What happens when my blood glucose (BG) is too low?
When we are low, we have little glucose in the bloodstream, so the cells in our body have no access to additional glucose. Our brain is a major user of glucose (it uses about 40% of the energy we use at rest), and quickly becomes impaired: when we are low we become really dumb and we make bad decisions, even very basic ones (such as how to treat our low). As we go lower, our brain becomes more impaired, and our body gets impacted as well. We may get a seizure. Ultimately (it may only need 30 to 45 minutes) we become unconscious. At this stage, we and our body are now unable to recover alone, and need urgent outside help. Another hour or so and we die.
What happens when my BG is too high?
When we are high, we have too much glucose in the bloodstream. Our brain becomes sluggish and unfocused. We do not function efficiently. The extra glucose damages our nerves and blood vessels can seriously damage whole organs in 5 to 10 years, almost certainly 15. If we are high enough, our body may generate ketones and bring us into DKA, when the acidity of our blood will kill us in a couple of days to a few weeks.
Why should I bother managing my blood glucose?
There are two simple answers to this. We can die very quickly by badly mismanaging our BG, and we can get major health problems with horrible consequences by mismanaging it long enough.
Here is how we can die quickly:
- If we get a low (by taking too much insulin) we can die in a couple of hours. Sometimes, a combination of circumstances can lead us to low BG while we sleep, and we end up dead in bed.
- If we get a high blood sugar for long enough, by not taking enough insulin, say, we can die of DKA in a couple of days.
Here is how we can die slowly, but badly and painfully:
- High BG damages the walls of blood vessels and capillaries as well as the way they behave, and the nerves. As a consequence, it damages every organ we have. I don’t know of one that does not get badly damaged. This is because every cell is connected to the bloodstream, and feels the consequences of high BG.
- High BG hinders our ability to heal quickly or at all: the worst impact is far away from the heart. Many diabetics get foot or leg amputations from not being able to fight off infection.
- High BG progressively destroys our eyes, and can make us blind. Many T1Ds have damaged vision, some are blind.
- High BG destroys our nerves, and we can get diabetic neuropathy, where we lose the ability to feel some parts of our body, and/or we start feeling unending pain in other parts.
- High BG destroys our kidneys, Many diabetics end up on dialysis: every two to four days they need to visit the hospital for a painful procedure to filter their excreted fluids.
- High BG destroys our heart. Many diabetics end up with heart disease.
But none of this needs to be our fate if we actively manage our BG!
We T1Ds have a very high motivation to treat our BG well every day—-it is not that hard, but it is a daily exercise and we can’t stop doing it even if we are tired or sleepy. The good news is that, if we can do a good job managing our BG, we can likely avoid all of these complications (and death). For me, I have been T1D for more than 5 years, and my worst A1c ever (a measure of your average glucose level in the past 90 days) was 6.4, when a glucose-normal is typically around 5.7 or 5.8. I am frequently around 5.5-5.6, and most of the time between 5.8 and 6.1, even though I don’t spend that much time managing my BG. But, that doesn’t mean I can afford to take a break. I manage it all the time, even if not for very long.
Am I doomed to die young?
Only if you don’t take care of your BG. I have no intention whatsoever to die young, and neither should you. You will find that, after a while, being a T1D becomes a part of us. we accomplish automatic actions that manage our BG every day, and that don’t take much focus any more, because that is what our life is: no big deal, really.
For those of us who were diagnosed early, as children, it is easy, because we are forging our personality as we go, and T1D is part of it. For those of us diagnosed later (often call LADA, Late Autoimmune Diabetes in Adults), that part may not be as easy, but, on the other hand, their diabetes is often less severe than ours, and they often have an easier time medically managing it, so that LADAs are at least as well off as we regular T1Ds diagnosed in childhood are.
What’s important is forging strong habits early on. Responsible automatic habits are what will keep you alive and healthy. But don’t worry! Millions of diabetics have forged a path for you to follow, and if you follow in their footsteps, you can smoothen it even further for the next diabetic to get diagnosed.
Am I contagious?
No. Nobody can catch this from you or me: they are destined to get it from birth, or they won’t get it. But—-our siblings are more likely to be T1Ds if we are T1D. If they are watched carefully, it is possible, in some cases, to diagnose them early, in a way where they won’t run into DKA and risk dying for no reason. So tell your parents to register them into TrialNet, a program that carefully follows siblings of T1Ds.
Can you die of DKA when you are diagnosed?
Yes: pediatric DKA is truly dangerous, and some kids die of DKA shortly after being diagnosed because it is difficult to treat well in children: not every emergency room is equipped for this kind of emergency. I was lucky: when I was diagnosed, I was immediately transferred to the best hospital in my state for pediatric DKA. But my parents would have been better off driving straight to Children’s when I was diagnosed. In my opinion, if one has the choice between several emergency rooms when suspecting T1D as a diagnosis, by far the best choice would be an emergency room in a hospital that has a pediatric diabetes department.
Growing up T1D 