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[IP] Re: Diabetes 103b: treating lows for fun and profit

Recently Gaye Thomsen asked:

Well, here's how I learned in class three years ago (after doing it
incorrectly for 37 years  :-)

1. Test if you can (I no longer sense lows reliably, so getting a hard value
is important to me). If it's a real emergency, of course, go to step 2
2. Take 15-20 g of _fast-acting_ carb (simple sugars; special tablets if you
have 'em, as they work faster). (How much depends on where I'm at).
3. WAIT! for 15-20 minutes. This is the hard part. As one of the teachers
said, you wanna "eat the fridge" at this point. For me, after I first eat
some carb, I'm suddenly ravenous, and can also suddenly feel the low more
intensely. But if you've got some CHO in, you're not in great danger any
more, so give things a chance to metabolize. And _don't_ go out and start
digging up weeds or run a marathon! Relax, let things happen.
4. Test again. If you're still low, with no sign up coming up, have some
more simple CHO. Don't go overboard here: if you're on the way back up, you
probably don't need quick stuff any more.
5. Once you're on the way back up to a reasonable level (or a bit later, if
you can resist), you should have some complex carb (maybe 15 g for me), to
replace the stuff your liver just pumped in.
6. Keep testing as usual, but you may _not_ want to bolus for a high that
occurs 2-4 hours later. Your liver is not as smart as your (non-functional)
pancreas once was; it'll keep pumping out emergency sugar long after the
emergency has passed, so you're likely to go high after a low. This may
affect things for quite a while, maybe even a couple days, and you don't
want to get on a roller coaster, where you bolus for a high, then eat for a
low, and bounce back and forth forever. Accept the high for a while, and
don't worry about getting it back down right away. Let your liver and other
organs settle down.

Does this sound like a plan? It works pretty well for me. I'm not sure my
Diabetes Health Center would agree with the way I've set it out, so don't
blame them if I'm off the track here!

--Keith Johnson
  email @ redacted
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