Defeating the Hypoglycemia Binge
By Adam Brown
How to overcome the most frustrating diabetes landmine
The “hypoglycemia binge” is easily one of the most frustrating parts of having diabetes. Upon seeing a “43 mg/dl” on the meter, the chain of events often looks like this: (i) open the fridge or pantry; (ii) EAT, EAT, EAT; and (iii) EAT some more, just to be safe and stop the hunger and shakiness.
Then, a wave of regret hits, followed by a frustrating rebound high blood sugar. In the worst case, I take a “rage bolus” (a term coined by Kerri Sparling), which is often followed by another low blood sugar. The insane part is how easy this is to do repeatedly, since hypoglycemia is so common and so unpleasant in the moment.
The following is the first “Diabetes Landmine” I mention in Bright Spots & Landmines, and it really illustrates the concept – if I can identify my Diabetes Landmines ahead of time, I can build a plan of attack to reduce the chances of stumbling onto them. For hypoglycemia alone, this approach has made an enormous positive difference in my diabetes and quality of life. As noted in the “What Helps Me” section below, setting up an automatic, go-to treatment helps me default to an optimal decision every time – no hypoglycemia-impaired thinking required. Now when I’m low, there is no dangerous pause as I open the fridge and wonder what I’m going to eat; I simply follow my system. Please tell me what you think!
Hypoglycemia binge: overeating to correct a low or using it as an excuse to “treat myself”
I consider myself someone with a lot of willpower, but with a blood glucose (BG) of 55 mg/dl, I just want to eat everything in sight. This leads to one of my biggest Diabetes Landmines: overcorrecting a low blood glucose with too many carbs, only to go far too high afterwards.
The picture below is a real example of what I mean – that misfortune occurred after I stormed the fridge at 2 am and corrected a nighttime low using free granola from a friend’s work event. The huge bowl was sitting in our fridge, looked really good, and “I only had a little.” DOH!
I’ve used four strategies to get around this trap, which are all directed at reducing bad impulsive decisions in the moment:
1. Have go-to automatic corrections for hypoglycemia that are quantity limited and unappealing to overeat. Glucose tablets and Smarties are predictable, relieve my low symptoms very quickly, and I know I won’t overeat them. Some of my friends with diabetes count out jelly beans, mini Swedish Fish, gummies, or hard candy – again, allowing them to modify the amount to match exactly what their BG needs.
2. Fill in the blanks:
Eating ___ (amount) of ____ (food) raises my blood sugar by ____ mg/dl.
Example: eating one glucose tab raises my blood sugar by 20 mg/dl.
The only way to discover this is by checking BG, eating a food that has been measured out, and then checking again in roughly 15-30 minutes.
Knowing this helps me adjust the amount of food to raise BG to my target of 100 mg/dl, but not overshoot. Instead of a hypoglycemia binge, it’s more of a precision dose of carbs. If I’m at 60 mg/dl, I know I need only two glucose tabs to get back to 100 mg/dl. If I’m exercising (including walking), have taken bolus insulin within the last three hours (“insulin on board”), or have a down-trending arrow on my CGM, I might add more carbs – glucose will continue to fall, so I need an additional buffer.
3. Do NOT use hypoglycemia as a justification to eat junk. Period. It’s enjoyable and easy to view a low as “treat time,” but I always regret doing so. Plus, it connects a food reward (treat) with something I want to avoid (going low), an easy way to build a bad habit.
4. CGM often has lag time in hypoglycemia; it should not be the only indicator of “I’ve recovered” or “I’m still low and need to eat more.” Continuing to see 60 mg/dl on my CGM encourages overeating correction foods, but often, my BG has recovered (100 mg/dl) and the sensor hasn’t picked it up yet. If I still feel low and want to eat more, I try to confirm a CGM reading 10-20 minutes later with a glucose meter before eating extra correction carbs.
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