Diabetes presents constant challenges for managing and maintaining blood glucose (BG) levels. It’s all about finding the right balance. Dr. Beverly Adler (Dr. Bev) compares it to walking an insulin tightrope, where a misstep could be very dangerous. Fortunately, there are many tools available to help people with diabetes keep BG levels within safe a range. Dr. Bev offered additional insights in this week’s Twitter chat, along with returning host Jewels Doskicz, who is a registered nurse, type 1, and mother to a type 1. Diabetes can be a scary disease, but being prepared and informed helps make it a lot more manageable.
Q. How do you walk the insulin tightrope and mitigate diabetes dangers as best as possible?
Dr. Bev: Sometimes trying to maintain blood glucose in a safe range can feel like walking a tightrope. Taking insulin is one of many factors that can affect BG—some within your control, some not. Checking blood sugars can help.
Jewels: Safety occurs through awareness. Every single thing we do has effects on our diabetes. There's a fine line between safety and a good A1c. Continuous glucose monitoring (CGM) helps, but there is always an element of danger.
• The more I pay attention to my data, the better my results. But even then, insulin isn't totally predictable.
• I rely on knowledge, gut feelings, recognizing patterns in my life, and understanding that sometimes diabetes is an art, not a science.
• CGM helps a lot. I am learning to spot trends early on and take corrective action before I fall off the tightrope.
Q. What is the most precarious diabetes situation you’ve found yourself in since diagnosis?
Dr. Bev: My lowest low BG ever was 23 mg/dL. I was pregnant and ready to eat Chinese food for dinner. I was aware and treated with orange juice. My scariest BG was 44 mg/dL. I felt fine and checked my BG after driving my kids home. Learned to always check BG before driving!
Jewels: Middle of the night seizure—it's one of the most dangerous times we face.
• My most recent was when I was pre-bolusing for a bagel that ended up on the bus floor. I had to survive 35 minutes until I could find another 60 g carbs.
• I left on a road trip without insulin once. I presented myself at the ER in diabetic ketoacidosis (DKA).
Q. What is your emergency plan at home? Do you have glucagon and is it easily accessible?
Dr. Bev: I recommend watching the "Glucagon Emergency Kit Tutorial" presented by @DiabeticDanica. A T1D I know who gets confused when his BG drops too low has his family involved in his emergency plan. They take over his care.
Jewels: My life vest is my glucagon with a tube of cake icing secured to it with a rubber band. [And an extra kit in case of human error]. Emergencies are chaotic, so having tools in place is necessary. Everyone in our house knows how to use glucagon and where it is stored. Glucagon saves brain cells. Sure you can call 911, but you won't get glucose for 20 minutes. Every minute matters for your brain.
• I use sugar pills and pretzels. I have never bought glucagon.
• I have multiple glucagon kits in my nightstand, my pocket, backpack, and my fiancée’s purse. I also have a Costco-sized tub of Jelly Bellies.
• I have glucagon and tutorials to use it for everyone at home. Nowadays I manage with glucose tablets since even the lows are as restrictive as the highs.
Q. How do you manage the emotions that inevitably erupt when caring for yourself with a high-risk medication?
Dr. Bev: Worrying about BGs does not make BGs better or worse. It just keeps you feeling anxious. Check BGs frequently and stop worrying. Avoidance of low BGs by keeping BGs higher than recommended works for the short-term, but can lead to long-term problems.
Jewels: It’s a huge sleep interrupter when a child has T1D. Overnight worries will never end for me. I’ve slept half-awake for 10 years. As a parent, managing diabetes worries while trying to let go is a task that is nearly impossible. It’s a heavy load.
• Emotions are irrelevant. I approach my body like a machine that needs fuel. I maintain and use my body to accomplish tasks I set for myself.
• I finally decided to see a psychiatrist.
• I try and figure out what went wrong so there's no repeat episode. I don't usually get upset.
Q. After a scary low or high blood sugar episode, how does it affect your diabetes management moving forward?
Dr. Bev: A scary low or high BG can be a wakeup call. Use the event as a lesson to adjust your insulin regimen. Talk to your healthcare provider or Certified Diabetes Educator. Do not feel guilty of mismanagement! Nobody is perfect and managing BGs is not easy. Continue to do the best that you can do.
Jewels: Scary lows increase worry and bring possibilities front and center. We manage a disease with a drug that could end our lives.
• High sugars are easier to manage because of insulin. Low sugars carry repercussions for a longer time. The damage done is to my confidence.
• Scary highs and lows are part of the game of diabetes life. They don't shake me up. I try to learn and move forward.
• Scary lows and highs almost always lead to overcorrections. You should take the rest of the day to damp oscillations and get steady again.
Q. Has your reliance on technology also made you aware of its shortcomings?
Dr. Bev: Prior to the 1980s, balancing BG in real time was a guessing game. I'm grateful for my fast/small BG meter. (I don't use a CGM.)
Jewels: CGM's are wonderful but there are sensor errors and transmitter issues. We can't solely rely upon them for safety—especially overnight.
• I work with technology, and planning for failures is part of my job. I'm always wondering about what can fail and what to do when it does.
• I have never been a fan of technology. It only helps you know that you are no good. 30 years back, we never checked BG and we were healthier.
• Technology is nothing but a tool in the diabetes tool belt. Use it, but don't rely on it 100 percent. Have backup plans. Understand how it works.
Thanks to Dr. Bev and Jewels Doskicz for their insights about walking the insulin tightrope and managing BG levels.
Join this conversation by commenting below, and join our next Q&A via Twitter on Tuesday, January 17, 2017 at 9:00 p.m. ET.