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URL:   http://www.diabetesselfmanagement.com/blog/jan-chait/limbo-stick-or-not-how-low-can-you-go/print/

Limbo Stick or Not: How Low Can You Go?

Jan Chait

June 3, 2014

It was as if somebody had dumped a bucket of cold water on me, but there was no water and no bucket. Instead, I was freezing and sweating — the result of a blood glucose in the 30’s. I checked again. Yep. That’s where it was, all right. Dang!

About that time, my Sweet Baboo walked into the room. “Good morning! How are…” then stopped and looked again. “What can I get you?” he continued, with a bit more urgency.

“Cereal,” I said in a barely audible voice.

“What kind of…” he continued before waving his words away. “OK, OK. Cereal,” he muttered before leaving and coming back with a bowl of something-or-other. I did remember that Mikey liked it. (Depending on your age, you may not remember that commercial.)

Thankfully — I mean, I felt like crap — I dug my spoon into the cereal. After about three bites…I dropped the bowl. He brought me a bowl of the other kind of cereal that was on the counter. I dropped it, too. Then I dropped the juice that arrived after two attempts with the cereal. Fortunately after I’d chugged a lot of it down.

The next morning? Same thing. Low BGs. Dropped cereal. This time, however, Hubby’s second choice was jelly beans. They’re not as messy when you drop them. (Think wet cereal and milk on a dark blue carpet). Also, the cleaning lady wasn’t there the second morning to shoo him out the door and let her take care of the mess. Under those circumstances, I would have chosen jelly beans the FIRST time!

Many times I opt for cereal to raise my BGs. It works for me. Ironically, I usually go for a bowl of “Life” cereal. It sogs up nicely (I don’t like crispy cereal when I’m low) and Mikey likes it.

Oh, yeah. The “irony” part. Did you know that hypoglycemia can kill you? Oh, yes it can. Even us Type 2s, according to some fairly recent research.

All this time, I thought “they” wanted us to avoid hypoglycemia because it could make you do stupid things. Like, oh, eating dinner with a cocktail fork because you couldn’t commit math well enough to count carbs. (It made sense at the time.)

And, of course, you didn’t want to be out there driving a car while under the influence of too much insulin.

As it turns out, you might not want to be under the influence of too much insulin for a prolonged period of time…um, period.

I’ve had a couple of friends with Type 1 fail to wake up in the morning. In both cases, they were fine when they went to bed. In both cases, there was no indication anything had happened during the night to cause death. The medical community just scratched its collective head and the phrase “dead-in-bed syndrome” offered some kind of explanation.

Dr. Richard Hellman, an endocrinologist in North Kansas City, MO, and former president of the American Association of Clinical Endocrinologists (AACE), notes that around 10% of people with diabetes who died before the age of 40 were found dead in bed.

As I recall reading (and, no, I can’t find it), the continuous glucose monitor (CGM) played a role in helping to figure out what was going on when a dead-in-bed victim appeared who had been wearing a CGM. It appears that prolonged hypoglycemia can lead to cardiac problems.

Type 2s — we’re not exempt. Recent studies have shown that people with Type 2 diabetes also can have nighttime prolonged hypoglycemia. Also, while it’s less frequent than in people who take insulin, use of sulfonylureas (oral medicines that cause the pancreas to make more insulin) can be a factor, Dr. Hellman says.

Common sulfonylureas include chlorpropamide (brand name Diabinese), glimepiride (Amaryl), glipizide (Glucotrol), and glyburide (DiaBeta, Glynase, Micronase). They’re also available as combination drugs.

Aside from the cardiac problems, other factors include age, with Dr. Hellman noting, “people are less able to bring up a low blood glucose as they age.” Also, he says, frequent and prolonged hypoglycemia can present difficulties in getting blood glucose levels back up to normal.

What to do? If your body doesn’t recognize the signs of hypoglycemia, ask your doctor or CDE what steps you can take. Get a CGM if you’re able to afford one. There is a petition asking Medicare to cover CGMs. I’ll try to find that information and post it. (Just remembered that one.) The CGM will alarm if you go lower than a number you’ve set. I don’t always hear the alarms, however. Perhaps I need to put my CGM in a glass.

Above all, don’t worry yourself. Life’s too short. If a lot of people were dying from dead-in-bed, there would be a lot more information out there about it. Wouldn’t there?



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