This is my first post here, so I'm not sure if I'm breaking any of the etiquette rules or anything ;)

I've been a T1D for 14 years, and for a long time I was in a state of denial about my health. I pretty much just did the bare minimum to stay alive through my college years a few thereafter. Anyways, the past few months I've decided to regain control of my life and my diabetes. That being said, I'm experiencing lows once again since I'm managing my levels and insulin intake far better now but am still working out the kinks.

My question is: I have a (somewhat) irrational fear of lows. The panic that sets in during one is unbearable for me (and everyone else I'm sure), but it creates such fear in me, that I intentionally run high so that I don't experience them, which has already caused long-term complications in my body from this strategy. I live alone, and the only person that is involved in my life in any way is my boss (cause I work for him), so if something were to happen to me, it'd be several days before I was found (since he works part-time), and I fear it'd be too late by that point. How do I get over my fear of lows?

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The first thing you need to do is get a CGM.

The best one is Dexcom.

Yeah, I've been looking a lot into a CGMS. I know the numbers aren't as accurate as a standard glucose meter, and are used primarily for trends and not exact numbers, but the accuracy of the CGMS has been a point of contention for me. I've never seen a side-by-side test of a CGM vs. a standard meter to see how off there numbers were in person, but I've seen a few forms with standard meters showing 55 mg/l and the CGM displaying 101 mg/l, which scares me more than a little. hah.

Hi Jack, I would encourage you to give a cgm a try. If you don't go into it expecting to fingerstick test any less, you may find it really helpful for avoiding lows. It will also let you know which foods really spike you.

I've used a Dexcom since September and went from having lows almost daily to almost totally eliminating them mainly because I can see on the Dexcom when I'm trending down. That's my clue to test more and keep a close eye on it. Then I can bump it up a bit when I'm 80 instead of getting caught off guard at 50.

I'm also hypo unaware for the most part and my Dex has saved me several times at night when sleeping. It's peace of mind for me.

First, good for you for taking the right steps to get back on track with things. I can assure you that you're not the only one who has done the things you describe (neglecting your T1D, running high to avoid lows, etc). Many of us are guilty of those things.

It's also not unusual to have a fear (even an irrational one) of lows. They are scary! And that fear is (I think) your body's way of trying to protect you in some way.

First question - is it possible to go on the pump? For me, the lows when I pump are far less severe and easier to identify and correct. I don't know if it's the same for others, but that's how it has been for me. This has made me feel safer and ultimately stopped my bad habit of letting my BG run high.

Second question - can you get a CGM? I know a lot of folks say that they feel so much safer using a CGM because it can alert them to an impending low. For you, a CGM might just give you the peace of mind you need living alone.

Third question - do you have hypo unawareness (where you can't feel the symptoms of a hypo coming on)? It sounds like you don't because you describe the fear kicking in when you start to go low. This is a good thing!! It's your body's way of telling you to get off your butt and do something about your dropping blood sugar. Because of that, it's highly unlikely that you will go unconscious from a low.

Keep in mind that for many people, a severe low that results in them being unconscious will result in their liver kicking in with a glucose dump, thus bringing them back to consciousness enough to treat.

I still have a fear of lows, but it's a healthy fear I think, one that generally drives me to test frequently and always carry fast-acting glucose. I do sometimes allow my BG to run a bit higher, but only in situations where doing so is for my safety (i.e., rock climbing, backpacking, etc). But to get to this point, I did have to go through an adjustment phase after years of letting my BG run high. It took about 6 months to get back to an A1C in the upper 7s. Again, for me, the pump really helped.

Also, keep in mind that as you bring your BGs back into normal range, you're going to feel low when you're not.

I've been looking more and more into a pump. The last time I looked was when I was a child, and they didn't appeal to me then, but I'm more responsible now, so I think I would benefit greatly from one. I'm just really self-conscious, so I don't know how I'd feel about wearing one all the time :/

CGMs look great, but accuracy is a little off-putting for me anyways. I've got an appointment with the 1st endo I've seen in 6 years next week, so I'm kinda nervous about it all, but I'm gonna ask him!

Yes, I have pretty serious hypo unawareness (isn't any serious though?). I rode my bike for miles 2 days ago and felt fine, and checked my blood when I got back just out of curiosity and came back at 48 mg/l! I felt completely fine too. That's kinda what prompted me to post this, because I've been really unsellted since that happened to me.

Well, there are several Steps you Have to do and do them consistantly..
1. Test alot more Often..I normally ave 10x a day..
2. Novalog last about 3-4 hrs, but If your Too Low by hour #2 ( Like 130's) odds are your going to be Hypo by Hr #3.. Thus? Gots to Test 2 hrs after eating.
3. Testing Overnite- Yes, if you take your Basal at Bedtime and/or a CB for being High? Have to Set the alarm for 3 hrs and roll over and test. and of course having Glucose tabs or Those Mini Musketeers Bars ready to go.. And Knowing How mayn Carbs you need as well, Like 5 carbs drivers my BG's up about 25 points a Mini Musketeer Bar is 10 carbs = 50 pts..

4. Before doing ANY Physical Activity? Gots to have 150 and taking 5 carbs every 15 min. and of course, testing every 1/2 hr ..

5. Knowing what BG level you need to have B4 Going to bed so your basal won't drive you Hypo.. I have to have 120, if I am 90? I eat 5 carbs..

This and many other Tricks of the Trade and steps are discussed in the Book
And if looking into a Pump? Might as well get John Walsh's -USING INSULIN>

and you can be 1 unit too much when eating and ? Bingo! Hypo..
Thus why So important to Know How many Carbs your Eating
And What your I:CR is to treat those carbs..
and based upon having a 100 BG at the time.

And guess what? Odds are? You were never taught this stuff, like so many of us others.. so it's Not your fault.. I blame the Medical Profession..

Hope that Helps..!

Hello Dennis:

With respect, When is too much testing I ask...? The March 16-17, 2010 FDA meeting in Gatherberg MD was painfully blunt and clear... the meters are just not that blessed accurate... the industry is in no hurry to fix it either.

Consider until relatively recently there was no home blood testing, it did not exist period! Are we truly, honestly better off even being concerned about middle of the night data?

I have serious concern the generic approach being used causes more problems than it solves...

Having known a dear friend who was going blind back in the 1970's at the ripe old age of eighteen due to diabetic retinopathy, I'd say that YES we do need frequent testing with our meters and CGM's, even if they are not perfectly accurate. Knowing that you're 140 vs. 340 vs. 40 is a huge boon, in my opinion. People have much better control now than they did then. Middle-of-the-night testing is the difference between rolling over and ignoring a 54 or a 254 and treating it. In my opinion, anything that gets us closer to knowing what's going on is a boon to us (knowing how it's trending is even better!)

Of course I won't be satisfied till we can cure diabetes -- and in the meantime I really, really, REALLY want a perfectly accurate, non-invasive way to measure my BG's -- but the technology we have is so much better than even one generation ago.

Hello Laguitariste:

Testing by definition is "self-injury". In any other context we'd be hospitalized for doing so. How do you frame testing to avoid that unfortunate "paradox"?

Can diabetics become mentally unbalanced pursuing too zealously "perfection" re: diabetes?



Hate to say this, Stuart, but you need to chill. If we do not test and understand and act, we die. We are not unbalanced at all. In fact the people here are some of the most balanced, knowledgable and focused people I have ever had the priviledge to meet.

Thanks to all of you who have taught me so much!

Good to see you back, Stu. I generally do not check in the middle of the night unless my body wakes me. Usually it does, if I am too low or too high. I check and the body feelings are almost always right. Of course I do a 3 am check when doing an overnight basal reset, but I do not regularly get up to check. I can understnd those that do it if they have frequent overnight lows.. it makes sense to. I agree with JeanV, on that one, we have many more ways to check and we can avail ourselves oto them, so much more than when I was diagnosed at 14 "Back in the Day". However,Everyone's diabetes is different.

God Bless,




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