Scary Low

Community
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Tonight after 18 years of living with diabetes I had for the first time a hypoglycaemic episode that really, really scared me.

I certainly have had some challenging situations in the past with hypoglycaemia, but none like tonight where I’ve actually felt that this could really be bad.

I’m not quite sure what the cause of it was, perhaps I never will know, I’d eaten my dinner and was getting ready for a shower and felt the classic symptoms of a hypo , so I went and checked my BGL. It was 2.8 mmol/ml. I wasn’t at this point too worried, I went and had a few teaspoons of honey, an amount which I calculated should raise me back to about 5 mmol. However, 15 minutes later, my CGM did not appear to be rising at all, in fact the CGM reading had dropped down to 2.4!

I quickly went and did another fingerstick to find my reading at 1.9, from memory the lowest I’ve ever had. I quickly devoured another three teaspoons of honey and sat eyeballing my CGM. From here my blood sugar began to rise, and was back into acceptable ranges within the next 15 minutes.

I had a year ago suspected I may have some Gastroparesis, or some other digestive issue slowing down my digestion, as I have in the past had similar delays in my BGL rising after eating, which has subsequently caused a hypo within the first 30 minutes or so after eating. It’s not a common occurrence, but one that certainly scares me.

I couldn’t shake the thought what if I can’t digest any of this glucose quickly enough for the insulin already on board.

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Do you have an emergency glucagon injection kit?

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That would really have been scary! I’ve had a low with a reading of 31 (1.7 mmol/l) myself, and that was bad enough. But other aspects of my health lead me to believe I likely have more rapid stomach emptying than average. A hint of possible gastroparesis with a low like that would probably have sent me into panic mode, as a relative of my friend went into a coma at that level. Glad you are okay!

If you haven’t already done so, I wonder if it might not be a good idea for you to get some glucose gel to have on hand in case of possible scary lows in the future. It might be a little more effective than honey.

Do you live alone? If not, it might be a good idea to have a glucagon kit on hand and have a family member learn how to use it.

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When you first tested at 2.8 how much insulin did you have on board?

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Lows below 2.0 mmol/L are scary! Did your Dexcom alert you in time? I used to have several lows in the 1s each year (lowest ever were LOs, below 1.0 mmol/L) until I got my Dexcom.

I think honey is fairly low on the glycemic index. Glucose has a GI of 100, and honey has a GI of 55, so honey is naturally absorbed more slowly than glucose. It might be worth having glucose tablets to treat lows.

I live alone but my endocrinologist insisted that I have one. And a CDE pointed out that glucagon is useful for mini-dosing during extended lows or things like stomach bugs. I don’t think glucagon is particularly faster than eating, though, but it is useful when you can’t eat for whatever reason.

I’ve also experienced lows within the first half hour of eating at times, which I attribute to either pre-bolusing too far ahead, having prior insulin on board, or having a basal rate that’s too high and was already dropping me prior to eating. I often find that lows take more than 15 minutes to come up, probably for similar reasons. I also feel like I have faster stomach emptying than normal rather than slower.

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@Donman90, I’m usually unsettled when my first attempt to treat a low does not turn the BG level around. It makes me uneasy and I start to wonder about what’s really happening. Gastroparesis could be one explanation but unless you’re consistently experiencing some other GP symptoms (bloating, diarrhea, vomiting), I wouldn’t make that conclusion. You may have just experienced a timing mismatch between your insulin and food curves. That could be caused by too much pre-bolus time, increased activity and exercise during the day, and other factors.

I checked a few sites regarding the nutritional content of honey and found that there’s more fructose than glucose in honey. Fructose does raise blood sugar but it is slower to metabolize as it processes through the liver instead of being quickly available like glucose. I would suggest, in the future, using glucose tablets followed by a glass of water for treating lows.

You survived a close call and I congratulate you on your awareness when it counted as well as the ability to take effective countermeasures. While no one likes these scary lows, they do lead to a renewed respect of what diabetes can do to you and that is a positive thing.

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Remember that sugars can pass through the mucous membranes of your mouth. One thing I do when my son has a particularly nasty low (especially if his Dexcom shows he dropped really, really fast) is I give him juice or candy and have him hold it in his mouth for a bit before swallowing. If it’s juice, he swishes it around. If candy, I tell him to stick it under his tongue (Smarties or Sweet-Tarts) or, in the case of hard candy like Lifesavers, in his cheek. This seems to get the carbohydrate in there a little faster.

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Scary. My son (2 years old) has had several 2.2’s (40 mg/dl) and one 2.0 (or 1.8 or 1.9 actually) (35 mg/dl).

Needless to say he downed 1 whole juice box and 1/2 of another to finally get him back to 5.5 mmol/ml (100 mg/dl)

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Thanks everyone.

I do have an emergency glucagon kit, and I live wit three others so if worse came to worse they would have been available. I’m interested though, do people use their Glucagon injections on themselves if they just have a bad low? I always thought it was only for if I actually passed out from hypoglycaemia.

@Jim26 I’m not sure exactly, as I don’t use a pump; I had given 6 units of Novorapid at 7:30 and the low came on around 8:15. I assume I still had around 4-5 units on board so quite a lot.

I normally don’t use Honey to treat lows, usually I have a tub of glucose tablets. I had unfortunately run out of these last week and am waiting for my shipment to come in, which is partially why I was worrying as I rarely use honey so I’m not as familiar with how quickly it acts to bring up my blood glucose.

@Jen My CGM did alert me in time thankfully, I could see it steadily dropping over the first 20 minutes but I was hoping my food would kick in and counter that drop in time, which it didn’t.

It may be a bit premature to say it was some kind of delayed stomach emptying. I had done a few things differently yesterday, I’d spent the whole day clearing out rubbish under my house including old fridges and washing machines so I no doubt had a heightened insulin sensitivity. I also for the first time in maybe 8 months ate a small amount of rice with my dinner and increased my total carbohydrates from my standard 30 per meal to 45. Because of that I gave obviously more insulin, but also bloused 15 minutes before eating. Normally as I eat only minimal and very very low GI carb I bolus after I eat my dinner.

@Terry4 I have had other symptoms related to Gastroparesis. I haven’t had this kind of major delay for awhile but I have had it a few times before in the past, none this year though from memory. What defines it though is that I also notice the sensation of a knot in my stomach, it’s not usually painful but it just feels heavier than usual.

I have also had intermittent bouts of nausea, diarrhoea and cramps. I haven’t had any of that since earlier this year, and those symptoms never actually accompanied what appeared to be a massive delay in emptying. I had followed the nausea and pain up with my General practitioner who wasn’t sure and had referred me to a Gastroenterologist if it didn’t get any better, but quite literally after my appointment with him it seemed to stop for some reason.

Though I appreciate all of those symptoms could be a myriad of things, not just Gastroparesis.

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This is the type of activity that has fooled me in the past regarding intensity of exercise. Major house cleaning projects like you describe have been notorious for me producing unexpected lows. Washing my sailboat is another activity where I inevitably go low.

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Sorry that happened… review your doses and try bolusing after you eat depending on blood sugar. Always have extra glucose tabs so you don’t run out, get some glucose gel, glucose shots(liquid) and juice packs- they all work faster. I use liquid sugar to raise me fast. Swirl it around in your mouth as someone said it will go through the mucous membranes to absorb quickly. The glucose gel is the best for this, it just sits there and evaporates.

When you see yourself dropping don’t wait for too long. turn off basal and eat a bit more/glucose if necessary.

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I don’t think you have to invoke gastoparesis or anything. Sometimes Humalog kicks in scary fast. And yes, “scary” is the operative word!

The way Humalog kicks in much faster than the meal is something that has caught me many times. So much that I should stop making it sound like a surprise. But it usually doesn’t happen, just sometimes.

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The definition of diabetes insanity is doing the same thing over and over and expecting the same results! :wink:

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Good point haha I definitely jumped too conclusions with that.

Sometimes it’s so easy after a really good week of blood glucose readings to forget how fickle diabetes is!