Three things about diabetes that I discovered quite lateType 1 Diabetes 19 February 2021
At some moment in time, you expect to know all there is to know. Especially after several years of living with type 1 diabetes. In the end, you live with it 24/7, so you tend to think you know everything about it. But it turns out there’s always something new to learn. Even when you’ re chronically ill. There are a number of things about diabetes that I didn’t discover until quite late. It could have helped me if I had realised those things earlier. But better late than never, I suppose. Maybe it could help you too.
Dextro(se) is not being absorbed by the stomach
When I have a hypo, I eat some Dextro(se) so that my blood glucose rises again. I have never really thought about the how and the what and the exact working of it. Too bad, because by understanding how it works, it is a lot easier to get yourself out of a sugar low again. Most important takeaway: Dextro, also known as grape sugar, is not being absorbed in your mouth or in your stomach. This only happens when it reaches your small intestine. Luckily, this is the very next station.
Your stomach needs quite some time to process food. Especially in a situation where you have just eaten, it can be difficult to get out of a hypo again. After all, your stomach is full. By drinking something, you make sure that the sugars still reach your small intestine relatively quickly. That is why I now usually drink some water when I take some Dextro, in order to speed up the absorption process. It is even more efficient to have packs of some kind of juice at hand. Each packet contains around 12 grams of carbohydrates; equivalent to 4 to 5 tablets of Dextro.
An inconsistent carbohydrate intake is not beneficial
The one day I had a daily total of over 250 grams of carbohydrates and the next day I was on 75. That is quite a difference. These fluctuations make it very difficult to find the right settings for managing my blood glucose. And there are quite a few settings. Because it is more complicated than just a carbohydrate ratio, which determines how much insulin to give at what time against what amount of carbohydrates. There are also different insulin sensitivities. These determine how much insulin is needed to correct the current blood glucose level. And last but not least, we have perhaps the most difficult of all: the basal, with which we determine the continuous insulin delivery.
As you can imagine, these settings can be quite different. Especially if you eat 250 grams of carbohydrates one day and only 75 grams the next. That’s why I decided for myself to be more consistent in my daily carbohydrate intake. That is: eating 100-150 grams of carbohydrates a day. Because by doing so, I notice that my blood glucose level is a lot more stable; which also provides a better basis for optimising and adjusting my settings even more.
Glucagon does not contain glucose
In my fridge, there is an orange box containing a GlucaGen injection set. “You can use it in case of an emergency”, I am told. If I should lose consciousness due to a severe hypo, then this injection can be my ‘lifesaver’. It is essential that I am not home alone at that time, but that is another story. A hypo is often solved with Dextro. That is why I have always assumed that the GlucaGen injection contains nothing more than a glucose solution. But I discovered quite late that is actually not the case.
The injection contains the substance glucagon: a hormone that does the opposite of insulin. Glucagon causes your blood glucose to rise, instead of dropping. The story of GlucaGen and glucagon is complicated by the similarity of their names. In summary, this is how it works: your liver is able to keep a little glucose in reserve for you. This glucose is stored in the form of glycogen. Then there are two hormones that can make your liver convert the glycogen back into glucose. These hormones are: glucagon and adrenaline.
Why is this so important to know?
When you receive a glucagon injection, your body does only one thing. It ensures that the glucose reserve will be released from your liver. However, this reserve must be available and your liver must be able to help out. This means that if your liver is busy breaking down alcohol, the glucagon injection will make no difference. Unfortunately, this also applies to a number of other situations, such as: after intensive exercise, multiple hypo’s or a stressful situation. As a result, the glucose reserve in your liver may already be depleted. It may sound frightening, but that is what makes this knowledge so essential. It is therefore important to always seek immediate medical assistance and not to rely solely on the injection.