Letter to a New Diabetic: Your first low

Dear Concerned:

Sorry to hear what happened, but it was a good lesson to learn early. It's a real learning curve, isn't it?

Two things caught my eye when I read your letter. First, you took insulin for a meal and then did not eat the meal. Second, you went for a walk without factoring in the affect it may have on your blood sugar level.

The first one is a huge mistake. If you give yourself a shot insulin, you MUST eat the meal or take some carbs to cover for it because your blood sugar will drop. In my experience, meals are missed either voluntarily or involuntarily. The voluntarily misses can be prevented by simply making sure you eat as much as you bolused for, whether you are hungry or not! The involuntarily misses are much more difficult. For example, I usually do not bolus at a restaurant until the food is at my table. I've had too many situations arise where I give myself insulin for my meal and then the food doesn't arrive for whatever reason. I've also had the situation arise where I became sick after the bolus but before I could eat.

The second issue is that you went for a walk. While perhaps not medically accurate, practically speaking exercise often increases the effectiveness of the insulin. So before you exercise, you need to check your blood sugar and either have it a bit higher, or have your meter and some carbohydrates with you as you work out/walk/run, whatever. It's a real pain in the ass, to be frank, but you do have to exercise. I've done some experience where instead of using insulin, I've used exercise to keep my blood sugar down. If you try it be sure to track your data and carry something to eat, such as the glucose tabs. For me, even something as common as mowing the lawn will cause me to get low, so I'll either eat before or keep an eye on my sugar level. A lot of people like the small boxes of Juicy Juice which are 15 carbs for those sudden lows. They are cheap and you can keep one or two in the car and drink them even when they are warm. Mmm, hot juice!

Hope this helps,

Niko