Ask the Diabetes Educator Archive

11/28/05

Q:
I have had type 1 diabetes for 32 years and have been having severe problems with hypoglycemia unawareness. I can be having a conversation one moment and passed out the next. My doctor is trying different regimes but my blood sugar can be 110 and 29 twenty minutes later. When I drink juice to raise it, it continues to drop and takes a good hour for it to rise again. What's going on? My doctor doesn't have a clue.

A:
Do you have autonomic neuropathy? This would impair your digestive abilities. Also, what is the status of your kidneys? It sounds to me like you are not reabsorbing on the kidney level at a proper rate. In cases where complications have set in, blood sugar goals are generally higher to avoid the situations you have described.

What insulins are you using? If your are on one like Lantus that gives you a steady baseline, you may need to closely evaluate any mealtime dosages. Often, it means varying the time of injection, even with one like Humalog, to 30 minutes are so before the meal to act on the meal.

Focused trials with hopefully fewer errors will give you a better idea of what you require. This, of course, is all based on you being diligent about your food intake and lifestyle habits. "Perfect" control may not be a realistic goal, but you should be able to tighten the range a bit, especially where blackouts are occurring. Seek another opinion if you feel it is necessary.



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