ALSO, I think that you have a chance to get a CGMS paid for through insurance because of these frequent lows. I think that it would be easy to make the claim that a CGMS is medically necessary for you, but I don’t know your insurance situation.

Wish you all the best and “just right” blood sugars!!

Sorry to post again here, but I can personally testify to Kristin’s method of early bolusing. She suggested it to me a few months ago and I don’t go past 140 after most meals now, which is my 1-hour post-prandial target.

No one would blame you for hating the highs. I was throwing up last night with ketones and a BG of 300 (which now feels SO much worse than it used to since my control has been so much better). And I, too, was diagnosed DKA long ago and spent time in the hospital with astronomical blood sugars. Much as last night sucked (and oh did it suck), an occasional high like that is not nearly as dangerous as a bad low. Rather than dosing huge amounts of my Apidra, I nursed it down and checked every hour. This morning, my sugar hovers between 120 and 135 (ketone-free) and I enjoyed my normal breakfast. I’m confident that the only damage done is the fact that I didn’t get much sleep. In the future, I won’t use ice cream (ah, milkfat) to treat a 10pm low.

Instead of avoiding highs, maybe you just need to redefine “control” for yourself. Aiming for a target and discovering - as with Kristin’s early bolusing suggestion - how to account for the food you eat or the sick days will keep the highs AND the lows in check. Or at least that’s the idea. I strive to be at 100 except for after meals. But even then, I have 1 hour and 2 hour targets. Think of your target as a suggested speed limit. You shouldn’t drive over 100 mph, but then again, driving 15 mph on the highway isn’t safe either. 5 under? 10 over? You’re okay.

Good luck. I think you’re going to find a solution that works for you. I hope you know we’re here for you, Anna. We all know how hard it is.

If you have worked out your carb ratio and know how to count your carbs, you should be able to give yourself just the right amount. Therefore you won’t be HIGH. It may take a few weeks of adjustments, but in the end it is the responsible thing to do.

You are causing damage with too many lows just as if you were having too many highs. Being alone and having a low is scary, don’t put yourself in that situation. You have been lucky so far.

The only thing I can think of to add is to ask if you have tried a low carb diet a la Dr.Bernstein? If you eat things that aren’t going to give you big spikes, then you don’t have to take too much insulin to dampen your postprandial blood sugars.

Also, if you ever go back on the pump, and you have a high blood sugar that’s bothering you and you need it to come down right away, you can also use superboluses instead of just taking too much insulin to make your blood sugar come down faster.

In any case, I can totally relate to that weird compulsive/subconscious aspect of diabetes, It really hurts to not just have things work the way that they should. I see people talking about eating disorders being more prevalent in people with type 1, and I wonder about all of the behaviors that have no analog in the non diabetic population. I wish that the medical community addressed this area more, instead of just writing it off as “patient non-compliance”.

Are you on shots or a pump?

If you’re on a pump and use the basal rates set by your physician that should help. The minimed pumps also come with a bolus wizard function which calculates how much insulin is currently active in your system already, your BG and the amount of carbs you are eating. It then recommends a bolus based on these numbers and your sensitivity ratios, also set with your health care team.

I still get low quite often but things have dramatically improved for me since being on the pump.