To JDF Team SGG - low blood sugar

[mlz]

My husband has been a Type 1 diabetic for almost 20 years. The last few years he's had more serious lows a day or two after a lot of physical activity (biking, hiking, long walks). I read your suggestions about raising your bs level for a couple weeks to help stabilize yourself. Can you give an example of how much he should raise his bs? Or if you have any more information on the article you've referred to several times, author name, or publication? I would appreciate it.
The last two times that these type of lows occured, he had just ate, but it was a slower acting carb, so it didn't kick in, but it was all that he had on him while we we casually hiking. That won't happen again. The next time, it was 30 mins after he had ate lunch, which hasn't happened before. We suspect the high activity and just not eating enough the days afterwords took a toll on him.
The last 5 years he has really been making the effort to be tight with his bs, eating on time, snacks, regular dr. appts. & so on. Other diabetic message boards I surf have horror stories of adults not taking care of themselves and the toll it takes on their bodies and caregivers. So I'm glad that he his doing all he can. And maybe we're asking too much to be 'perfect' all the time? There are so many days that go by with nothing unusal going on with him, that when something does happen, it's a huge reminder that we have this disease to deal with.
Any other suggestions on the lows and activity is much appreciated too.
Thanks for a great site and vaulable information.

[mlz]

Thanks to both of you! Your suggestions and comments are very helpful. We read the comments and then had positive discussions about it afterwards. This allows me to ask him questions about topics I didn't know to ask about and he didn't think to explain to me. We both benefit from this. Reading these posts, as well as others, should help to create and maintain better dialog and communication between a diabetic and their spouse or family members.  
We will take your suggestions to heart and use them as we can. He said he will keep checking the board and will probably even ask his own questions.
Thanks again, keep up the good work.
mlz

[JDRF-Team-LRS]

I would like to echo SGG's terrific bottom line,
"As long as he works to make sure he keeps his hypo warning symptoms healthy and always is prepared with the right quick carbs when he does go out for exercise, he should be fine. We tend to get careless and then cause our own hypo problems by just not being prepared or not testing enough."

It is not possible to have BGs that're steady .. at, say 100, 24*7 ... for diabetics who LIVE life fully.  It is possible, however, to carry a bit of extra weight in the form of quick-acting glucose/ sugary stuff and also more balanced foods for grazing while doing fabulous actitivies like hiking.  Then, there's the after-exercise phenomenon.  Seems that you're in a position to write down the data you're collecting about lows ... and then study that data to find patterns.  We have another variable to tweak and that is our insulin doses.

It might be time for hubby to evaluate his insulin-carb ratios and to figure out if his basal (long acting) insulin is at the correct time(s) and dosages.  As folks become more physically active, our NEED for insulin drops as well -- never to zero, of ocurse.  Hubby may be more insulin sensitive now that he's active more regularly.  

Managing this diesease will always be a mental and emotional challenge as we do the amazing feat of manually trying to duplicate what well-functioning set of pancreatic islet cells do automatically.

[JDRF-Team-sgg]

The article about the study on hypoglycemic unawareness was published in my hometown newspaper in 2001.  I remember it so clearly because I was one of those diabetics with a real problem wtih hypoglycemic unawareness. I followed the suggestions and truly my warning symptoms are great now. I still of course have occasional lows -- I think that any type 1 diabetic under tight control risks occasional lows. But the good warning symptoms take away the fear, for we feel it happeng when those warning symptoms are intact and can take the proper actions to fix the problem before it becomes dangerous.

I have been searching the web to see if I could find a copy of the article about this study, and I found lots of references to it, but not the entire article. Here is an excerpt from an article that refers to this 2001 study:

"Hypoglycemia unawareness. This is a condition in which people become insensitive to hypoglycemic symptoms, usually after experiencing severe episodes. It affects about 25% of those who use insulin. Even a single recent episode of hypoglycemia may make it more difficult to detect the next episode. With vigilant monitoring and by rigorously avoiding low blood glucose levels, such patients can often regain the ability to sense the symptoms. One 2001 study found that by temporarily letting up on glucose control and then tightening it again, diabetics could "reset" their awareness of hypoglycemic symptoms."

Another web site has this to say, which agrees with the study I read about: "According to [the doctor interviewed], three separate studies have shown that hypoglycemic unawareness is 'largely, if not entirely, the result of multiple hypoglycemic reactions.' Two of these three studies also showed that as little as two to three weeks of 'scrupulous avoidance of hypoglycemia will reverse hypoglycemic unawareness,' says [the doctor]."

Below are two other web sites that discuss the possiblity of regaining good warning symptoms by avoiding ALL lows for a varying length of time (one article mentions the two weeks that I read about in the 2001 study, and this other article talks of a study on hypoglycemia unawareness that lasted for 4 months, after which people regained ther warning symptoms:
http://www.defeatdiabetes.org/Articles/hypoglycemia040216.htm
http://www.diabetesireland.ie/view.asp?ID=869

You ask how much to raise the glucose levels. I think this varies from person to person, but I think that the solution would not necessarily be to decrease insulin, but to do very frequent glucose checks for those two weeks. By testing every few hours, he could catch a drop happening and treat it with just a small amount of juice before it ever got below 70. This way, he could avoid the hypos for those two weeks with little extra work other than lots of fingerpricks. And he could keep his good control while doing this. During that time, he would have to have some quick carbs handy at all times so he could catch and prevent any drops as they start to happen.

But frankly, I think the real issue with your husband is probably NOT the hypoglycemic unawareness problem, but his body's reaction to exercise and perhaps a lack of knowledge of exactly how long he needs to watch carefully after doing extreme activity. Lows can happen as long as two days after strenuous exercise, and most diabetics are not really LOOKIN for this to happen that long after the exercise. Even if his warnings are good most of the time, he can have one take him by surprise if he isn't really looking for it to happen. My twin is the reallly active diabetic, and her doctor has told her to be on guard for up to  2 days after strenuous exercise. She tells me that drops two days later are not uncommon for her after strenuous AND prolonged exercise. So we are not talking about the walk around the block doing this to him, but the all-day hike. That long period of activity uses up the body's stores of glucose, and it does take days to recover them, depending on how much of the body's stores were used.

I certainly am an advocate of exercise, and so wouldn't tell diabetics to fear exercise, but just to be very cautious for the next few days and do lots of finger pricks for a couple of days to be safe. Frequent testing makes the severe drop fairly unlikely, for drops will be seen happening hopefully before they disable him if he tests often. I think that a glucse test every 2-3 hours is probably a good goal to set on those days when he is on guard after strenuous exercise.

Now, I am not a physician, so do tell him to check out all that I write with his physician. I am merely a long-timer like himself who happens to be an avid reader of all things diabetic, and of course who happens to also have an identical twin whose experience adds to my own. Yes, tight control WILL probably protect him, and so it is important to keep the control tight. But this does mean that lows are a risk and that we cannot go for a 5-hour stretch between meals without testing becuase even the slghtest miscalculation in our food or in our activity can cause a hypoglycemic episode. The testing is his safety net. Also, my twin's doctor told her that when active, a sports drink such as Gatorade is really the absolute best quick carbohydrate to drink, for it not only digests quicker than juice, but also has electrolytes and minerals that help replenish the active body quicker than mere orange juice or soda. So tell him to strap a backpack on and throw a few bottles of any good sports drink in his backpack before he heads out to do his biking or hiking. I played USTA tennis for years, and found that exercise was quite workable if I prepared properly and sipped something like this every few games to keep some fuel going in and prevent glucose levels from STARTING to drop. This makes more sense than eating a huge meal to boost sugar levels up high and then doing the exercise without having any carbs with him. It is safer and healthier to eat the normal meal in order to keep the glucose normal, and then make sure that sips of sports drink happen as he walks. He can work out the amount of carbs he will need by looking at what he normally eats to get that glucose boost to last through the exercise, and then he can make sure he has more than enough with him so he is safe until he returns home. I

applaud him for making the attempt to keep the tight control these days. As long as he works to make sure he keeps his hypo warning symptoms healthy and always is prepared with the right quick carbs when he does go out for exercise, he should be fine. We tend to get careless and then cause our own hypo problems by just not being prepared or not testing enough.  I hope this helps.