Low blood sugar vs. high blood sugar

I have been recently battling with my diabetes educator over my blood sugar levels.  I am on a Minimed Paradigm pump with access to upload my numbers to their website.  My DE has access to my numbers and has just now, after five years of seeing this doctor, wanted to make adjustments.  My last three A1cs have been 5.9, 5.9, and 5.8.   I've never had an A1C over 7.5 and I can still feel low blood sugars.  I never ran super low, but did have an occasional BS below 60.  I've told her yes, I do feel those and treat them immediately because I know the consequences of low blood sugars.  She told me, just last week, that she wants me to run in the 200s for a week so I can continue to feel my lows!  I told her I wasn't comfortable doing this.  Anyone with diabetes knows why i wouldn't want to do this!  I explained to her that when I'm high, it pretty much affects how I feel all day long (sluggish, tired, thirsty, etc).  I then explained that when I'm low, I treat it, and fifteen to twenty minutes later I'm fine.  Yes, I do get shaky, and weak, and suffer the symptoms of hypoglycemia.  My point was, that once I treat it, I feel normal again.  Unlike when I'm high, it affects me all day!  My wife and friends can usually tell when I'm high too.  My DE said this was backwards and weird.

Now, here's my question for anyone who would like to answer.

Which makes you feel worse- high blood sugars or low blood sugars?  Do you recover better from a high or low?

Am I the only one who feels worse with highs than lows?

Just curious.

i'd have to say i feel equally icky with highs and lows. lows make me feel panicked, like I NEED FOOD NOOOOOW! and then i get headaches while highs just make feel like i have the flu - tummyaches, thirst, lethargic. neither make me feel all that great. i'd prefer to be high than low because i don't feel the scary "immediate danger" feeling with highs, but all together i prefer to be in range :o)

also, your CDE is weird. i would never recommend that to anyone. you know what's best for you and what works. as long as you keep things available to you for lows and test often, you will be fine. good luck and i'm sorry you have crazy people for educators. :o)

I feel much worse all around with highs......All I want to do is sleep.....I am grumpy and very moody...snippy even.  After I get over the low that I am having, I pretty much feel wasted.  Highs make me feel worse.  I have to agree with C that your CDE is out there......who would want to have blood sugars at 200 or over????  As long as you are still feeling your lows.....just go with what you are doing...just my suggestion.  When in question, test! 

About your CDE....  Wow.  I don't even know what to say, except Wow.  She sounds like the one who is "backwards and weird".  You are the keeper of your health and body, and you're the one who will have to live with or without complications later...  so do what you think is best for you.  Your medical team is there to guide you, but ultimately, the choice is up to all of us how to take care of ourselves.

Although I fell pretty craptastic either way, lows are worse for me.  I can handle the headaches, tiredness, and irritability that comes with highs - but the loss of motor skills, confusion, and shaking from lows just creeps me out.  It's the worst. 

As far as recovery, I recover from lows much more quickly.  I am more insulin resistant than most other T1's I've met, so it takes quite a lot of insulin (or insulin + exercise) to bring me back to 'normal'.

Highs for me are a definite drag. I get sluggish and tired. It takes forever to feel better. I have to admit lows scare me to death though. So I would say lows suck immediately but then you are over it but highs take forever for me to recover. How about we all stay in range and feel great!!!

Hi…I am DT1 - 7 weeks since diagnosis. I currently test blood morning, before each meal (3) and at bedtime. Mostly they are good, now and then I get a spike. My current target range” is 100-140. As mentioned, most times it is there. I, out of curiosity, have checked it in between meals, usually around the 2-hour mark. I have seen 150,178, and lower also. A CGM is in order for me,
I wonder is it “normal” and OK to get these higher numbers on occasion? I understand there are MANY factors that can raise them.
Also, I have a high number sometimes at bedtime…189.
Any opinions or should I consult with the Doc?

Highs make me very tired - sometimes I sleep better if I’m high when I go to bed (although of course I’m adjusting to bring the number down).
That advice from your CDE sounds odd to me. I think I recall hearing some years ago that some people (particularly those who are older but if course I don’t know your age) should aim their numbers a bit higher on the normal end of the scale, especially but not only of they have hypoglycemic unawareness, which you say is not an issue (way to go!). So an A1C under 6 is admirable but could be problematic for some, and since the recommendation is to stay under 7 you have some wiggle room.
I’ve also heard (famous last words😉) that frequent lows can affect the ability to detect them - again, this was a while ago - perhaps before the great CGM+pump technology - so maybe your CDE is making the recommendation out of an abundance of caution.
Running steady in the 200s (versus the occasional excursion) does sound drastic. It’s your body and your decision, but if she presses you perhaps you could compromise with a number higher on the scale than where you typically fall, and a top of 200. Trying that may still be an affront to your hard work but a week shouldn’t affect your great A1Cs. What does your doctor say?
I’m tagging @Dennis - he is a huge storehouse of knowledge and can probably contribute wisdom and (correct my) history (:wink::wink:, Dennis).

Hi @HopeFloats2020 you can always talk to your doctor. The deal with insulin is this: it’s synthetic and it doesn’t work exactly like your own. Even the fastest insulin takes 10-30 minutes to start working and it chugs away, relentlessly, for up to 4 hours. If you eat food that absorbs exactly the way the insulin works, your blood sugar will be perfect for those 4 hours. If not, the most typical thing is a sugar arc (blood sugar vs time)that goes up and comes back down again. We usually see the latter.

You can play with pre-bolus and glycemic index and you can walk right after eating but be careful, you don’t want to be low at 1 hour after a meal because you have 3 hours of bolus burn left. This is a game of what works for you. I disregard my blood sugar for 2-1/2 hours after a meal because it will be higher than my target. After that I want in target blood sugar to the best of my ability without losing my mind. Cheers and good luck :four_leaf_clover:

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Thanks, Joe.
What foods absorb exactly as insulin works? No simple carbs?
“Without losing your mind!” I get it. Today I lost my mind and went into angry mode for a good 90 minutes. I was thinking that no matter how well I do with this, I will fail and some complication will rear it’s ugly head.
I cleaned while jamming to music and feel a bit better.
I will get in touch with the doc about my concerns.
Have a good day, Joe.

Hi Cathy @HopeFloats2020 , in my opinion, I feel that our primary goal, especially for us “older” people like us s to feel comfortable while living a normal active life; this includes a good healthy diet and adjusting insulin to maintain safe body [BGL] and blood [BG] glucose levels. A “healthy diet” should also be enjoyable to your acquired tastes and include proteins, fats, and carbohydrates that may be quickly absorbed as well as those that work more slowly [like pasta and pizza] in YOUR body.

That said, what is a recommended glucose level? Over the years I’ve heard many, many recommendations and suggestions, but let’s not dwell on the past but rather look go with the present and more learned thinking. A few years ago, an international panel of diabetes experts suggested BGL, what your anticipated CGM readings will display, is 70 to 180 mg/dl. This “In Range” includes 24 hours every day, both fasting and after eating; it is recommended that a person with diabetes [PWD] be in-range at least 70% of the day. “Time in Range” [TIR] over a period of time is proposed to be the preferred method for identifying “effective diabetes management”, a phrase I’ve been using for several years. You will be able to know your TIR quite readily when you begin using your new CGM.

When you get your new CGM, I expect that like many of us, you will be looking at it every few minutes. Try not to become too alarmed when you see numbers that you never expected to see - numbers are just numbers and just tell you where you are, and give you information for FUTURE action. Look more at trends and patterns to guide you for insulin dosing at future meals with similar foods. The arrows displayed on your CGM will give you a better idea of the effect that food has on your BGL and effectiveness of the insulin you took for that meal. Also, keep in mind, that your BGL sensor reading can lag behind your BG finger-stick value by 10 or 15 minutes. Don’t look just at the current CGM number and arrow, but rather, look at at least the last 3 or 4 “dots” to know of your BGL is dropping [or rising] before injecting insulin. If I see my BGL dropping, I will NOT take my meal bolus before I begin eating - during the last year, Humalog has once again begun working in my body very quickly, 5 to 10 minutes.

Diabetes is unpredictable, so I’ve reached the point where I try not to let some “way out” glucose readings bother me, they will happen. Your new tool will show you just how crazy your diabetes may be.


That’s the easiest question: NONE! :crazy_face: I find all simple carbs faster than insulin, some to a high degree like for me white rice, and all crazy fats and protein mixes slower. Pizza and ice cream for examples are very much slower. So it never ever happens like that (perfect absorption) for me. That doesn’t stop me from learning how to use insulin so I can eat what I want within reason.


LAUGHING OUT LOUD @ “ When you get your new CGM, I expect that like many of us, you will be looking at it every few minutes.“
I am anxious just thinking about that! Also about learning to know all the data coming from that CGM. Ugh, another learning curve.
At my doc appt a few days ago she has given me the ratio which we believe to be 1:15. I knew she was testing me by limiting me to 30-40 g carbs a meal since this is all new to me but I have proven myself that I know how to count carbs, making good food choices, etc., and she is still very pleased at my progress. In a way, I don’t want to disrupt the progress by getting the CGM. Bad enough I now have to do MORE meal planning with the green light for more carbs!

ahhhhhhhh, haha, Joe.
Ohhhh I cannot imagine trying to figure out how much I could eat of simple carbs. I have not had a grain of white flour or ANYthing white. I have had tsp of sugar in my oatmeal. My body seems to be ok with that. No crazy numbers before the next meal.
I am CRAVING a cookie, haha. Maybe at my next visit in 8 weeks, I can ask about that.

Cathy @HopeFloats2020 , an insulin to carb ratio of 1:15 is a good starting point; every insulin pump I have used arrives with a 1:15 set as default. Now with your CGM, you may see that may need adjustment, depending on time of day. Currently [and these change occasionally]. my lunch ratio is 1:15 while my breakfast ratio is 1:10 and my evening snack [after 10 PM] is 1:20. Before making any changes, I observe several day’s graphs and stuff recorded by my Dexcom G6 CGM.

Once your CGM is inserted, set-up and you are getting readings, just observe the number and arrow occasionally - don’t let it raise anxiety. It just gives you data, markers on your life journey, and doesn’t doesn’t tell you if you are “good” or “bad” - words that must be outlawed when speaking diabetes. Whatever brand CGM you get [you didn’t mention which] , be sure to install the software so you can really utilize the data produced. I find the Dexcom Clarity reports very helpful, and also the Tidepool.org [a JDRF sponsored independent provider, easy to use.


As always, thanks for sharing.
I think my dinner ratio may need adjusting as I, once or twice a week, have high numbers (170, (180) before bed. I am no expert at this. Maybe I will have fewer carbs at dinner to see if that makes a difference.
I am getting Dexcom but I doubt my phone (ancient) is compatible for any app they may offer. And I am not about to spend hundreds of dollars for a newer one. Or Maybe one day.
I only get anxious as I don’t care much for trial and error methods. I want cut and dry…HA, I have the wrong disease for that, huh?!

@HopeFloats2020 you got that correct Cathy, you “chose” the wrong condition, TypeOneDiabetes, if you want cut-n-dried management or a condition that can read a medical textbook and follow directions. TypeOne has its own mind, and we each must understand how it affects “The ME”.

You do not need a phone to use the Dexcom Clarity tool; it was less than eight months ago that I retired my old flip-phone and got one that does “fancy stuff”. The Dexcom Clarity tool can be used on both PC and Mac platforms as well as on android devices. Just to see what it is like, go into clarity.dexcom.com ; every Sunday morning, I get an email from Dexcom showing my prior week Summary and access to 8 or 9 graphical reports letting me see where I guessed correctly for meal-time insulin, and where I guessed incorrectly.

As for your “high” 170 and 180 mg/dl readings before bed, decreasing your supper carbohydrates will not eliminate them; I’m assuming that you calculate your meal bolus insulin by counting carbohydrates and dividing by 15 - you said you have been using a 1:15 carb ratio. To eliminate those late evening [4 hours after eating] , you would need to INcrease your carb ratio and possibly use an 1:14. Be Careful!!! You haven’t mentioned what you are using for your basal or “background” insulin, or the timing of injection. For instance, if you are using Lantus and injecting in the evening, it could be that your Lantus does not “cover” you for a full 24 hours [not surprising or unusual] and that might be the reason that your BG doesn’t return to a more normal level by bedtime.

A CGM, in my humble opinion, is the most useful tool yet invented for diabetes management; you will benefit immensely by using it and observing the effect of different foods, and your insulin dosing skills. Yes, it will take time, and you will learn.

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I checked out the TidePool site. I will check the other. Thanks!
I take 10u of Lantus in the morning and Humalog B4 within minutes of eating each meal.
The high at bedtime occurs only on occasion. I will maybe test the dinner ratio. I am so apprehensive to change ANYthing.
I am looking forward to CGM…I think. Coming this week.
Ya know, I already have a full-time job!

Cathy, whatever changes you make, be conservative and observe for a couple of days before making any other changes. All changes should, under almost all circumstances, be gradual - doing little bits at a time may relieve your apprehensive feeling.

For me, a BG that is a “little” higher is more comfortable than going too low. Keep in mind that insulin once injected can not be pulled out.

Lows used to upset me for long periods of time— hours of just feeling rotten ( although not as bad as initially.) Highs are great,except I know how bad they are, so try to avoid them.