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Ask Dana: how to treat your low blood sugar readings

QUESTION:

Dear Dana,

For years I have struggled to get my blood sugars under control. This year, I started to use a continuous glucose monitor and insulin pump for the first time and have noticed a big improvement in my management. Now, my biggest problem is that I feel low even when I’m not actually low. I also struggle with overeating when I am low – I get so nervous and anxious that I can’t seem to stop. Do you have any advice or direction for me?

– Leslie O’Malley, Miami, Florida

low bg

ANSWER:

Dear Leslie,

You bring up some great questions and are dealing with issues that many people struggle with while improving their diabetes management.  Congratulations on your hard work and dedication to managing your diabetes in a new way!

Let’s discuss two things to begin with. First, we always want to find a way to stop the lows.  The use of a continuous glucose monitor can help tremendously with predictive alarms and ways to help you prevent lows from occurring on a regular basis.  You always want to make sure that your pump settings are optimized and not causing these lows on a regular basis.  However, we know that despite all of our hard work and focus on diabetes management, lows STILL occur – even to the best of us!  You may not have experienced so many lows when your blood sugars were running on the higher side in years past.  So, second, we need to talk about how you are treating your lows.

After spending many years or even just a few months with higher than desired blood sugars, your body does evolve to feel better (or even just decent) at a higher level.  It is natural for you to feel low at healthier numbers if you are not used to it.  This will get easier and more comfortable the more time you spend in a healthier threshold.  One strategy to use while you bring your blood sugars down slowly is to set a higher target blood sugar on your pump for a short amount to time.  Another strategy is to eat artificially sweetened items like sugar-free popsicles, sugar-free soda to trick your brain that you are treating a low even if your blood sugar is in a normal range.  This can be challenging but after three to five days, you will start to feel better at healthier blood sugars.  I promise!

Now, how should you treat true low blood sugars?

It is very easy to finish a bottle of juice when your feel low and are scared of dropping even more.  It is even easier to dive into the chocolate chip cookies while you are waiting for your blood sugar to recover and raise to a normal level again.  So, plan what you will use to treat a low with something that feels “medical” in nature.  Use only fast-acting carbohydrates that list sugar as one of the only ingredients.  Chocolate or anything that contains fat or protein will slow down your recovery from the low.  Keep fast-acting carbohydrates nearby at your desk and nightstand and, also, in your backpack or car.  Maintaining a well-stocked supply of fast-acting sugar can also help with anxiety about lows – you will have the tools you need to manage a low and won’t have to walk into the kitchen where there are more temptations.

Fast-acting carbs will increase your blood sugar based on your body weight.  Find your weight on the table below to see how much 1 gram of carbohydrates will increase your blood sugar.  For example, if you weigh 155 pounds, you will see that 1 gram of carbohydrates will increase your blood sugar by 4 points.

A single gram of carbohydrate will increase BG by:

60 lbs (27kg) or less…….……… 6-10 mg/dl (.33-.56 mmol/l)

60-100 lbs (27-45kg)…………… 5 (.28 mmol/l)

100-160 lbs (45-73kg)………….. 4 (.22 mmol/l)

160-220 lbs (73-100kg)…….….. 3 (.17 mmol/l)

greater than 220 lbs (100kg)..….. 2 (.11 mmol/l)

After you have a sense for how much a gram of carbs will increase your blood sugar, you can do a simple formula to measure how much you should have (assuming you are feeling OK to do some math!).

(Target BG – Actual BG) / BG Increase per gram of carb

Using the same body weight example as above, if you weigh 155 pounds and have a blood sugar of 50, you may want to raise your blood sugar to 100mg/dl or so.  So, using the above formula, you would need (100 – 50) / 4 = 12.5g. This is about two rolls of smarties candy or three glucose tablets.  Typically, people are very surprised to see how few grams of carbs they actually need to achieve a normal blood sugar again.

What to use to raise your blood sugars?

Dextrose containing foods convert to glucose quickly.  You can buy dextrose tablets or gels and even find dextrose in some easy-to-find candies. Sweet Tarts, Smarties, Pixie Stix, Nerds, Runts, Air Heads, and Sprees all contain dextrose and act quickly.  Some people prefer a more organic approach to treating low blood sugars and that is fine as well – we just want to make sure that whatever you choose does not have fat and protein to slow down the digestion and the rise of your blood sugar.

Now, what do you do while you wait for your blood sugar to rise?

The waiting can be the hardest part – listening to some calming music or an interesting podcast can help you stay calm and keep busy while you wait.  Deep breathing and meditation can help curb anxiety associated with lows in the moment.  Also, setting a timer can be helpful as you will know when 10 or 15 minutes have passed.  After that time, you can evaluate if you need additional carbohydrates to increase your blood sugar even more.

Treating low blood sugars is part of having Type 1 diabetes and should be something you feel comfortable doing – even though you would rather avoid them altogether.  Ask your health team to help guide you or reach out to an IDS staff member.  We are here to help!

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