Hypos

Upon diagnosis, a type 1 diabetic learns about “hypos” straight away. The word is short for “hypoglycemia” which literally means “low sugar blood”. Wikipedia has loads of information on it here. Having a bad hypo is BAD, so we need to be able to recognise and treat them.

In a normal human being, glucose levels in the blood are regulated by the pancreas. Beta cells secrete insulin to bring glucose levels down, and glucagon to bring blood glucose levels up. For a diabetic, if for whatever reason blood glucose starts falling to unsafe levels, there is a problem. Because we have to inject insulin (we have no beta cells), once injected that insulin stays there – still pushing down the level of blood glucose. A normal person would just stop producing it. Secondly a diabetic’s pancreas will not produce glucagon (according to Wikipedia anyway: I don’t understand why, so plan to check with my doctor). [Edit: I asked Dr Powrie and he told me that type 1’s do still have cells which produce glucagon. He said that the absence of beta cells may impair the function of cells producing glucagon, but that its complicated and that the process isn’t fully understood.] So the first (and maybe second) lines of defence against low blood sugar do not exist in a diabetic.

Symptoms of a hypo, according to diabetes.co.uk are feeling dizzy, feeling hungry, a change in mood, feeling sweaty, finding it hard to concentrate or trembling. In severe cases it can lead to unconsciousness, seizure or even death! In terms of blood sugar levels, the rule of thumb seems to be that less than 4 mmol/l is a “hypo”. Given that healthy adults have between 4-7 mmol/l of glucose in their blood, if a diabetic is managing their blood glucose to be near that level, the odd hypo is inevitable.

Dr Powrie is currently getting me to manage down my very high levels of glucose upon diagnosis (30-ish) to aim at 6-12 currently. So I haven’t had a hypo yet. On my second or third night as a diabetic, after taking my long acting insulin before sleep, I did lie awake for a bit wondering if I was having a hypo. I wasn’t. I then came close after walking back from the hospital last week – I was 4.3 when I got back to the office.

So it’s still the unknown for me!

A complicating factor for someone who is active, is that some of the symptoms of hypoglycemia  are the same things that we experience whilst exercising. I’m beginning to see how running a marathon could be a challenge…

In the past day and a half I have now run twelve miles in three lots of four mile runs. After the first two runs, my blood sugar rose from 8-ish pre-run to 11-ish post run. Then just now, my blood sugar fell from 7.6 pre-run to 5.2 post-run. Below the level I’m aiming at. Panic!!! 🙂

To treat a mild hypo (blood sugar level under 4), one must consume 15g of high GI carbohydrate like jelly babies, coke, juice or glucose tablets. To treat a severe hypo, when a person is unconscious, glycogen needs to be injected into the muscle. This stimulates the liver to produce glucose.

In my case just now, I decided I had enough leeway to eat something nice rather than something sweet like a jelly baby, so I had two mini nectarines (yum!) and a bottle of alcohol free Becks beer (drinking alcohol increases the risk of a hypo several hours after consumption). I reckon that’s about 19g of carbs and my sugar level has now gone up to 8.9. Disaster averted!

In the future I will need to be able to judge whether my identical run will increase or decrease my blood sugar. I will ask Dr Powrie for advice of course. My theory is that it has to do with how much short acting insulin, I’ve taken beforehand. But I won’t bore you with the details.

In any case, I’m now more motivated to run than ever. The more runs I do the more data I will collect and the more likely I’ll be able to go ski touring and run a marathon.

What is type 1?