October 29, 2002
Hypoglycemia
Question from :
Ohio, USA:
I have had type 1 diabetes for almost 39 years and have been controlled by different generations of insulin pumps for 22 years. However,since it was so long ago, I was never properly trained since my doctor was a novice at controlling me, and I ended up controlling myself (big mistake) for about 20 years.
I am a registered retail pharmacist at a large Midwest chain, a job which requires great mental alertness and an even temper. To keep my customers safe, and to keep from getting fired because of hypoglycemia, I have kept my blood sugars in the 200s mg/dl [11.1 mmol/L] while I worked, and as a result, I am now suffering complications.
To counter this, I have strived to keep my sugars near to normal which means more hypoglycemic reactions at work. Because I have had so many, I now have hypoglycemia unawareness, and don’t feel low until my blood sugar is about 40 mg/dl [2.2 mmol/L], and I missed an prescription mistake or exploded at one of my technicians in an emotional reaction. I really care for my customers and employees and don’t want to put them in danger.
I’ve looked into the GlucoWatch, but its cost and limitations are prohibitive. I’m now under the care of a diabetes team and test my sugar every three to four hours. Things are much better but I’m still worried.
Answer:
There is information from clinical studies to suggest that avoidance of severe hypoglycemia may result in return of some of your low blood sugar symptoms. It is important for you and your diabetes care team to choose appropriate target ranges for blood sugar control. Special consideration should be given to avoiding nocturnal hypoglycemia.
I empathize with your situation and assume you are now using a more current insulin pump. The insulin analogs (Humalog or NovoLog) are great for obtaining post-meal blood sugar control.
The only other suggestion for severe and recurrent hypoglycemia is the use of pancreas transplantation. However, the benefits must be outweighed by the risks of immunosuppression. You may not be there yet. A real-time glucose monitor is not yet available in an affordable price range.
JTL
