Photo by Sweet Life / Unsplash.
Low blood sugar at 2 a.m. A phone that will not stop beeping. The daily challenges of managing type 1 diabetes, told by someone doing the work.
First published August 19, 2024. This personal account describes the author's experiences at that time. Editorial health notes distinguish those experiences from current safety guidance.
Low blood sugar at 2 a.m.
Often enough, my typical day begins at 2 a.m. I wake up and feel exhausted. My body shakes with tiny, repetitive tremors. I am simultaneously freezing cold and boiling hot, having too many blankets but simply not enough.
My boyfriend softly snores, sometimes uttering an incomprehensible sentence, as I reach over to grab my phone. In the dim light, the software somehow manages to recognize me, although my eyes are crusted over and a thin stream of drool runs from my bottom lip.
I open my glucose-monitoring app, scan the sensor on my arm, and wait for the number. Whether it's my right or left arm depends; I change the sensor every two weeks. I am met with a big, bright, red screen. There's an arrow pointing downward, seemingly into Hell, where it feels like my body is.
The number is 2.5 mmol/L, or about 45 mg/dL. I sigh. My glucose is low again.
The medical name is hypoglycaemia: low blood sugar. Under sweet, if you like. There is nothing particularly sweet about it.
With type 1 diabetes, the immune system attacks the insulin-producing cells in the pancreas. Insulin helps glucose move from the bloodstream into cells that use it for energy. Without enough insulin, glucose builds up in the blood.
My pancreas hasn't disappeared. But the insulin job it should be doing automatically has become my responsibility. The insulin, the carb counts, the nutrition labels, the beeping monitors.
I am a human being and a sentient organ.
I'm too exhausted to get up and do anything, so I try to sleep it off. I last about seven minutes before I stumble into the kitchen and rip open my fridge like a frenzied animal.
I pour orange juice into the biggest cup we have, which just so happens to be the Cineplex Morbius: The Living Vampire collector's cup. It's filled to the brim, and I begin chugging. I stop after a second and take a long, drawn-out breath. I'm almost choking, it seems like. I swallow it down and just keep drinking.
Now I'm waiting for the juice to bring my glucose up. My stomach growls, and I clutch my abdomen in pain. It also feels like I'm starving to death.
The hunger, the fog, and the drive home
The closest comparison I can make to a low is smoking a big fat joint or eating an edible shaped like a Sour Patch Kid, and then greening out. Every sensation is off, and every thought is muddled and fuzzy. Sometimes, I can't see properly or concentrate.
Me? I also get hungry. Ravenously hungry. I've smoked weed before, and I know what it's like to get the munchies, to have the urge to absentmindedly munch on whatever.
When I'm low, my brain seems to focus automatically on the most carb-dense food in the pantry. I have my favorite: Rice Krispies and milk. There have been times when I've eaten four bowls, contemplated a fifth, and woken up later with a sore stomach or vomiting.
A low can also make me feel drunk. Seriously drunk. I remember driving home from a night shift a couple of years before I first wrote this. It was winter, and snow was gently blowing across Highway 9.
I thought I'd miscalculated the insulin for my peasant's dinner of an iced tea and potato wedges, eaten in the break room before heading back to my cash register. As I drove, I gripped the wheel tighter. My eyelids weighed a thousand pounds, and my brain was shutting off.
I did my best to focus on the road, and yet I took what seemed like a long blink. Suddenly, I was at home, my car parked in the driveway. My aunt texted me: “Are you coming inside? It's late. You've been out there for 15 minutes.”
Back in the kitchen, after the orange juice, I've had two granola bars, one plain tortilla, and a cup of mixed berry yogurt: the pinnacle of nutrition.
I stumble back to bed, flop on my side, and curl up in a little ball. About an hour later, my phone goes off again. I pick it up and read the alert.
When low blood sugar becomes high
High glucose makes me pee. It makes me tired and irritable. When I was in my first year of university, before I was diagnosed, I slept the most I've ever slept in my entire life.
It also makes me thirsty. So thirsty that it feels like I've wandered for forty days and forty nights in the desert. Sometimes a high feels less awful than a low. That doesn't mean it's harmless.
I reach into the nightstand again and grab my rapid-acting Humalog. I stick the needle into my gut and press the button. It clicks slowly until the insulin has gone into my system.
I have to keep changing where I inject. Repeated injections in the same spot can cause fatty lumps under the skin, called lipohypertrophy, which can make insulin absorption less predictable. I remember my first visit to the endocrinology clinic at St. Joe's, when the dietitian showed me a plastic piece of skin designed to mimic what those lumps feel like.
An hour later, I may still be high, or I may be heading low after overcompensating. Then the whole song and dance repeats.
The mental load of type 1 diabetes
For me, the distress comes from the constant seesawing of low to high glucose. It's feeling like death in one way, then feeling better but still worrying about what the numbers are doing.
I worry about my eyes, my nerves, my feet. I don't want complications. I also just want to get on with my life without having to think about all of this.
My phone says that my glucose level has become stable. It's now 4 a.m. I'll have to wake up in five hours to get ready for school, catch the bus, and go to my office hour. Then I'll have a two-hour lecture and a choral concert I need to usher as part of my job at the theatre.
All the while, my phone will beep, saying I'm going low or going high, and I'll have to deal with it. I am the sentient organ, after all.
I look at my boyfriend. While I've been doing all of this, he has simply been asleep.
I sigh.
The insulin, the carb counts, the nutrition labels, and the beeping monitors. This is my every day.
That is usually how my day starts.
A note from the editors
The frustration and exhaustion that can come with managing diabetes are often called diabetes distress. This is distinct from depression, although both can occur. A diabetes team or mental health professional can help with the emotional burden as well as the practical work of care.
The food quantities and insulin decisions in this account are personal experiences, not treatment instructions. Taking more carbohydrate than needed for a low can send glucose high. Insulin treatment remains essential in type 1 diabetes; food choices and exercise cannot replace it.
Too little insulin can lead to diabetic ketoacidosis (DKA), a medical emergency. Vomiting with an inability to keep fluids down, trouble breathing, or high ketones needs emergency care. Follow your diabetes team's sick-day and ketone-testing plan.
More first-person perspectives on type 1 diabetes
- Living with type 1 diabetes: childhood diagnosis to young adulthood — Kaycee Aultman on growing up with the condition.
- Highs and lows: my daughter's type 1 diabetes diagnosis — Mandy Nadyne on the experience from a parent's perspective.
