Hypos

Forever Learning

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“I never get it wrong. I just learn for next time.”

If there’s one quote that truly resonates with me in the way I manage my diabetes, Grumpy Pumper summed it up for me perfectly in a tweet that surfaced this weekend from the Sports and Exercise Weekend he was attending in the UK.

The biggest piece of diabetes wisdom that I often impart is that time and experience is my biggest asset in living with diabetes. Because each and every one of those valuable hours spent managing my diabetes have taught me something. Like only bolusing for 60% of the carb count on my banana. Or living to regret every hypo that I’ve treated with something nicer than skittles or glucose tabs. Or remembering to bring a spare of everything with me.

I am a bit of a perfectionist in the way I manage my diabetes. I meticulously monitor my basal rates, count my carbohydrates, time my insulin to the kind of food I’m eating and give deep thought to the physical activity I undertake each day. It’s no simple equation, by any means.

My biggest downfall is that I don’t handle it very well when things don’t go to plan. I can often be found swearing out loud in front of my meter, verbally expressing my frustrations.

Yesterday was one of those days, as I found myself low twice after my breakfast and wondering how today had been any different to my other mornings of late.

As I sat in my desk chair at work, recalling the actions I’d taken that morning, two particular things came to mind. The first being correcting a blood sugar of 7.1 upon waking up, ignoring the insulin I already had on board from an earlier correction (and perhaps if I’d washed my sweaty bed hands prior to checking, the number may have been different). The second being the ginormous orange I added to this morning’s brekky. As I searched through my Calorie King app, I learned that oranges had 5.5% carb content, rather than the 8% I had in my head.

Living with diabetes is a constant learning process. I still surprise myself at how much I continue to learn after a good two and a half years of more diligently managing blood sugars. I wonder if I will ever live to see the day where I’ve learned everything that there is to learn.

What I do know, however, is that I don’t feel so guilty for my blunders when I can identify reasons for them.

Treating Lows.

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The very first thing that I used to treat my hypos were jellybeans. You know, the ones that came in little packets at the Chemist, and had the glucose syrup mixed into the recipe.

Those packets weren’t particularly easy to walk around with, especially once opened. The jellybeans often got squashed at the bottom of my bag, or went hard fairly quickly once opened.

During hypos, it was easy to lose count of how many I’d pulled out of the packet and popped into my mouth. It was difficult to translate a serving size into individual carb counts per jellybean. Having to ‘chew’ through six of them during a hypo often felt like a lot of work. Not to mention all of the little bits of jelly that got stick in-between my teeth afterwards!

They weren’t particularly cheap, and I absolutely hated having to throw all of the black ones that were left at the bottom of the packet into the rubbish bin! On occasion I would pick up a 1kg bulk bag, but I always felt like I was being judged for the number of hypos I was having from the Pharmacist behind the counter.

It wasn’t until I joined the Young Adult Diabetes Committee last year that I entered the world of glucose tabs, which are one of the perks of being involved (just quietly, they’re the only reason I come along to meetings…) I absolutely loved how portable they were to carry around, with the ability to carry 40 grams of fast acting glucose in one very tiny container. One tablet was four grams of carb. Easy enough to count during a hypo. No sticky bits left in my teeth afterwards!

Anyhow, these TRUEplus soft glucose tablets were on show at the Diabetes Congress last month, where I picked up a few free samples. There are two new flavours, choc marshmallow and kiwi strawberry. I sure as hell envied all of the healthcare professionals in the exhibition hall who were able to taste them for fun!

I consumed a few of the chocolate tabs during a hypo the other night, and I guess they tasted a bit like Cocoa powder or Nesquik. Meanwhile, the Kiwi Strawberry tabs kind of smell like our cupboard under the stove where the olive oil and salt is kept. They were also far less chalky than the Dex 4 tablets that I’m currently consuming.

One tube of eight glucose tabs retails for $4.95. I was told that these will launch in December, available online, through some Pharmacies and at Diabetes WA.

I’ve tried and tested a lot of hypo treatments over the years, and if there’s one recurring theme, its that I get sick of them pretty quickly. And I often have to will myself not to treat them with something more appealing like chocolate.

So, hooray for more choices for people with diabetes!

Disclosure: Diabetes Australia covered my registration, travel and accommodation costs to attend the Australasian Diabetes Congress. These are my own views, and not those of Diabetes Australia. My time, including the annual leave I took from work to attend the Congress, was my own.

Hypo in the Diabetes Clinic.

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“Are you still using the Animas?”

“Actually, I have the new YpsoPump.” I replied to the nurse, pulling it out of my pocket.

“Would you like to use your own lancet?”

“Good idea,” I replied, pulling it out of my pencil case and avoiding a bloodbath on my fingers.

“Oh, you’re 3.8,” the nurse said to me after I had applied some blood onto the test strip. “Have you got some hypo treatment on you?”

Before I was even given any time to answer, she had poured me a glass of sugary fluid to drink and handed it to me. Encouragingly, it was an appropriate sized amount that wouldn’t send me rebounding.

“Are you able to feel your hypos?”

“If it’s a steady 3.8, like this one, I feel fine. But if it were a 3.8 and dropping rapidly, I would.” She was lovely, and I didn’t feel that I was being judged.

Another nurse walked in, also wanting to have a look at my new YpsoPump. “Of course, you should treat your hypo first!” She exclaimed to me in a motherly way, after being reminded by nurse one that I was hypo.

“Are you sure I can’t get you some biscuits or anything?” the nurse asked me, as I made my way towards the door.

“No, I’ll be fine. The tea will probably bring me up as well,” I said as I grabbed the Styrofoam cup that I had been given in the hallway earlier.

I made my way back toward the end of the corridor, took a seat and buried my head into my iPhone, grateful for the warm drink on my sore throat. I wasn’t worried.

Some time later, the nurse returned. She hovered for a moment, but I didn’t really notice until she spoke.

“Frank, would you like to check your blood sugar again?”

Knowing it had been sufficiently treated, I had completely forgotten about my hypo. I pulled out my FreeStyle Libre, registering the 3.7. I wasn’t convinced that I needed anything further, and pulled out my meter.

“I’m happy to leave it,” I said, holding up my meter that was displaying a 4.4. “I don’t want to overtreat it, and the tea will probably bring me up a bit more as well.”

“Are you sure I can’t get you any biscuits or something?”

“No, I’m fine. Thank you.”

I get that this comes from a good place. A really good place.

Perhaps if hypos hadn’t interrupted many of my work days, bed times, socialising, housework, walks and errands over the years, I might just treat them with the same response as that nurse.

Hypos are not a scary thing, provided I know how to manage them. They are a part of living with diabetes, just like checking my blood sugar or injecting some insulin. Last year at the Roche Educator’s Day, I made a big point of stating that two hypos per week was an unrealistic expectation from my healthcare professionals. Moreso as my skills in managing blood sugars improved and I was spending more time in range.

I get that hypos are not good for me in the long run. I get that hypos can impair my cognitive function. I also get that hypos can be life threatening – and maybe I’m just lucky that I’ve never had one where I’ve needed help. Believe me, I don’t like having hypos anymore than a healthcare professional likes seeing them appear on a blood glucose meter.

However I feel it’s more important that I’m dosing insulin responsibly, checking my blood sugar often enough, travelling with glucose tabs on hand and am able to sufficiently treat a low.

Some healthcare professionals condemn people with diabetes for having too many lows, and this is where we need to reshape our attitudes toward hypos.

Making me feel any lesser for the number of hypos I have will only make it more difficult for me to share openly in front of a healthcare professional, ultimately jeopardising the provision of any support I may need.

The First Hypo of 2017

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I went seven days into the new year without a hypo. And then this happened…

My blood sugar level was 8.8 an hour after dinner on Saturday night. I let things be and went about brushing my teeth, clearing the debris of diabetes waste on my desk, and putting away the clothes and shoes I had worn earlier in the day.

When I checked my blood sugar an hour later, my meter came back 19.8. What? I couldn’t believe I had risen so quickly in such a short space of time. I probably should have tested again, just to be certain.

I entered the reading of 19.8 into my insulin pump so that it could suggest a correction dose for me. I reactively overrode my pump’s suggestion, giving the whole correction dose and ignoring insulin I had on board.

When it was time for bed, I suspected as much. Sure enough, my meter came back with a 2.9. I reached for my insulin pump, which told me I had 3 units of insulin on board to eat my way out of.

I shoved four Chocolate Cream biscuits into my mouth, struggling to recall how many I had eaten by the time I got to (what I think was) number 4. Side note: Christmas biscuit tins are proving to be awesome hypo supplies. Unless they’re tins of shortbread. Shortbread is simply too good to waste on hypos…


I shuffled into the kitchen to weigh one of the biscuits, just to be sure that the serving size was right and I had eaten enough carbs.

As I lay down on my bed, and placed the back of my head on the pillow, the hypo really hit me. The sweat, the shakiness, the feelings of exhaustion, the paralysis. I didn’t want to do anything else other than lie there, willing my eyes not to shut.

Those hypo feelings weren’t subsiding, but almost half an hour had passed and I knew it was time to check my blood sugars again.

My meter came back at 1.8.

I frantically shoved another 2 biscuits in my mouth. My hypo brain decided that those Chocolate Cream biscuits needed to washed down with a glass of Cadbury drinking chocolate. I shuffled my way into the kitchen, driven only by the cravings of chocolate milk. Stirring the powder and the milk together in my glass was absolutely painful. Making sure I scraped every visible bit of powder stuck to the bottom of my glass in my stirring action, and waiting for it to come to that perfectly blended consistency before I could skull it down.

Satisfied, I shuffled back to my bed, once again waiting. The next check came back at 3.6, followed by a 4.7 minutes later. I knew I had overtreated. Not wanting a repeat of the night’s events, I set consecutive alarms for the next three hours until I had brought my levels back into range.

“Are You On a Diet?”

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I can’t begin to describe some of the funny looks I’ve been getting when I sit down with my bag of almonds at morning tea time. Those looks that just scream of “is that all you’re eating?” or “are you on a diet?” or “are you not feeling well?”

The young guy in the fluoro shirt who should be skulling choc milk and having a Woolies donut, eating almonds? Yep, I get it. While my diabetes is pretty transparent, people still forget or don’t realise it’s there.

Last week, one of my work Mums brought in a tray of leftover sweets to share from her weekend. As usual, I got the typical Nonna treatment. “Go on. Take it!” I politely said that I was trying to be good, and asked her to save me something for later. “Why?”

Last week, we had a bake sale in the staff room at work. I felt guilty for not buying anything. As I sat down in front of all of the tempting cake with my bag of almonds, someone remarked to me “you’re being good today, are you?”

I don’t put a lot of things off limits when it comes to diabetes and food. So long as I feel that I truly do enjoy eating something, then it is worth the effort. But I absolutely hate to perpetuate the myth that someone with diabetes can’t eat whatever they choose. I felt compelled to explain my choice not to indulge in cake at 10am on a work day to the staff room table.

After six months of experimenting and fine tuning, I am finally starting to see some consistency in the mornings while I am physically active at work. I am starting to feel that sweets are just not worth the effort while I am working. I will be guessing the carbs. I will be giving a generous dose of insulin. That insulin is more sensitive while I am physically active, and I am more likely to go low. What tends to follow is a day where I am trying to juggle highs and lows. I don’t feel very motivated to manage my diabetes well after days like this, and it’s just not fun. 

I eat a satisfying breakfast when I wake up. My treat in the morning is my Coffee Club Cappuccino with no sugar, enjoyed with my team mates. It’s 12g of slowly digested carbs, and I can handle that just fine.

But at 10am, I eat almonds. Almonds have minimal impact on my blood glucose while I am working. They don’t send me into a vicious cycle where I am correcting highs and warding off lows. Turning down cake is a small price to pay for the juggling act I so badly want to avoid while I am at work.

Plus, the cake will still be there to enjoy later, right?

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