Tuesday, December 12, 2006

Hypoglycemia, my longtime companion

I have hypoglycemia. I know it's common for a diabetic to say that, but what I really mean is that I have the condition hypoglycemia - my symptoms definitely fall under that umbrella although I probably don't fit the diagnostic criteria, which I think is having bg <50 mg/dl regularly. I certainly have the data, though.

For many years, I would get cranky and irritable if I missed lunch or if dinner was delayed. The earliest specific incident I remember was in 2001, but I suspect it goes back much farther than that, until at least high school. When I started testing my blood sugar in March of 2005, my fastings ranged from 83-89 and my postprandial numbers from 110-185. Every afternoon, from about 5 pm to about 7:30 pm, my bg would drop to 65-75 and just stay there. I tried things like drinking some Propel or eating a snack, but it would just drop again. It's as if my pancreas just decided 70 is the number to be and was determined I stay there. During this period of time I would be extremely tired and would often get a headache. I was also at my crankiest. Low blood sugar at any other time of day doesn't result in crankiness, believe it or not. Partly it could also be the length of time I ran that low. (If I ever decide to get pregnant, I don't think I'll be able to run low like they recommend.) On a few days where I really exerted myself, I got lower numbers during that time period - 48 (my lowest bg TO DATE) 59, 60, 62. That 48 is when I apparently almost punched someone who was trying to help me. This is, of course, before I was on insulin or any medication for diabetes. None of my other medications cause hypoglycemia.

Fast forward to now. I still have that hypoglycemic period, and note that for four months I was only taking Novolog. It may seem like every diabetic's dream, but believe me, it isn't. I have to eat a meal. If I just try to treat the low, my pancreas stubbornly clings to its notion that 70 (or now with the Lantus, 60) is the place to be. I get aching headches and my irritability knows no bounds! Enough food will overcome it, but then I'm too full to eat dinner. Running high, although it might defeat my pancreas, is just not an option for me. So the result is that I am a diabetic on MDI (very MDI) and yet I still have to have dinner on time. I suspect that this will continue as long as I have good control up until I stop making insulin altogether and my pancreas has nothing to work with.

A maybe-related problem (or maybe it *is* the problem) is that my liver doesn't dump glucose in response to lows or stress. I think in a normal person this is supposed to happen, but not to the level it does in a diabetic. Mine doesn't seem to. So for example if I'd taken the Lantus at bedtime like it was prescribed, and it lasted 27 hours like it seems to, I would go low a couple hours after falling asleep and I'd stay low all night. This is also why I can't take Novolog and then fall asleep - if I end up low I'll just stay low all night and wake up with an awful headache. I *have* woken up a couple times below 60 - both times I felt awful and had a really hard time keeping anything down. So yeah, to be avoided.

I took four units of Lantus yesterday and four units today. Yesterday I did 1/20 for dinner and was fine. Today I did 1/20 for dinner and I'm high in a manner suggesting 1/14 was the way to go. So I think my plan is working, yay.


Scott said...

What a strange situation!

Big kudos for you on knowing what works for you, working through some testing and experiments to figure it out, and coming up with a way to make it work for your situation.

Lili said...

Thanks, Scott. I definitely am my own science experiment.

Megan said...

Lili, I know we chatted on DF about this once, but damn, you sound a lot like me! I did this for awhile too. It was very weird and sorta pushed me into a denial state of believing that I don't really have diabetes. But since pumping things have settled down a lot more, and I have a more definite need for basal insulin and run higher. I'm so excited that your pump is on the way and hope it will help you too.

Lili said...

Megan - definitely I see some parallels. I am excited about starting.