Sobering

maurie, how do you know (or how do we know) if it's too much basal or bolus? if it's insulin, food, whatever...that's causing lows/highs. so confusing sometimes. Also, do you have/wear a CGM? If so, what are your alerts set at?

i don't understand why some people dismiss the liver's role in blood sugars. the liver produces, stores and releases glycogen (or whatever it's called). this is why we take basal insulin (which has nothing to do with meals or food, as we know) it stops the liver from dumping stored glycogen (same thing with type 2's who take metformin). also, once we've had some bad lows, we deplete our reserve of it and can often continue to have lows. that's what every CDE/Endo, Diabetic nurse has told me.

karen, do you have more lows pumping then you did on MDI? I just don't understand how changing basal rates all the time on a pump really helps because, unless one has a clear pattern, which seems impossible because there are SO many variables, it seems useless and ones just simply changing basal rates all the time?

I don't think it's worth it to blame my liver. It's lurking there but so are my kidneys and my stomach and living with a 15 year old and all the other stuff. I can only control insulin. I see lots of threads in various places in the internet "I was at 38 so I had 2x juice boxes and 6x glucose tabs and the liver dump sent me to 250." There's so much of that that it's become the conventional wisdom but, if you have a stick of Beamon's and hit the 38 with like 10 or 12G of carbs while you're lighting the candle and you survive, you might question your liver...

OK, if you say so. but it's not a matter of blaming the liver, it's the role of the liver, that's what every endo has told me, they do study this stuff, no? http://www.stanfordchildrens.org/en/topic/default?id=anatomy-and-function-of-the-liver-90-P03069

I don't keep track of how many lows I've had but, since I started treating them more conservatively, I've had very few post-low highs, which seems like a huge victory to me. It can be quite unnerving as my inclination is often to eat everything in the pantry and then scrounge the ice cream sandwich out of the back of the fridge but, when I do a moderate bump and chill for 20 minutes, I don't fly up. I have not interviewed my liver to see what it's doing but whatever liverisms are out there seem to be sated by this approach. I'm a very small sample size though...

I seem to get the reverse when I'm really low, I actually feel nauseous and feel like I'm going to vomit, sometimes have to force myself to eat more. Glucose tabs, I think too, are the best for bad lows. it's so hard sometimes to sit it out and wait when you're shaking so badly, seeing spots - weird vision, sweat pouring out of you and the d@mn CGM is still pointing down, down, down.

...but that's the CGM 20 minutes ago so you chill out, I try to find something do do (firing up some psychedelic rock...oh wait, I am always listening to psychedelic rock, or psychedelic jazz or psychedelic classical...). A lot of times at home, I set the kitchen timer for 20 minutes and don't worry about it until it goes off. It seems like most of the time, it's at least started to go up, overcome the IOB or whatever. If there's a ton of IOB, I might figure I overestimated my carb count and eat some more carbs, have a glass of skim milk (ok, I don't use a glass...) or something for a bonus boost and to cover the IOB but I don't like to get carried away. I'm just following the narratives I've seen where it's low--->carbs----> high and trying to avoid the high part of that diagram. I don't disagree it's hard to wait but if you can, the "liver highs" disappear...

HA! Well, as TP says, "The waiting is the hardest part; don't let it kill you baby, don't let it get to you." :)

Due to them maybe seeing so much of that, in my area I question that, this was a long time ago and maybe I'm wrong, they should be "able" to tell the difference between the two and not try to diagnose something as hyperventilation, that was really inexcusable imo. I'm glad you didn't have police questioning you also! Sounds horrible.

Sarah, who is suggesting you should change basal rates "all the time?"

Normally I will wait with most lows but for my fast dropping lows when I know I'm in trouble I drink glucose drinks immediately and as Maury said around 30g to start(2) if I haven't taken anything else. I have drank as much as 80g oj and glucose drinks/tabs and had no spike. That one was without even testing first because I knew it was bad from my symptoms. They taste awful, the berry flavor is the best one I think, but they raise you really fast, faster than tabs.

I'm so glad you're okay Maurie!! Really scary and, as Melitta said, a good reminder to us all to take lows very seriously.

thanks for sharing…lows are the most dreaded experiences…log your experience and see if you are able to see a pattern…i have glucose tabs taped throughout my house in case i goof…dog carries a little metal canister on collar that she could bring to me if needed…good luck and do your best!

I like SweeTarts. Many years ago their slogan was 'bite 'em for a burst of flavor'. Each one contains 13/8 gm glucose at half the price of Walgreen's glucose tabs, but they fit nicely in a Walgreen's glucose tab vial.

Thanks Melitta. The thing is I didn't come to feeling especially bad, just subdued. What was most sobering is how a couple of small mistakes got me into so much trouble.

On the bright side, after another bad day on Sunday I finally figured out that my basal was off and as a result nothing was working. I bumped my daytime basal up 20% yesterday and the change has has been remarkable.

Maurie

Thanks Emily. I had a tendency to try to figure out the minimum additional glucose I needed to treat my lows. I'll be erring on the high side for awhile - at least until I forget this experience.

what is a "stick of Beaumon's". Am I showing how old I am?

Ooops, I misquoted it, it's Beeman's, gum with Pepcid (Tums...) bummed from the ground crew by Chuck Yeager in "The Right Stuff"! You chew it before you blast off...heh heh heh...

Maurie, I had a 43 this afternoon, again! That's how I felt w/this one, extremely 'subdued' or weak and tired. I looked at my CGM it said 93, got in my car and then I felt exhausted and started seeing spots, pulled over and I was 43, this was 5+ hours after my bolus and due to activity, I guess. this keeps happening to me, i downed 3 glucose tabs got it up to 120 but then it dropped back down to 90, waited and then actually pulled into an Urgent Care because the shaking started again so badly and my vision was messed up. I thought I was going to have these convulsing shakes again. I don't know what's going on. Activity seems to be having a HUGE impact on my BG's, doing like 1:30 for meals now too. I just feel exhausted again today.