Diabetes & low blood sugar?
June 8, 2006 2:48 PM   Subscribe

I have a question about diet & exercise-controlled Type II diabetes and low blood sugar.

There’s something I hear occasionally that bugs me. Here are a few examples.

1. A friend was recently diagnosed with Type II diabetes. She is working with her doctors to get her numbers under control with diet and exercise. During this trial she is not on ANY oral meds or insulin. But the educator gave her a card for her wallet that says something like, “If I am unconscious it may be due to my diabetes. Give me juice or something with sugar.”

2. A co-worker mentioned that her friend has “really bad diabetes” but is able to control it solely with diet and exercise because he is a marathon runner (again, her words). She once said, “He just has to be careful and always carry M&Ms in case his sugar gets too low.”

3. Someone once told me she was “borderline gestational diabetic.” She claimed she would “almost pass out” every afternoon and have to chug a Dr Pepper in order to get her blood sugar back UP. Again, she was not on meds or insulin.

Are these people are mistaken (or in some cases, maybe liars)? My admittedly limited understanding of diabetes is that LOW blood sugar issues are a result of too much oral medication or too much insulin (possibly in combination with too little food, but the key being the meds, which lower the blood sugar).

It seems that many people believe diabetes causes blood sugar fluctuations in both directions. Is there any evidence that diabetics are more susceptible to blood sugar crashes than anyone else (in the absence of meds)? Any other explanations? Any thoughts on why my friend would have been given that card?
posted by peep to Health & Fitness (21 answers total)
Yeah they are mistaken - diabetes (in the general everyday sense, not the excessive-urine/thirst sense) is marked by the failure of the body to respond adequately to increases in blood sugar. Having type I diabetes (mellitus) i find it highly improbable that a person identified as diabetic would suffer from hypoglycemia in the absence of medication, even with obsessive exercise. the best a type II diabetic could hope for is stable, normal (90 - 120 mg/dl) BG levels.

then again i'm not a doctor, so take this with whatever mineral you see fit.
posted by casconed at 3:00 PM on June 8, 2006

and i missed the card question - long-term, excessively high BG levels (250+ mg/dl) can lead to coma or death. but it's the sort of thing i imagine you would feel coming on...
posted by casconed at 3:02 PM on June 8, 2006

Type 1 and Type 2 diabetes are quite distinct diseases.

Type 2 is generally triggered by a combination of obesity with genetic vulnerability, and in many cases a Type 2 diabetic can achieve adequate blood sugar and peripheral circulation simply by lowering their body fat to an appropriate level and maintaining it there. ("Diet and exercise" is simply a proxy for "what it takes to cut fat.")

Type 2 diabetes rarely causes acute, life-threatening episodes, especially early on so it is reasonable not to prescribe medical interventions right after diagnosis if a doctor thinks an adequate (in time and amount) amount of fat loss is reasonably likely. If a Type 2 patient is too old, or too fat, to lose enough fat soon enough, it makes sense to begin to medicate immediately, as it does if the diet fails.
posted by MattD at 3:11 PM on June 8, 2006

I agree with everyone else - I too, am not a doctor, but from my understanding of diabetes mellitus (my young niece is a type I diabetic, and as such, I have developed a good lay-person's understanding of the disease), is that people whose type II diabetes is unregulated by medication would almost NEVER become hypoglycemic (low blood sugar). It is only following my niece's insulin shots that she runs the risk of (and frequently falls into) hypoglycemia. A regular, non-medication using type II diabetic would run the risk of high blood sugar, but not low blood sugar, given the absence of insulin control. Furthermore, a type II diabetic who controls their diabetes through diet and exercise will rarely hit the sustained high sugar numbers that would put their life at risk. I fear your friends are confused.
posted by msali at 3:14 PM on June 8, 2006

Someone in my family has Type II - they do keep their blood-sugar lowered by dietary choice/discipline, because of the tissue-damage associated with chronic, high blood sugar. When first diagnosed, they were very prone to light-headedness if they missed a meal-time, because their body was used to their "normal" high blood-sugar levels, so even a slight dip would leave them woozy. After they got things under better/closer control, they didn't become dizzy until their blood sugar got much lower, and their normal, day-to-day blood sugar level was lower than before they were diagnosed.

It's possible your recently diagnosed friend is still in the "normalizing" phase of her treatment, and may experience dizziness just before meals or after exertions, until her condition is stabilized at a safer/lower "normal" blood-sugar level. In which case, a bit of sugar may be better than passing out if she is caught away from a meal.
posted by Crosius at 3:23 PM on June 8, 2006

If that marathon runner had type I the comment would make more sense. Athletes with type 1 have to be very careful about their blood sugar dropping while training.
posted by desuetude at 3:33 PM on June 8, 2006

I found this post by a paramedic at MakingLight very helpful in terms of explaining diabetes. Here is the relevant passage but you should read the whole thing:

While high glucose levels can lead to unconsciousness and death (diabetic coma), what’ll kill you fast is insulin shock. That’s when a person has taken their normal insulin dose, but for some reason doesn’t have their normal glucose levels in their blood. Forgetting breakfast, unusual exercise, a low-grade fever — lots of things can cause that. The glucose level plummets, the nerves starve, the cells die, and it’s lights out
posted by hindmost at 3:38 PM on June 8, 2006

I wouldn't give any unconscious diabetic (or any unconscious person full stop) any food or drink or anything. Call a paramedic unless you have the appropriate medication to hand.

Sticking stuff in the mouth of someone unconscious is probably not the best idea. If you need to do it, I'd expect the person on the other end of your 911 call to tell you that. And I've never heard of a situation where that's been necessary.

Otherwise, don't.

Do check for ID that might give people a heads up on what's wrong however. That's a good thing.
posted by edd at 3:47 PM on June 8, 2006

desuetude - funny about your comment: I am a type I diabetic training for a marathon and it is a ROYAL P.I.T.A. trying to keep my sugar from dropping on long runs. I'm just starting out but i'm holding out hope that it gets easier as training progresses.
posted by casconed at 3:51 PM on June 8, 2006

You know, I posted that passage sort of hastily but here is the gist if you dont' read the link:

High blood sugar is bad, but low blood sugar can be much much worse. Ergo, having some juice and candy to keep your cells from dying is a good thing. In fact, in an emergency situation, you give the sugar regardless and if they had low blood sugar, they get better, if their symptoms were from high blood sugar, the extra won't make a big difference.

The reason that diabetics have such high blood sugar is because glucose is such a big molecule that insulin is required to bring it to the cells. When your body doesn't produce insulin or doesn't process it properly, the glucose stays in the blood and you have high blood sugar. This is not a chronic state. It's just that the sugar that was supposed to go fuel their cells isn't getting there.

My highly unmedical metaphor based on my unknowledgable interpretation is that you have a car that has a leaky gas tank, and you find fuel on your driveway all the time which is causing environmental damage to your lawn. You've diagnosed the problem but can't fix the leak. You still can't run your car without filling up. And since you're leaking so much of it out, you have to make doubly sure that you have enough gas to keep the engine running. Or something.
posted by hindmost at 3:54 PM on June 8, 2006

If a person is insulin resistant (one of the symptoms of metabolic syndrome, or "pre-diabetes"), then they can sugar crash - I know I do. From Wikipedia:

In a normal person, insulin is released from the beta cells of the Islets of Langerhans located in the pancreas after eating ("postprandial"), and it signals the body to allow glucose to enter insulin-sensitive tissues (e.g., muscle, adipose) and maintain normal blood glucose levels. In an "insulin resistant" person the message does not get through to those cells until much more insulin is released in an attempt to compensate. Occasionally, this can lead to a steep drop in blood sugar and a hypoglycaemic reaction several hours after the meal.
posted by obiwanwasabi at 4:08 PM on June 8, 2006

peep: In general you're correct, and I'm frequently annoyed by people who insist that hypoglycemia is a consequence of diabetes mellitus. It's not; it is, indeed, instead a consequence of the medicines used to treat it. However, since many people with diabetes are on treatment, symptomatic hypoglycemia is frequently observed in people with diabetes.

Symptomatic hypoglycemia not due to anti-diabetes medication is extremely rare, and usually due to the effect of a systemic endocrine illness or a medication. I was until recently convinced that symptomatic hypoglycemia in the absence of diagnosable endocrine illness or medication effects was in fact a myth, but I have recently run across a couple of patients who seem to have proven me wrong. (I suspect one of them was actually injecting insulin on the sly - something that's well-described in malingerers and those with Munchausen syndrome - but I wasn't able to prove this.) As I say, it is extremely rare.

However, those hordes of annoying office workers who use hypoglycemia as an excuse for their poor 3 p.m. behavior are completely chock full of bull crap. If you tested their blood sugar, you'd find it well within normal limits.
posted by ikkyu2 at 4:09 PM on June 8, 2006

("Diet and exercise" is simply a proxy for "what it takes to cut fat.")

That's not strictly true; both diet and exercise directly affect blood glucose, and Type II diabetics who are not overweight (they exist!) can certainly still use diet and exercise to help regulate their blood sugar. Regulating blood sugar and thereby limiting the amount of insulin your body produces also helps to regulate weight.
posted by redfoxtail at 4:24 PM on June 8, 2006

(Which is not at all to say that I'm claiming diet and exercise alone would lead to dangerously low blood sugar -- quite the contrary. It's my understanding that oral anti-diabetes medication like Metformin is also extremely unlikely to induce hypoglycemia.)
posted by redfoxtail at 4:32 PM on June 8, 2006

Regulating blood sugar and thereby limiting the amount of insulin your body produces also helps to regulate weight.

Yeah, little known fact - insulin promotes weight gain.
posted by casconed at 4:48 PM on June 8, 2006

So, ikkyu, what causes hypoglycemic symptoms in non-diabetics? I'm one of those annoying office workers who gets dizzy, shaky, nauseated, and woozy if I go more than a few hours without eating. It definitely happens more after a carb-heavy meal, and eating something always fixes me right up. It's really hard to deal with on days when I have 6+ straight hours of meetings and am not allowed to eat during that time.

My doctor says I'm not diabetic and doesn't have many other ideas about what could be wrong. She has a similar attitude that if I'm not diabetic, the symptoms I experience don't matter - but it definitely doesn't feel healthy to me. I also can't get an accomodation at work allowing me time to snack as needed unless I have a medical diagnosis to back me up.
posted by rhiannon at 4:49 PM on June 8, 2006

casconed, a friend of mine is pretty freakin' seriously type 1, pump and all, and is also an avid cyclist. He says you'll anticipate your body's warning signals earlier, and you'll get good at being careful, but sometimes it's still hard. He calls his wife first thing if she's travelling on business during his training so she knows he's conscious. Because a couple of times he didn't eat enough before bed after hard training and got a mouth full of icing in the morning for his negligence.
posted by desuetude at 5:00 PM on June 8, 2006

My experience as a type 2 diabetic has shown me that exercise *can* cause a dip in glucose levels however not enough to get to a low blood sugar situation unless I'm on meds and not eating.

A good workout -- one that is strenuous but not too strenuous because that will cause the body to release more glucose -- will lower my blood glucose levels but within the tolerances of "normal".

The card in the wallet might not be necessary in your friends case. Type 2 diabetics are insulin resistant so the friend's body will produce insulin and regulate glucose levels -- but more impaired than a non-diabetic. When the body stops making insulin -- like in type 1 diabetics -- is when one has to worry about low blood sugar. Or if the person takes too much insulin or meds to up the insulin production.

When I had a low blood sugar episode I fainted and scared the shit out of my friend. I was only out for a second and asked for some orange juice and a moment later I was fine. If I stayed unconscious longer, I'd need to go to the hospital.

I'm lucky in the sense when my blood glucose gets too low, I'll get signs like sweats and shaking so it I eat something to keep from passing out.

And the "give me candy or juice card" should say if the person has regained consciousness. If the person is unconscious, it is hospital time.
posted by birdherder at 5:05 PM on June 8, 2006

desuetude - i recently started rocking out a pump, and i love it, but it's taking some SERIOUS reprogramming since i started training (as an aside: i was the assistant lacrosse coach for a local team, and would suit up and run with them in practice, sprints and all, so i consider myself to be in good shape). but (4 weeks in) i already notice that my sugar is tighter all around, and the only thing that is really giving me trouble is the long runs.
posted by casconed at 5:12 PM on June 8, 2006

I'm one of those annoying office workers who gets dizzy, shaky, nauseated, and woozy if I go more than a few hours without eating.

I call it "being hungry." Being hungry is a normal behavioral state, not a diagnosis of disease. It's probably also associated with mild dehydration - if you're not allowed to eat, you're probably not drinking your RDA of 64 oz. of water a day, either.

As for what you should do in a workplace where you are not allowed to eat or drink when hungry or thirsty, that's a hard question to answer. It sounds like your supervisor is a moron - employees who are well fed work better and more efficiently. Is there a way you can point that out?
posted by ikkyu2 at 5:21 PM on June 8, 2006

Thank you, everyone. I should have been more specific about my "limited" knowledge of diabetes. I guess I meant from a medical professional standpoint. I actually had gestational diabetes myself and certainly know the basics, but personally never had to worry about numbers that were too low.

So many people have expressed this belief, though, that I wanted to be sure there wasn't some connection I wasn't aware of.

To expound on ikkyu2's second comment, I did test myself a few times when I felt so hungry that I thought I was going to pass out, and usually got readings of 85 to 100 - absolutely normal. Of course, pregnant hungry is very different from normal hungry, so YMMV.
posted by peep at 6:06 PM on June 8, 2006

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