Strange T2 Lows

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1

Today was weird. I actually went low. I even cheated on my diet & went low again by the end of the day.

A little background - last night I was much more active than normal. I practiced distance throwing golf discs with friends for about 3 hours, then hit the pool for another 2 hours. After all that, I went to bed a bit late and didn't eat anything after about 6:30 last night.This morning, I woke up late, still tired and forgot to take my thyroid medicine for the first time ever. I have also been trying out a different meter - a Freestyle Lite - in addition to my normal AccuCheck Aviva.

My fasting this morning was 96, taken around 8:45 with my Aviva, not too long after I got to work. I was a bit hungry, but not starving. I had to do some traveling to an off-site about a half hours drive from my office. By the time I got there, I was feeling tired, but I mostly attributed it to the long day yesterday & lack of sleep. I only had to check in, and wasn't there too long. On the way back, I realized something was wrong. I started feeling kinda dizzy, and pretty hungry. I made it back into town and stopped at a gas station. By that time, I was starving, but it was only about an hour until lunch at that point. I picked up a Beef Jerky & cheese pack, and scarfed it down. I felt better. At lunch, I cheated on my diet & had chinese food, rice & all. I felt my sugar spike, but about 3 hours later (around 1:45pm) I was down to 115. I finished out the day & went home. Because I was still feeling tired, I kinda dozed for a while. Around 7:00, I realized I had yet to eat & that I needed groceries. On the way to the store I started having blurry vision & feeling like I did early this morning. While walking around the store, I felt off & had a bit of tunnel vision walking down one of the aisles. I made it home & immediately tested using both meters. The results were way off at 97 with my Aviva & 76 with the Freestyle. I tested again and got 95 & 81.



I know T2s on strictly diet control aren’t supposed to go hypo, but I had a lot of the symptoms twice today. I sure felt closer to 76 than to 97. These results also make me question the accuracy of the Aviva that I’ve been using since diagnosis. I had just about decided I liked it better than the Freestyle I’ve been testing (mainly because of the Multiclix lancet). Going by what I’ve read, BGs of 70 & below should be cause for concern, & most meters aren’t that accurate for lows, so I’m going to keep an eye on this for the next couple of days. It’s definitely an anomaly. I went ahead and made Spaghetti meat sauce (minus the actual pasta) for dinner. I was craving meat balls, but the store was out & after cheating earlier I ruled out picking up a sandwich. I finally got to eat around 8:30, and now I feel much better. I think I’m going to call it an early night too.

Writing these blogs is actually kinda cathartic.

2

If your blood sugar has been elevated for a while, your body will get used to the high readings. And then if you suddenly lower your blood sugar, even just down to “normal” readings, you will feel hypo. Those hypo feelings are real, but your blood sugar is not technically in the hypo range. As a T2 (not on insulin or sulfonylureas) it is actually very hard to go hypo. I was able to get down into the 50s by exercising right after eating. But Bernstein believes that an average fasting should be 83 mg/dl. Now that I use insulin, I don’t consider readings in the 70s a hypo, I consider 70-120 to be “normal.”

As a T2 it is important to understand what a hypo is. If you go down below the 50s, you need to be attentive and take quick action to treat lows. But for the most part, unless you are using insulin or a sulfonylurea, you shouldn’t worry about hypos. If you feel uncomfortable, you can treat yourself with a few smarties (smarties tabs are 0.4 g carb each and will raise your blood sugar 2-4 mg/dl) and you will feel better.

3

bsc,

Thank-you for the input! I spoke to another T2 friend of mine that has been dealing with this for years, and he told me pretty much the same thing. He lost a lot of weight at one point, and he said he had the same symptoms. He hypothesized that it was as you said. My body may actually be getting more efficient at using insulin as I lose weight and get healthier, and that it’s not used to being down in the lower ranges. I’m still learning, but this does make sense to me. I woke up this morning at 99 after eating a late night night snack of a handful of cashews. It’s 9:00 AM now & I’m starving; so I’m going to go in search of some breakfast.

Thank-you again for the re-assurance, and the tip about smarties!

4

I had the false sense of going low when first diagnosed. Its pretty common with anyone whose blood sugar is higher than normal.

However, I started out with reactive hypoglycemia before developing diabetes, so I recognized the symptoms pretty easily.

You may experiencing some irregularities in your body’s insulin response, especially when your meals are irratic. When diabetes starts, and you have insulin resistance, the pancreas can be kicking out an insufficient amount of insulin, causing a blood sugar rise that’s too high, then your pancreas overreacts and kicks out more, causing a sudden drop.

I’m sure yours was caused by the extra activity, since activity makes your body burn sugar and also reduces insulin resistance. Skipping a meal or being late for a meal on top of this can definately lead to going low, especially when you’re still newly diagnosed and have some active beta cells.

Many type twos are diagnosed too late and their pancreas is pretty much burned out, with something like only 10 to 20% of normal insulin production left, which quickly goes down to zero. If you are controlling it with diet and exercise alone, you’ve got an early start and may be able to control it this way for a few years.

By the way, fat slows down the absorption of carbs, so Smarties aren’t the best choice for treating lows. You’d be better off using LifeSaver candies or any sugar based candy, rather than chocolate.

The best way to treat real lows, is with glucose tablets. Dex4 are not too expensive and work very well. At this point you probably don’t need to bother with them, since regular candy will work and you’re not on insulin. Later on, if you go on insulin, you need a very fast dose of glucose, which is why I carry Dex 4 in my purse and keep them handy in the house.

I find that my Freestyle meters are extremely accurate. I’ve had them lab calibrated and they are within 0.1 of a point. Pretty good if you ask me!

5

All of those look like perfectly normal, perfect blood sugars to me.

It may be that you might have gotten used to running higher blood sugars, so anything lower than what you are used to might feel ‘low’. I was dx with an A1C of over 20% and in the first few weeks, my hands started shaking when I was in the 120s.

So this is a change for the better. And it sounds like you are doing great with your diet too!

6

I too am a type 2, and go low frequently, sometimes LOW. Not that unusual…unfortunately!

7

Type 2’s on diet and exercise can definitely go hypo. The reason is that although your first phase insulin response may be blunted or absent, your second phase response is usually unimpaired, at least in the early years, and when it sees the high spike caused by the lack of first phase response, it goes into overdrive and puts out too much insulin and drives you low. A lot of people who are not yet officially diagnosed as having Type 2 diabetes nevertheless suffer from reactive hypoglycemia for that very reason.
You really should carry glucose tablets or some form of hard candy so that if you go low, you can treat it promptly. Better to have a couple of pieces of hard candy than another whole meal!

8

Thanks for the advice, everyone! I went ahead and bought some glucose tablets to bring with me when I am working out as a precaution. I have felt low a few times since that night, and have just been treating it by eating a small serving of carbs (a cracker or two, a tortilla chip, or even a spoon of peanut butter). That seems to help pretty quick, and usually gets me through until time for my next meal. I’ve been trying to keep my BG down in the normal range, and I seem to be slowly adjusting.