Trouble accepting my diabetes but hoping to avoid more frequent lows

Type 1 and LADA
1

Hi ya’ll. How’s it going?

So, I’m not really newly diagnosed, I’ve had Type 1 for going on 18 years now or so. However, mentally, I think there’s still times where I just refuse to admit that I have it.

Like, I don’t do anything crazy like not check my blood sugar (although I used to do that) or skip out on injections or stuff like that, but, when it comes to coming up with solutions to certain problems, I seem to follow a similar pattern: I have a hypoglycemic attack and either pass out or do something really embarrassing or destructive. Following that I spend the next week trying to do little things like change my insulin dosage a bit…and then it’ll work for a little bit until the next hypoglycemic attack and then the cycle begins anew.

I’ve been talking to a therapist and she advised me to start trying to get more serious about fixing whatever’s broken in my routine that’s causing me to keep having these low blood sugar attacks. We’ve agreed that part of it is sometimes I have a mental block with the disease and I don’t want it to consume my life so I maybe don’t give it the kind of attention it needs.

I know things need to change, though. These latest lows have been particularly bad…One morning, I was mostly out of it, but I for some reason rammed into my kitchen window with my fists. I didn’t hurt myself or anything but I could have. Then before that I dropped my laptop and had to replace my screen again, the second time I’ve had to do that since December, both times I dropped it due to my having a low.

So, I guess my first question is…has anyone had success adjusting habits to prevent frequent lows? And then, how have you gone about getting those changes to stick? I’m tired of having these scares, and I know it’s not healthy for me either…so, I’m willing to try anything. I’m not really loaded in terms of money so I can’t buy any fancy technology to help, although I’d love to get a CGM but I’m not sure my state’s Medicaid plan covers it.

Thanks for anything anyone can share, it’s not easy to deal with this stuff sometimes it feels like, but I guess we all do the best we can!

2

most would suggest, start at the start and do a miss a meal basal test and get that right or you just chase your tail

then do a refresher on diabetes management
A USA workbook (the certificate ran out but the site is safe)

some find a lower carb way of eating is better

did you get stuck in one of the diabetic 5 stages of grief?

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Hey Jake! If you’re having lots of severe lows your problem basically comes down to over-treating, so that’s what you need to get control of. Big question is what treatment are you on? If you’re using a pump there are a lot of adjustments you could make. If it’s basal-bolus MDI, that’s a somewhat different story, since you’re kinda stuck with whatever you inject for the day basal-wise, but still there are things you can do. Either way it’s a matter of really having a look at what you’re injecting versus what you’re eating. And the main problem is this, which I totally sympathize with:

We’ve all been there, but ultimately there’s no choice. It all comes down to looking at your carbs, ratios and doses. Can you tell us a little more about what you’re doing leading up to these hypo excursions? Is it a matter of guessing at carbs and not getting it right? Or underestimating, spiking too high, then overcompensating–the infamous roller coaster effect? Or some other combination of factors?

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Thanks for the helpful links. I’ll be digging into them here and seeing what I can find there. I really appreciate it. I may have gotten stuck in one of the stages of grief…I don’t really remember too many stages, honestly…like I didn’t do any bargaining and I didn’t get too angry about anything…so, yeah, who knows.

Anyhow, thanks again!

5

Well, I think the problem comes down to a combination of factors. Guessing carbs, there’s been times where I’ve overcorrected, another time I had a spike due to my drinking wine, something I don’t do much of but now and then I’ll have a glass.

I think the big thing is when it comes to counting carbs I just get lost. I know it’s not too difficult, but all I remember from when I tried it last was I thought I did everything correct and I still ended up crashing. I’m open to trying it again, but I think what keeps me from really counting carbs too much is that I’m not entirely sure how to do it right and the whole not committing the energy and time on it. I think though, I’ve gone through all of those things you’ve mentioned. So, I guess I gotta start at the very start again and take some different steps.

6

Oh and yeah I take injections. I’d like to get a pump but have never had one yet. So, I guess I need to re-evaluate how much I’m injecting in relation to the amount of carbs I’m eating.

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Jake, hopefully you won’t mind a bit of input from an insulin-using Type 2 here. One thing to keep in mind, as far as not letting it consume your life, is that it IS part of your life. If you take care of it, and give it the time it needs to take care of yourself properly, in the end it’s going to consume less of your life than it will if you don’t. It’s kind of like the old saying, “If you don’t have time to do it right, when will you have time to do it over?”

When I first started, counting carbs was much harder and more time consuming than it is now days. With applications like SparkPeople, My Fitness Pal, and Lose It where you can enter what you are about to eat, they do all the math for you rather than having to look at every single label and add it all up in your head or on a calculator. Most of these programs have a free option with paid versions that offer more bells and whistles.

I’m trying to lose a rather significant amount of weight, so I weigh,measure, and track everything that goes in my mouth though. As I lose weight and exercise more which changes my insulin sensitivity, I’ve been having more lows and having to constantly adjust my insulin regimen. I get the whole not wanting it to consume your life part!

I have a variety of health problems to go along with my Type 2 diabetes. Fibromyalgia, degenerative discs in my lumbar spine along with arthritis and bone spurs there also resulting from multiple falls/accidents, hypothyroidism, PCOS, and a couple of other things stacked against me. Usually I’d lose 25 pounds, get stuck, give up and regain it all back. A year or so ago I was a house-bound recluse. I could barely walk, and used a rolling walker. I decided this time that I’m DONE with that. I want my life back. I’ve lost 50 pounds so far, and have another 100 to go. I’m going to tell you what I tell those who ask me how I keep plugging along:

"If you decide that you can do this, you can. You get to decide if you dread this or not. Decide that you don’t. You get to decide if it’s too hard or not. Decide that it isn’t. Find what makes you determined to do this for the long term. I tell myself I don’t have to be excited, or motivated - I just have to be committed and determined. I have to tell myself I’m worth it. I have to remind myself why I’m doing it. "

I wish you the very best of luck.

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So injections. I assume that means basal-bolus MDI with Lantus (or Levemir) and Novolog (or Humalog) not R/NPH. Not many still on that, but it does happen and it makes a huge difference in how you do this. Sounds like you’re using what medicos call “sliding scale,” or in the vernacular, shear guesswork. I did that for a while when they first switched me to MDI. But it doesn’t really work very well as you’re finding out. It sounds like this is a real block for you, and it was for me, too. I’m just not a math-n-chemistry kinda guy, and I hated hated hated having to weigh and calculate and just basically have to think that hard about eating–just felt like the big D grabbing too much space in my life.

Yup.

And there you have it–T1 in a nutshell. No matter what you do, sh** still happens. Even with carb counting there’s still a matter of some guesswork. When you’re at a friend’s house or a restaurant you can’t just ask to see the package with the nutrition data and whip out your handy pocket food scale. Though if you have a smart phone there are mucho apps to help with this stuff.

The one thing all of it depends on is getting your insulin-to-carb and correction ratios nailed down. If you’re having a lot of problems, I’d guess that’s what the issue is. And it is probably the single biggest pain-in-the-a** because there’s no way to do it without the fasting and the doing the math and all the stuff that–for me anyway–made me want to dig in my heels and say I Just. Don’t. Want. To. Deal. With. This. But after a few weeks it wasn’t like I was poindextering away every time I put food in my mouth. You’re still doing a lot of estimating but you have a much sharper sense of what you’re estimating with. Your guesswork gets a lot more accurate because it’s based on certain ground rules that you just internalize–how many carbs in a slice of bread and so on.

But yeah, that’s really the only way to do it if you’re trying to get off the spike and crash roller coaster. Low carb diet makes things a lot simpler too.

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While I don’t carry a food scale with me, I’m actually not above asking my friends for a package if it’s a snack-type thing that came from a box. A full meal, not so much :slight_smile:

That said, a lot of restaurants do have their NI online these days, at least chain restaurants, which has made life SO much simpler. Some even have meal-customizers where you can add/subtract certain things from your plate. I love those the best! I try to familiarize myself with the menu and have a couple of go-to items in mind at our favorite spots, and save them in my food tracker so they’re ready to go whenever we visit.

When I’m out at at a steak restaurant such as Texas Land and Cattle, Texas Roadhouse, or Outback Steakhouse, I KNOW they have food scales, and I take advantage of that! I like getting a baked sweet potato as a side. They’re more than happy to drop a potato on the food scale in the kitchen and tell you how much it weighs if you tell them you need to know for dosing insulin. No one’s ever batted an eye at the question and getting up the nerve to ask has made it possible for me to enjoy them in a restaurant setting and to dose accurately.

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You have some great suggestions here. If you take them to heart and persistsntly act on them you will make good progress. I’d like to emphasize one point made earlier. It’s a paradox of diabetes management. If you give diabetes everything it asks for you will eventually, in a matter of weeks and months, integrate these new habits into your routine. This will lead to better blood glucose levels, fewer and less severe hypos, more energy and – more time for the rest of your life.

Diabetes, as you well know, is a nasty character that will take advantage of opportunities you grant it and make your life miserable. Ignore it at your own peril. Pay attention to it, learn all you can, and you can tame it into a much less fearsome nemisus.

Don’t let the size of the project intimidate you. You can do this. Do a little every day and you will build a critical mass that will work in your favor. Good luck!

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If you’re willing to be a little assertive, there are answers to be had, yes–it’s a good point. My biggest problem with restaurant food is sauces and glazes and things like that, where there’s often more carbs than you’d think and it’s not as simple as just weighing something. Someone recently pointed out that IHOP puts pancake dough in their omelets, f’rinstance–not but what my BG spikes just driving by one of those places on the highway. Chinese food (or what goes by the name “Chinese” in the U.S.) is one of the worst, even if you’re avoiding the obvious starches like rice, noodles, Peking dumplings etc. You just have to figure there’s half a teaspoon of sugar in every bite. Best answer: like pizza, avoid. But sometimes you just gotta…

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Well, surely you are not alone - who would want to have life consumed by D?? You’ve already got lots of good feedback here. I’ll add one more, which may seem obvious, but here it is: use your bg meter as often as you can. There is no good reason or excuse not to check your bg at least before every single meal, and couple of hours after a meal. Once you see what’s really going on with your bg, you will be able to make much better decisions about how much bolus insulin you really need for a certain amount of carbs. With more frequent checking, you should also be able to catch and treat lows well in advance, and substantially reduce chances of passing out. So, do yourself a favor - use your bg meter more often.

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I wholeheartedly agree with this sentiment. More than almost any other habit I’ve adopted, frequent BG testing, creates an awareness of what your glucose level is doing. I’ve been accused of being obsessive and compulsive about checking my BG but all that checking has firmly embedded an awareness in me. Obsessions and compulsions have no goal; frequent BG checking not only constitutes a survival skill but also enhances quality of life. Don’t overlook the gravity if this advice!

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Wow

I just wanted to say thank you everyone for the stellar feedback. It’s too much sage advice I almost don’t know where to start but I will be looking at all of it carefully. I have been testing myself more, especially now that I can get test strips for.cheap under my Medicaid plan and I am anxious to read up.more on proper carb counting. I’m thankful I found this place again!

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One of the best helps I had found for carb counting is calorie king, an app on my phone. I also have a tiny book where I write down meals I eat and the dosing at restaurants. If it works out well. BG wise I will eat it again. If not I try something else. It is nice to go out to eat with a plan. My energy is spent on the enjoyment of the meal not figuring it out. By the way you are certainly not alone in how you feel. We have all been there. I personally have pity parties but nobody comes to those. I am t1 diagnosed at 57. I was quite bummed out at this. Now I am 60 and this old dog is still learning new tricks

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16

You are right Jake, we all do the best we can.

Everybody here has been through this or better yet are going through this. I don’t know that it ever completely goes way. There is so much to understand and so many different ways to approach this disease and its management. You have gotten a lot of great advice, good ideas and powerful resource links. All very necessary and all valuable.

As difficult as it can be to find your way the real challenge comes in implementing the needed changes and routines in a way that fits our own lifestyle, physical condition, abilities and personal preferences. To be truly successful in a consistent fashion, the things we do to take care of ourselves need to fit seamlessly into our life. The closer we can come to doing that with our management routines the more successful and consistent we will be.

And that, in reality, is the hardest part of the whole process. Things we have done our entire lives are no longer appropriate or sometimes even safe. These are often very big changes. Many of them are life altering adjustments. This is a big deal for anyone. Anyone. This is where support comes in. To expect we can do these things on our own is a stretch for pretty much everyone. I know for myself that finding that support was just about the most difficult thing I did in the process of gaining control. Effective support is priceless.

I must admit that the starting point for all of my progress and support was right here at TU diabetes. I found great support in the community at large and the information and resources provided here. Ultimately though it was up to me to assimilate what I learned and reach out for the support I needed. So I think you are there. Keep at it. Look for the support that works best for you ask for it and accept it.

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Jack16’s advice is sound. You have to start at the basics, starting with a basal rate check (6-hour periods at a time), then bolus ratio check (breakfast/lunch/dinner), then correction ratio check. It won’t be easy, and it won’t be fast, but it is so worth it because you will feel so much better, and the feeling of managing your BG’s is very empowering in other ways. The trouble with the rollercoaster effect is that your response to lows gets diminished. Once you are able to stabilize your BG’s more, keeping in mind they will never be perfect and stuff happens, your hypoglycemic response should improve to where you feel it coming on a lot sooner. You don’t need CGM to achieve this, just follow the steps in the order he lists below over the next few weeks and within 2-3 months you should see an enormous difference. Let us know how it goes!