In Which I Learn Not to Fear Low Blood Sugar

Despite the scientific fact that a person with diabetes is statistically more likely to die due or experience severe brain damage due to DKA brought on by extended high blood sugar that produces ketones, it seems that the biggest fear of some adults with diabetes and even more parents of children with diabetes is a severe low blood sugar resulting in seizure and brain damage or death.

Before I continue and further provoke the fears of someone reading this who is dealing with a new diagnosis, I want to make it clear that, though both scenarios do happen, they are both statistically rare. It's actually much more likely that a person will die of DKA because their new onset diabetes is incorrectly diagnosed or not diagnosed at all. Once you're diagnosed and getting proper treatment, your risk goes way down. That is, of course, presuming you're able to get ahold of enough insulin for your needs (a serious problem that needs a whole other post to address it).

When Kittygirl was first diagnosed she could not feel either high or low blood sugar. Her doctor assured us that this would happen with time. However, even three months in when we got the Dexcom CGM Kittygirl did not show any symptoms when she had low blood sugar.

Some people argue that kids like her will eventually learn to recognize their body's symptoms of high and low blood sugar if parents don't use the CGM as a crutch. However, we've tried all kinds of tips and tricks, and, while Kittygirl does feel something now, her feelings are very subtle and easily missed. When her blood sugar drops under 70 she starts to feel hungry (easy to miss if it's near mealtime anyway) and when it rises over 200 she starts to feel thirsty (again easy to miss, especially if it's a hot summer day). The classic feelings of weakness, headache, irritability, nausea, crankiness, etc, are so far just absent for her.

You would think that, since my child's symptoms of low blood sugar are so mild I would not be worried about it. However, initially, her lack of awareness made me feel even more worried. I practically carried a trick or treat bucket worth of low treatments around with me, and, once we got the Dexcom, had Kittygirl eat something when her blood sugar started to trend below 150.

Mr. Engineer tried to gently point out that 100-150 was still a very safe blood sugar range and that, if we wanted Kittygirl's blood sugar to be closer to normal, I had to get comfortable letting it get below 150. Ironically, one incident that caused me to lighten up a bit was a very low blood sugar that occurred at a park.

Mr. Engineer and Kittygirl were headed to a park and Kittygirl wanted a snack first. I gave her insulin for the snack and then proceeded to forget to give her the snack. They blithely went on their way, Kittygirl having forgotten about the snack. As Kittygirl played Mr. Engineer watched the dots on the Dexcom drop more and more steeply. He stopped Kittygirl from playing and gave her a juicebox, but the drop continued until the Dexcom just read LOW. Measured with the meter, Kittygirl's blood sugar was 26.

Via phone, Mr. Engineer consulted with me and we tracked down the source of the low blood sugar to the uneaten snack. I told him how many carbs Kittygirl should have had. She ate them, and then impatiently waited until her blood sugar was back in range. Kittygirl felt totally fine the whole time.

The experience was stressful for Mr. Engineer, but, for me, it served as a wakeup call that, if Kittygirl could feel totally fine with a blood sugar of 26 and it could be handled with food and a short rest, it really was okay to let her blood sugar drop to 100 or even 80 in the course of a normal day.

I still stock a lot of low snacks at my house (see the above picture) and carry more with me for a short outing than I'm likely to need over the course of a week. However, I've stopped being afraid that a low blood sugar is going to be a huge disaster. Sometimes, thanks to Dexcom, I'm able to head off a low blood sugar before it gets below 70. Other times this fails miserably or I don't catch it in time, but Kittygirl eats something and she's totally fine. I've learned that, most of the time, hypoglycemia is not the emergency I feared it would be.

Now, just like with everything else on this blog, I can only speak from my own experience. I know there are people with really severe reactions to low blood sugar. I imagine that, for an adult living alone, the idea of having a low blood sugar that they can't treat independently is terrifying.

I'm not saying that low blood sugar is never a big deal for anyone. What I AM saying is that we shouldn't be so afraid of low blood sugar that we run our (or our child's) blood sugar relatively high all the time to avoid it.