As I noted yesterday, I've decided to participate in the Diabetes Blog Week, which my friend Karen at Bitter-Sweet suggested last week in her post here. A full list of diabetes bloggers who are also participating can be viewed here. Today's topic: Making the low go.
Tuesday 5/11 – Making the low go. Tell us about your favorite way to treat a low. Juice? Glucose tabs? Secret candy stash? What's your favorite thing to indulge in when you are low? What do you find brings your blood sugar up fast without spiking it too high?
For me, hypos (or lows) are a major inconvenience. When I was a kid, I viewed lows as opportunities to enjoy the candy or juice that I was routinely denied on a day-to-day basis, but now that I'm older, I view hypos as just a major PITA (I think you can probably guess what the acronym stands for). For one thing, they are an unwelcome distraction from more important things, whether that's work, sleep or something else. They always happen at an inconvenient time (when ARE they convenient?), and treatment sucks a good 15 minutes away from productive time I'd rather be spending on something else.
The irony of hypos is the fact that they are more often caused by insulin than any other diabetes treatment, and yet again, the drug industry sees nothing wrong with that, and has instead made it's priority to make insulin last longer, but with little effort to address hypos. If insulin were discovered today, I have little doubt the FDA would probably not approve it without a blackbox warning label because of the safety concerns and the fact that insulin causes more than 58,000 Emergency Room visits each year. Another historical irony is that the ONLY reason insulin is delivered subcutaneously is because that was the only practical way in 1921, but because artificially replaced insulin is never delivered in a physiological manner, the risks for overdosage remains a permanent risk of insulin treatment, although the costly boondoggle known as the artificial pancreas project involving an insulin pump and a continuous glucose monitor hopes to make insulin a bit more fool-proof, but until insurance coverage can be assured, it will be a costly effort that many will still struggle to attain coverage for, even with exapnded healthcare coverage.
In terms of treatments for lows, I know everyone has their personal fav's, and what works for me will be totally inappropriate for someone else, and the reverse is true, too. Personally, I HATE, HATE, HATE, HATE fruit juice of any kind as a hypo treatment. Some people claim they carry juice boxes around to treat lows, but that just doesn't work for me -- they're too bulky and I hate the taste. My disdain for fruit juice as a hypo treatment is especially true for orange juice, a beverage that the mere smell of makes me want to gag and barf (sorry to offend, but you get the point) -- the pulp and texture and the taste is equally as gross to me -- I really hate oranges (the Anita Bryant endorsement did little to help change that opinion). On the other hand, I love grapefruit juice, so I have nothing against citrus fruit, just oranges. I don't mind apple or grape juice, but not as a treatment for a low, because I don't ever buy either, and these would literally grow penecillin in my refrigerator. Besides, both are loaded with empty calories, and I find them cumbersome to measure making the risk for overtreatment (which is as bad as the hypo) quite real.
I almost always rely on premeasured dextrose (which Americans call glucose, even though they are actually dextrose), although my reliance on Glucose Tablets has practically ended. For one thing, Glucose Tablets are way overpriced even though they are usually branded with the store's name, not the biggest brand in the business Dex4. I have long favored Smarties (catch a recent post here), as 2 1/2 rolls works out to exactly 15 grams of carbs. Lately, I have migrated to Mega Smarties, which are a larger sized tablet sold in the same cellophane rolls, but each Mega Smarties roll contains 15 tablets (each tablet is exactly 2.5 grams of carbs) that sell for $1.79 at my local 7-11, while a roll of glucose tablets containing only 10, 4-grams of carbohydrate tablets sell for the exact same price at my neighborhood Walgreens. That means for the same price, I get about 5% more glucose, and they're very easy to work with, as 15 grams equals an even 6 tablets of Mega Smarties (by comparison, regular Glucose Tablets cannot even be measured evenly into the ADA's recommended treatment for a hypo, which is strange). The only thing they really need is a plastic container to store them in so they don't crumble in pockets or purses, but beyond that, they are fully functional and even better, I never get strange looks from people on the street for eating Smarties!
Sure, they have the chalk-like consistency that gives many PWDs the same reaction I get from Orange Juice - nausea, but as I said, this is very much a personal option, and I have always avoided fruit juice at all costs for the reasons previously noted. So that's how I make the lows go, but for a person with type 1 diabetes, the only real way to make lows go away is to do away with insulin replacement, which means finding a cure, not trying to improve a flawed treatment protocol that is delivered in a non-physiological manner!
OK, that's today's diatribe. Did you expect me to be cheering life with diabetes? How silly of you!