Treating a low
I can always tell when Marshall has had a low in the middle of the night. Typically I’ll wake up too, but sometimes he’s so quiet about it I’ll only find the evidence left behind in the morning. Empty candy wrappers, discarded soda or gatorade bottles, a knife half covered in peanut butter, and lots of crumbs left like a trail around the kitchen.
When a low hits, so I’ve been told, it takes over you and sends you into a frenzy. Imagine the hungriest you’ve ever been and having it hit you like a ton of bricks all in an instant. The problem is it takes a bit of time for the juice or candy or honey to actually start working on the system, usually around 15 minutes. During this time you’re still ravenous; your body tells you you’re still needing more food while your head knows you need to stop or else you’ll be sent into a slingshot high. We’re always telling ourselves, “don’t dose for the first 15 grams of carb, but dose for the rest of the pantry you ate.” Because that’s typically what happens, you end up eating many many more grams of carbs than were necessary to pick you up from the low.
Tonight, just before dinner, Walker had a low. My pressure cooker had 15 minutes left on the timer. Her CGM was reading at 85 steady but she said she felt shaky. We told her to check with blood and it was 55 mg/dL. I handed her a chocolate milk (28 g), and she chugged it and asked for more food. She was exhibiting her typical symptoms of a mild low: jittery, shaky, acting silly, glassy eyes. We gave her a roll of smarties too (7 g). Still, she wanted more, saying she was super hungry and couldn’t wait until dinner. We convinced her to wait, and breathe, and tried to distract her while dinner finished cooking. As soon as the pressure valve released she started eating dinner before the rest of us could even sit down to join her.
And here’s where the hard part lies. We had to dose for her dinner knowing she had just had a low, but trusting that 35 g of chocolate milk and smarties were going to start kicking in and it would send her into a high. We could see on her CGM graph that she was no longer dropping and instead was starting to rebound. If you wait too long you’ll be fighting highs for the rest of the night. But if you dose the full amount and too soon you’ll send her crashing back into a low. So we dosed for 15 g to take a bit of the edge off the pre-dinner “snack”, and dosed for all of dinner.
These decisions, to bolus or not and to correct with more sugar or not, are never easy ones to make. We have to assess the situation: how are they acting, what have they been doing, what will they be doing, what time of day is it, what will we be eating for dinner (and does it contain fat and/or protein). Sometimes we nail it. Sometimes we miss the mark and end up correcting one way or the other a little while later.
Playing the role of a pancreas is hard work. So is playing pantry referee.
