Re: Blood Sugar Dive While Driving -So Scared!

July 11, 2005

Welcome Marilyn. I know you will get some very good advice here. I am sorry you

had such

a horrible time and hope you will get regulated soon.

Lou

marilyn wrote:

>>

July 11, 2005

Vicki,

Is there an actual technical name for the way we're dosing? I

made the mistake of calling it 'sliding scale' and sorta confused

my previous doc

" Carb to Insulin Dosing " maybe?

SulaBlue

> The sliding scale concept is often used but is NOT very

efficient

> either. It is based on your BGs but corrects after the fact, i.e.

after

> your BGs are high. Much better is to count the carbs you eat

then base

> your insulin dose on that amount of carbs. This method

requires some

> preliminary testing to learn what your carb to insulin ratio is, but

> there are many on this list who can help you with that.

>

> I belong to another list whose moderator is a retired diabetic

engineer

> who has devised an insulin dosing system that really works

and if you're

> interested, I can give you the signup information. He's helped

lots of

> people.

>

> Good luck and take care,

> Vicki

July 11, 2005

Hi, Marilyn -- welcome to the list. Sorry you had such a horrible

experience. That was really scary.

It sounds like your diabetic education is sadly lacking and I think the

dosing schedule your doc gave you was WAY off.

I have a bunch of stuff to say to you at the end of the standard newby

letter, so read on.

First of all, I'm going to attach my " standard newby letter " . Read

everything carefully, including all the links -- that'll keey you busy

for a while. Ask any questions -- we're here to answer them for you.

If you've already read the " standard newby letter " (because I recently

posted it for another newby) just skip to the end of it for more from

me.

***

First of all, let me refer you to two of the best books about diabetes.

Read 'em and you'll learn a lot:

The first one is called " The First Year, Type Two Diabetes, An

Essential Guide for the Newly Diagnosed " by Gretchen Becker. Gretchen

is a list member and her book is an excellent guide. It's in paperback

and available online from Amazon if your local bookstore doesn't have

it.

The second book is called " Dr. Bernstein's Diabetes Solutions " by

K. Bernstein, M.D. You can get it from the library but it's such

a good reference that you

really should have it in your home library. Dr. Bernstein is a longtime

type 1 who controls his diabetes using a lowcarb diet as well as

insulin.. Many of us - both type 1 and 2 -- on this list have found

great success using his plan or a modified version thereof.

.

And here's the URL to Dr. Bernstein's website, where there's lots of

good stuff:

http://www.diabetes-normalsugars.com/index.shtml

These two books will give you good basic information on the ins and

outs of diabetes management.

I would further refer you to an excellent informational website titled

" " What They Don't Tell You About Diabetes "

http://www.geocities.com/lottadata4u/

If it isn't there for some reason, let me know and I can email you the

contents -- I have it in my archives now.

I would also refer you to Mendosa's website, where

there's a wealth of diabetic information and good links. He also has

an online diabetes newsletter which is very good. It's also an

excellent source for information about the GI index (glycemic index).

www.mendosa.com

There's one thing that's sure to make BGs rise and that's carbohydrates.

Cutting out high GI carbs is an excellent way to control your BGs and

the more you cut, the better. Most of us find that the " whites " --

breads, cereals and pastas, in fact anything made with grain - will

raise our BGs. Also, rice and potatoes will do the same. And of course,

cakes and cookies and sweets of all kinds, including fruits and fruit

juices.

Watch out for " low calorie " foods; often they're higher in carbs. Learn

to read food labels.

Dr. Bernstein recommends about 40 carbs a day total. This is really only

for the dedictated low carber and IMHO hard to maintain over the long

run. However, I've read that the average American eats about 300 carbs a

day, so the truth is somewhere in between. The best thing you can do

for yourself (if you haven't already) is buy a meter and use it

FREQUENTLY. At the beginning you want to learn how different foods

affect your BG and to do this you need to eat one food at a time,

testing first...then test one and two hours afterwards. Weigh out the

amounts and keep good notes. You'll use up a lot of strips in the

beginning but the rewards are definitely worth the expense and bother

because in the end, you'll know what foods to avoid and which are okay.

Diabetes is a very individual disease and we often say YMMV - " your

mileage may vary " -- what works for one may not work for another. You

want to aim for postprandial (two hours after meal) BG of 120. Keeping

your BGs between 70 and 140 are your goals. If you can do this

longterm, you can probably avoid the dreaded consequences of longterm

poor BG control...and I'm sure I don't have to list those for you. (I

will if you want, though).

Here's my own list of pretty lowcarb veggies:

Spinach

Cauliflower

Broccoli

Summer squash (zucchini, crookneck)

Spaghetti squash

Mushrooms

Asparagus

Greenbeans

Cabbage

Sauerkraut

And of course lettuce and avocados which aren't a veggie but a fruit

..but they're definitely lowcarb. I have a large mixed lettuce salad with

avocado every night with dinner.

You can eat a reasonable portion (4-6 ounces) of meat, chicken, fish

without problem; it's all protein, no carbs.

Berries are the lowest carb fruit but even so, you should eat them very

sparingly. Here's the website of the USDA, which you'll find very

helpful. It has carbs, calories, protein, etc.

http://www.nal.usda.gov/fnic/cgi-bin/nut_search.pl

It's helpful to have a food scale. A cup measure isn't nearly so

accurate. I use a Salter scale. It weighs in both grams and ounces and

cost me somewhere around $35. I got mine at a local gourmet shop but

they're available online too. Just do a Google search for " Salter food

scales " .

The A1C is a test that measures your average BG for a three-month period

with slightly more weight given to the latest month. All diabetics

should have this test every three months. And you should ask for, and

keep, copies of all your lab reports.

Good luck. And keep those questions coming. There's a really steep

learning curve at the beginning of your diabetes education but hang in

there -- it will all make sense eventually. And remember -- the only

stupid question is the one you didn't ask.

Vicki, diabetic since 1997, A1Cs comsistently under 6 for a long time,

no complications, planning on forever no complications,smile.

**

Now for my additional comments:

It sounds as though your doctor (hopefully your former doctor)

prescribed a " standard dose " of insulin. This rarely works, because

you're not eating the same thing every day, although " standard dosing "

assumes this. And your doctor's standard dosing was WAAAAYYY off. Did

he even mention eating a specific amount of carbs to cover that amount

of insulin? Even so, it is bad.

The sliding scale concept is often used but is NOT very efficient

either. It is based on your BGs but corrects after the fact, i.e. after

your BGs are high. Much better is to count the carbs you eat then base

your insulin dose on that amount of carbs. This method requires some

preliminary testing to learn what your carb to insulin ratio is, but

there are many on this list who can help you with that.

I belong to another list whose moderator is a retired diabetic engineer

who has devised an insulin dosing system that really works and if you're

interested, I can give you the signup information. He's helped lots of

people.

Good luck and take care,

Vicki

Blood Sugar Dive While Driving -So Scared!

> I'm new here. New to having low blood sugar for a change, as it

> had been much too high for the last year (I nearly died twice last

> summer while in the hospital for congestive heart failure; up to

> that point I had only taken micronase but when I finally came home

> (after two months in the hospital, we began the insulin regimen) and

> my doctor had prescribed large amounts of insulin 3 x a day. Last

> Thursday, I left my dentist's office (no meds given there) intent on

> stopping by the grocery store on the way home. This was at 4:30 pm.

> At 6:30 pm, some kind gentleman waved me over to the side of the

> road, 50 miles from my home, and I was sobbing loudly because I

> didn't know where I was. My brain had ceased to function. I had

> been on the interstate in a complete fog and fortunately, I turned

> off onto a state highway where this man was able to wave me over.

> He had evidently been following me and had already called the

> highway patrol and an ambulance. He asked me, " Lady are you okay? "

> And I said, " I'm a diabetic, and I don't know where I am. " He asked

> me to sit in the back seat and he took over the driver's seat

> (probably so I wouldn't start driving again) then told me he had

> called an ambulance already; then a state trooper was at my car door

> and started asking me quesions, too. He found a peppermint in the

> depths of my car console and told me to take it to bring my blood

> sugar up. When I told him my address, he said, " You're a long way

> from home. " It crossed my mind that I might have Alzheimer's. The

> paramedics arrived, took my blood sugar, which was 46 and we called

> my daughter to come and get me at the hospital, since the paramedics

> said they wouldn't let me drive even after I took the glucose in a

> tube and I started " coming to. " I said that was fine with me, I was

> so scared about what I had done. I could have had a horrible

> accident and killed somebody and/or myself. I didn't have enough

> sense to realize I was going the wrong way or to pull over and take

> some sugar. All I can remember is driving and screaming, I was so

> scared. Not stopping! Not until the man pulled me over on the

> state highway. He was truly an angel. Anyway, when the ambulance

> got me to the hospital and I was checked over, they decided I needed

> to eat some dinner before my family came to get me. Then the ER

> doctor came in and asked me about my insulin doseage. I told him I

> was taking 23 units before breakfast, 40 units before lunch and

> dinner, and 60 lantus at bedtime. He frowned and said, " That's too

> much insulin. " I thought about it and said, " My blood sugar was 64

> before lunch, I gave myself 40 units of insulin, as instructed

> daily, and I went to the dentist at 3:30. " Probably stress helped

> cause the rapid drop in blood sugar, he suggested. But he wanted me

> to take insulin on a graduated scale until I could get hold of my

> doctor the next day (Friday).

> On Friday morning, I began calling my endocrinologist's office to

> ask questions and tell him about the event. I demanded to talk to

> his nurse, if I couldn't talk to him, and told her of my incident.

> She said through the receptionist she couldn't tell me anything

> until she talked to him, and my chart was put on his desk. His

> nurse finally called me back late in the afternoon and she had new

> numbers for me. I didn't have enough sense to question these new

> numbers, and when I told my family members, they pitched a fit and

> said I probably needed to stay on the sliding scale, since my blood

> sugar was between 80 and 120 all that day, and I didn't have to take

> any insulin according to the sliding scale. If I had taken 30 units

> when my blood sugar was 80, it would have nose-dived again, right?

> So, this morning I'm faxing him my numbers (as I have always done

> weekly) and putting on the fax sheet that I want to continue on the

> sliding scale insulin, as my family insisted. (My dad was a diabetic

> before he died of cancer 6 six years ago, and my mother was

> horrified that I had taken 40 units of insulin when my blood sugar

> was only 64.)

> I'm losing faith in my doctor because of all this. Of course, maybe

> I should have known when I left the dentist's office that my blood

> sugar was dropping and taken a snack or glucose tablets (which I

> hadn't been told to carry in the first place!) before I blacked out

> on that crazy 50 mile drive. And even though he has reduced the

> insulin since then, I'm really scared to take 20 units when my blood

> sugar is in the 60s.

> Am I wrong? I'm getting ready to call the doctor's office again to

> let them know I'm keeping with the sliding scale, per the ER

> doctor's advice.....maybe that statement will get them to call me

> back. I've never been so scared in my 67 years on this planet,

> feeling completely out of control and screaming while driving on the

> interstate, with double vision, no less. I now have glucose tablets

> in my purse and will take them the minute I get that " funny feeling "

> as before and not ignore it. Sorry this is so long a post.

> Any comments?

> Marilyn

July 11, 2005

One more thing, Marilyn..do you carry your meter with you at all times?

If you don't, you should. And when you get that " funny feeling, " check

your BG first.

The good thing about glucose tablets is that they raise your BG a set,

specific amount EVERY TIME. So you need to test and find out what your

parameters are. To do this, right before you take any insulin, before a

meal, check your BG. Eat a glucose tab. Wait 10 minutes then start

checking your BG every 5 minutes. Use a timer. When things level off,

i.e. when you get 2 readings that are approximately the same give or

take 5 points or so, that's the amount of time it takes for a glucose

tab to work. Then you'll know. Make a note of it.

Let's say you feel " funny " and you check your BG. It's 55. Well, you've

tested before and you know that one glucose tab raises you 20 points

(this is fairly typical for type 2s)

Since a hypo is considered anything below 65, and you know that 1 tab

raises you 20 points, you take 1 tab and there you are - at 75, which is

out of danger territory. Or you could even take 2 safely; 95 is an

excellent number.

You should try to maintain BGs as close to 100 as possible.

I can't believe your doctor didn't tell you about glucose tabs. Get a

new doc!