The Plunge

diabetes dietHello fellow and female diabetics, and the friends who support us. This week, I’d like to talk about The Plunge.

If you are on insulin or other blood glucose-lowering medications, you’ll know The Plunge. It’s where your blood sugar drops at an alarmingly rapid rate usually because of insulin or other medicines. It feels very unpleasant.

What’s it like? Explaining diabetes feelings to non-diabetics is tricky, and it needs a lot of imagination. You search your vocabulary and powers of observation for ways to describe it and still come up short. Metaphors work the best, but they are still hard to think up.

The Plunge works well for me because it signifies a roller-coaster. There you are at the top; then suddenly, you’re heading to the bottom at super-fast speed.

Signs of fast-dropping blood sugars include tiredness, a lot of yawning, shakiness and confusion. They are also all symptoms of hypos.

One of the reasons we promote The Diabetes Diet (low-carb eating) is that it makes The Plunge easier to avoid. This is because you won’t need to take as much fast-acting insulin with your meals. Using fast-acting insulin can be a be a bit like picking up a sledgehammer to crack a nut. It isn’t subtle stuff, that’s for sure.

This isn’t a guarantee. Sometimes, you’ll need extra insulin to cover unexpected high blood sugar levels, and The Plunge may result.

But overall, using lower levels of insulin to cover meals means steadier blood sugar levels overall. Dips up and down are far less dramatic and therefore don’t feel as yucky. (This is a technical term.)

How do you experience The Plunge, and can you think up better ways to describe than I can?

Hypo or Not?

diabetes diet
A “serious and important” hypo.

When do you feel the symptoms of a hypo?

The November/December issue of Balance, Diabetes UK’s magazine, reported that researchers have proposed that we need to take a fresh look at defining low blood glucose levels.

At present, a ‘hypo’ (low blood glucose level) is 3.9mmol and below (70.2mg/dL in the US), which the researchers feel isn’t all that low.

A severe hypo is one where someone needs help from another person to recover, something that rarely happens in clinical trials. Rightly so, as letting someone go so low without help wouldn’t be ethical.

Researchers suggest that there should be three levels of hypo – low, lower and oh f*****g shit. I’m kidding, obviously, but they are looking for the level that, below this point, a person’s health is seriously affected, i.e. where their brain, blood and cardiovascular systems are compromised, the risk of death begins to rise, and the level that has an impact on mental health.

Current research suggests these begin to take effect at about 3.0mmol (54mg/dL in the US). The team’s three definitions are:

  • Level 1: 3.9mmol or less –a hypo alert
  • Level 2: less than 3.0mmol – serious and important hypo
  • Level 3: serious hypo, requiring external assistance, even if none is available.

Like all of us, hypos are individual. One person’s “I’m fine at 3.9” is another’s “oh shit”. I sometimes feel the symptoms of a hypo coming on at 4.6, say. Other times, I’ll prick my fingers, get a 3.9 and wonder where it’s come from.

As you can see from the picture, I had a “serious and important hypo” this morning, thanks to undereating and walking too enthusiastically yesterday. Oof. It happens.

Keeping your blood sugar levels stable without going too low is a huge challenge. One of the reasons we promote low-carb eating for type 1s in particular is that the risk of hypos can be reduced because you don’t need to take as much insulin.

If the researchers could include advice about how to avoid hypos, while also achieving good HbA1c results in the long-term, we will cheer them on…

 

*Some good news! The NHS has approved flash glucose monitoring technology – i.e. systems such as the FreeStyle Libre. I’m off to investigate the possibilities of getting one. Also, big love to the NHS, a wondrous, wondrous institution.