A life with insulin dependency is dominated by constant injections to find the magic glucose level. How to balance the eternal circle between low and high blood sugar?
Written by diabetes coach Hildegunn Fossheim
One thing that most insulin users have in common is that hypoglycemia (often referred to as a hypo) tends to occur at the most inopportune times – during a task that requires your complete attention or in the middle of the night, interrupting your beauty sleep. In addition, because low blood sugar temporarily decreases both judgment and the cognitive function, you simply risk making a complete fool of yourself in public. Nop, it’s never a good time to have a hypo!
In addition, hypos can feel very uncomfortable and traumatic, not only for you with diabetes but also for your loved ones. I am married to a man with over 20 years of experience with diabetes type 1, and have been a diabetes nurse for over ten years. In other words, hypos are part of my everyday life. Yet, I still fear my husband’s hypos from time to time.
The diabetes patient vs. health professionals
Living with diabetes, it’s always in the back of your mind that the disease can cause you serious harm if you don’t take the right steps. In addition, healthprofessionals are very good at reminding patients about all of the serious complications poor diabetes control can cause. Diabetes control is in itself a systematic search after possible complications. No wonder one gets easily frustrated as an insulin user. However, the reality is that most people, whether one has diabetes or not, live in the present, and spend their time worrying about the challenges or problems they face at the moment. Most people with diabetes type 1 have experienced such severe hypoglycemia that they have needed help from others. Therefore, it feels more important to avoid the low blood sugar than the high blood sugar, which can reduce the possibility of complications one might get twenty years from now.
There has traditionally been a gap between the patient’s desire to avoid a low blood sugar and the medical need to reduce the risk of complications (caused by elevated blood glucose over time). Recent studies have shown that frequently occurring hypoglycemia can cause memory disorders, or in the worst case, brain injury with cognitive impairment. The Norwegian health care system will now be looking at systematic measures to reduce the number of patients with dependent hypoglycemia. The fact that a major issue is finally on the table at a national level, and that there finally is a correlation between the patient wishes and the medical treatment, can be viewed as a great victory for the individual insulin user.
A vicious circle of high and lows
Another common challenge is the high glucose values many get after a hypo. It is well known that when the blood sugar level get low, the feeling is so unpleasant that most people consume more sugary foods and drinks than necessary to get your blood sugar back up. The result is that the high blood glucose causes many unfortunate corrections, which in turn trigger new hypos – no wonder one gets tired!
In other words, to feel safer you risk a vicious circle, constantly fluctuating between insulin injections and hypos, and a blood sugar that will be more difficult to regulate. Based on this, patients that have frequent hypos don’t necessarily have a low and well regulated HbA1c. In fact, many will have an HbA1c value well into the 9 ‘s, but still suffer problems with hypos. Even for some patients with a well-regulated HbA1c it’s not uncommon to have big and unpleasant fluctuations in blood sugar.
The pursuit of the magic blood sugar level is not easy. My tip this week is simply that we need to remember that everyone are different, and that blood glucose levels will vary from person to person. It is not certain that every insulin user should strive to reach the recommended HbA1C level. Many will have a better quality of life with values just above the recommended level, without it having a huge impact on the risk of complications. I know I’m starting to sound like a broken record, repeating myself every week, but the most important thing is to talk to your doctor if you are struggling with your diabetes. There are many measures that can be taken, and the change in one’s insulin profile will often drastically change one’s quality of life.
What is your experience with high and low blood sugar? What is your golden level?