Side Effect of Increased Stability?

So, my Doc and I threw a dart and, for once, somewhat coincidentally, I think, we hit a bullseye. My BG’s are ‘ultra’ stable, compared to what I have ever seen in my lifetime. Either we got the bullseye on basal rates, or something is different with my physiology/behavior (perhaps due to age or inactivity). Super duper stable numbers that I can’t explain.

Something else happened that I believe is connected. I suddenly have extremely low tolerance for low BG’s. I start feeling quite faint at 70. That has never before been an issue, for me. I was able to reason, down into the 30’s, before. I find this new development quite unsettling and have a lot less confidence in my ability to recover from lows. The first warning sign was a car accident, during which I became extremely disoriented and went quite blind while driving. The medics read BG = 40.

I have concerns about participating in my normal winter activities. I think that I ought not ski alone and will need to bring an escort. Has anyone else experienced this? Do you have any strategies?

I haven’t experienced the precise pattern you describe, probably because I’ve always had reasonable stability to begin with. Not always great, but reasonable. But what you describe makes sense intuitively. If you went from a regime of frequent and significant excursions into redline territory to a more “normal” pattern, it figures that what was a “customary” drop before might now have greater effect than it used to.

The body does adjust to whatever’s happening at the moment. The textbook example we hear all the time is the person who has been very high for a long time and feels symptoms when they finally drop down to the “normal” range or something close to it. So what you describe sounds reasonable, at least on the surface.

But whether we’ve correctly analyzed the cause or not, the bottom line is that you have to take care of yourself. So, if low symptoms are happening sooner and having more profound effects now than they used to, then yes, IMHOP you need to take greater care.

This is a good thing.

IMHO nobody should ski alone. Don’t bring an escort. Bring a friend.
:smile:

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You might have thought you were fine down to 30 before, but you were not. You were unaware of your problems before. Not just hypo-unaware but unaware of your mental and other limitations while hypo.

I write the above from “been there done that myself”.

Now that your bgs are more stable you are more aware of bgs. Likely, due to increased experience and awareness, you are more aware than you’ve ever been. It is really disconcerting to be frustrated by the new awareness.

Yes there is a uncomfortable and frustrating feeling with being hypo aware in this way. When I’m unaware of hypos I can just “power through” although maybe “obliviously blunder through unhindered by the thought process” is more correct. When the bgs stabilize and my awareness is back I’m no longer able to just blunder through in the same way. Instead I’m frustrated, fuzzy, and aware that I’m frustrated and fuzzy and it bothers me.

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Yes, David, I agree that it makes sense intuitively. It’s just not something that I ever anticipated. I thought that stabilizing BG’s would make the whole system easier to manage and decrease risk. That’s why it seems so surprising and infuriating that, what seems like an even greater risk has popped out of thin air. I have never in my life had such severe symptoms at such minor fluctuations out of range. I have always been grateful that I wasn’t a diabetic with high risk lows. This has taken me totally by surprise and I find my new physiology nerve raking because I have so little experience with how to deal with it. It really creeps me out.

@Tim35, we never really ski much alone because its pretty dangerous skiing. I have friends I can bring with for the drive that I trust as ‘fantastic street medics,’ fully capable of dealing with whatever low BG situation develops (although, they have never had to do that much in the past because I was pretty self sufficient). But, none of them can ski at my level. So, sooner or later, I’ll be out without a trustworthy ‘street medic.’ God help me if I fall into the clutches of the ski patrol. I would sooner chew off my own leg or fall into a mine shaft then rely on them to help me. P.S. by ‘escort,’ I meant ‘friend,’ not

Although, I’m sure this woman would help more than any darn ski patrol.

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@Tim12. It was dumb luck. Happened totally by coincidence. Neither my Doc or I could do this again in several years of trying.

I have less awareness and less ability to react to lows, due to an increase in severity of symptoms at much higher numbers. That’s whats counterintuitive and goes against the book. I feel FAR more at risk and believe that I may be less able to engage in certain physical activities. That’s the problem.But, I’m not going to purposely make the system erratic. That doesn’t make any sense. Maybe I should target the people who have always struggled with lows for some strategies ???

Its like I haven’t decreased risk at all. Its as if the risk just morphed into a different (and more deadly) type of risk. Lows are much rarer, like weekly instead of daily. But, when they hit, they hit harder than I ever thought they could. Damn you, Diabetes, you win again! https://www.youtube.com/watch?v=ehmC6hVVdkM

Can you get a dexcom? Maybe then you can identify the lows when you’re skiing (or other activity) before the lows become a problem?

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Yea, I’ll use my Dex. Thanks for that reminder. This is the most ridiculous diabetes ‘Zonk’ ever. https://www.youtube.com/watch?v=1hzq9xztiWk
https://www.youtube.com/watch?v=W6ZhOPBdQ_U
I think that, in reality, it becomes very difficult for me to participate in certain things. I am pretty confused at 70 and if I’m doing things that introduce a high irregularity into the system, like skiing, then things become quite dangerous. I’m not sure how this will work. Maybe, after some time, my physiology will change and adapt so that I can squeak by. I’ll have to run some tests…and be nice to the ski patrol.

Don’t discount the possibility that your body is changing, either. I don’t know your age, but it’s a fact that physiology changes with time. Sometimes it changes in predictable ways, and sometimes it blind-sides you. I’ve been subject to both.

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Again, I think you are simply more aware and responsive to the risks of hypos, than you were before.

I’m not sure all of your history but maybe the bg of 40 case tested by the medics in response to your accident, was your first hypo you couldn’t take care of yourself? There is no way you were actually completely functional when you were hypo with bg’s in the 30’s in the past. You just didn’t know how poorly you were functioning because those higher parts (including self-awareness) of the brain were all shut down.

I’ve had a couple ER trips because of hypos and they’re scary and changed my thinking about bg control and the risks I take too. But mostly they changed my thinking because I have a family to take care of now - it doesn’t matter what I think I’m capable of handling when it’s just me, what actually matters is that I don’t wrap a car around a tree with my family in it.

I FULLY AGREE that when hypo awareness comes back it can throw me for a loop too. When bg’s are highly unstable a lot of parts of hypo awareness are lost - my mental model is that my body stops being able to respond during a string of multiple hypos a week. But then I stabilize and awareness comes back and yes it can hit surprisingly hard when hypo awareness comes back.

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Maybe I’m reading this wrong, but it sounds like you’re afraid that you are going to pass out or otherwise be totally incapacitated by a low of 70. I think “feeling” a low much more acutely is one thing (which can be very unpleasant), but I’m fairly sure a low of 70 should not cause someone to actually pass out or otherwise be fully incapacitated unless it’s a really rapid and far drop. Could something else be going on? I’ve done skiing with diabetes and I would just keep a meter and glucose gel within easy reach so that, even in the middle of a run, you can pull over and test and treat if need be. You could also test on the lift on the way up to each run (easy to do on a chairlift, other types of older lifts not so much, but you could also test at the top of the run). Set a temporarily reduced basal rate on your pump for the day, if you use one. And I agree with others, I’d always ski with a friend regardless of diabetes.

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Thanks, Jen. Some of this is just in the hands of the heavens, but I’ll do the best I can. I have very limited confidence in my ability to deal with severe symptoms associated with lows because I don’t have much experience with symptoms like this. Maybe this is a diabetes-confidence-thing. I’m hoping that I become more accustomed to symptoms or that they become less intense.

My BG regularly alternates back and forth between 30 and 400 while I’m skiing at this mountain, sometimes multiple times over a couple hours. That stuff happens even without eating. Its a rocky, ungroomed mountain where I have to jump around a lot in order to avoid trees and rocks. Its my favorite. I suspect that it has a lot to do with a combination of adrenaline, aerobic, and anaerobic activity. In general, if I’m skiing very well or really enjoying myself, it goes high - that’s why I suspect adrenaline is involved. BG does not strictly correlate with exercise intensity. I downhill in a highly anaerobic way on this mountain, which we all know produces higher numbers. I think its because I’m half scared to death, I tend to lean backwards in my skis, making the activity more strength based (because I’m continually using the large muscles in my upper legs). But, there are periods of ‘skating’ around on level ground, which is more aerobic. 15 minutes of skating (like on XCountry), last year, in general, might spike me to 400. I suspect that my body pushes adrenaline and maybe releases sugar to account for high intensity exercise.

Lows are much harder for me to predict and just seem to appear randomly on this particular mountain. The only predictable pattern of lows that I have identified is that exactly four hours after leaving the mountain, I will have a very rapid, very severe drop. Even in the best of circumstances, it has almost knocked me out suddenly, so I know to watch the Dex really close, starting at hour 2 after leaving the mountain. That has really helped.

I’ll search for some strategies for dealing with severe lows from our community. I will not drive the 8 hours home from the mountain. I think that’s one of the major sources of risk that can be easily avoided. If I go off the road, there may not be another car for 12 hours. I will avoid going inside nearby buildings- that should decrease risk of seizure from flashing lights that I believe have prompted seizures (in me and others) in the past. I will wear the Dex. I will prepare by skiing small hills and X-country to see how my body attunes to both aerobic and anaerobic patterns. I will confide with trusted patroller friends that I a little nervous and tell them that THEY are in charge if anything bad happens. I’ll carabiner clip myself into the chairlift so I don’t fall off if I pass out. I may not ski at altitude. I will not ski in the middle of nowhere. I WILL NOT LET THE BOYS PEER PRESSURE ME INTO CLIMBING UP ANY MOUNTAINS in order to ski down in the moonlight. I will only climb quickly uphill for a sustained distance if someone is (badly) hurt. Maybe I will get a hat that says “type 1 diabetes.” I will bring a cyanide pill incase I am captured by enemy ski patrol. That should help reduce risk.

Nope, Tim12, there is DEFINITELY a decrease in ability to recover from mild lows. I’ve skied through partial seizures. I’ve skied the men’s olympic downhill at BG < 30, where I climbed up a cliff to assist a woman who was stuck there and crying. That’s because certain mountains are just going to push me low, and they are going to push me low for days at a time. There are certain mountains where I have to eat a granola bar EVERY run, and I’ll still run low. Its just the nature of the beast on some mountains. My physiology adapts surprisingly quickly to that. I’ve never had much problem recognising and recovering from those lows. That’s why this new turn of events is so unsettling to me. I really don’t know how this is going to work. I’m scared, but I’m certain I will learn something about diabetes this year…perhaps something unpleasant. :slightly_frowning_face:

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I think your complaint is that when your bg is low now, you don’t feel well, but you didn’t used to feel that way.

I hate to tell you this, but all the rest of us feel like crap when our bg is rollercoastering between 30 and 400.

To get back to the start of your thread, your TDD for an inactive calm day (where you seem to be settling now without any wild variations) may be twice your TDD for a day when you are intensively skiing.

I don’t ski a lot but I know that I have to massively cut all of my doses well in advance of that kind of activity.

Side question: when the paramedics found you with bg of 40 after your accident, did they give you glucagon? Glucagon just by itself has thrown me for a quite a loop. A full dose depletes your livers glycogen stores and they take time to build back up. I’m not sure exactly what the timescales are to get back to the old normal, but it’s not instant.

I wonder if your alpha cell function has changed. You said that you don’t recover from lows as quickly, right?

Alternatively, you may have just been in range more often the last few months (as others have said I think). Now that ski season has started and your blood sugar is swinging between 30 to 400, you’re going to feel that. I would definitely feel that!

When I was younger my control was not as tight as it is now, and I definitely didn’t feel higher blood sugars as much as I do now. My sister also has diabetes, and I remember telling her that I could really feel when my blood sugar was high (around 200-250), and she thought that was odd. Then she got a Dexcom, and a year later she was telling me the same thing.

If you spent a decent amount of time in the 30 range in the past, you may have been able to mostly function in that range (not as well as normal, but perhaps close). If you haven’t been 30 for awhile, then when you drop to 30, you’re going to feel it!

If this truly is the cause, then that means you must’ve been managing better lately :slight_smile: silver lining!

All other considerations aside, sustained aerobic exercise absolutely, positively lowers blood sugar, sometimes dramatically. Before I had access to insulin, it was the only way I had to quickly reduce a high. I think Tim’s point is worth echoing:

As for the vexing question of why this is happening now when it didn’t used to . . . SMH. But if that’s what it’s doing, then that’s what it’s doing. As a dear friend’s endo once said to her, “If you can figure out the reason in 10 seconds or less, great! Otherwise correct and move on.”

Diabetes is always a moving target. For me, that’s the single most infuriating thing about it. As I’ve said more than once, I could never have been a doctor. Spending my entire working life chasing moving targets would drive me absolutely schizophrenic.

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Yes, first unexplained hypo in twenty years (all my diabetic life), where I TOTALLY couldn’t take care of myself. But, I’d been noticing 70’s were hitting hard for about 4 weeks since we adjusted into the ‘perfect’ basal rates I had ever seen. This time, at BG = 40, I went blind. It freaked me out. I couldn’t see to pull the car over, so I was driving really slow and did the best I could, but I hit things (things I couldn’t see - I rear ended the car in front of me at around 15 mph). Then, I got out and ran for help, but I couldn’t see well, so it was scary. I found a cop because I was right next to the courthouse and he called medics for me. (The medics told me that the call came in from dispatch that a woman just got released from jail, was angry or on drugs, and was purposefully running her car into cars in front of the courthouse.) I was able to kneel on the ground and answer all the cops questions, which included: 1.) Where I had been that day; 2.) The address I had come from; 3.) What day of the week it was, etc. Medics gave me granola bar and I was fine 45 min later. They were nice. We talked about insulin pump. BP was 150/90. I was stressed out, but not very ‘shocky.’ Not sweating (which seemed unusual to them and to me because in the past, if I was that disoriented, I would expect to be sopping wet.)

I have had glucagon once (about 8 years ago after I climbing a hill with my skis on - which I have done many times, but this time dropped me like a hot potato and I had to call 911 about 10 hours after the event. I unlocked the door for the medics and could answer questions, but couldn’t stand up, except in a very sloppy/unstable way) My partner (who was an EMT) gave me glucophage once while we were onshift together because I started sweating like a pig and looking pretty pale. He could have given me a granola bar, but he thought the glucophage would be faster and it was sitting right there. We got a call from the supervisor that we used the ‘expensive ■■■■,’ and to use the ‘cheap’ brand next time.

I’m not sure what an alpha cell is, but I will look it up.

Its not that I don’t recover from lows, if I know what your saying. Its that the severity of LOW symptoms is greater, leading to more confusion and, in that way, less ability to recover. Like, I seem to jump into symptoms that I would associate with BG = 30, at BG = 70, or symptoms I would associate with BG < 30 at BG = 40. I guess low symptoms are 30 or 40 points below where I would typically experience them.

I haven’t noticed much for changing symptoms associated with highs. But, I haven’t had many.

Ski season is just starting here, so there is going to be an introduction of rollercoastering BG behavior due to that. I am certainly going to hit 30 this season. Perhaps on the first day out. I think your right that increased symptoms are a direct result of not hitting 30 very often, of late. One of the frustrating puzzles is that I thought better system stability was going to make be more safe and secure on the hill. However, I am not at all sure how safe I will be if I have to get down the mountain in the condition that I was in at BG = 40. I guess I should plan for a medical emergency and ski it off. Like, stay near home, bring someone I trust, and ski aggressive as possible for a few days and see if my physiology doesn’t adapt to those conditions before leaving home for any skiing that could result in death.

Thanks for helping me think through this stuff and develop strategies.

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