Diabetes; Health
What YOU need to know when Employing, Living with, or Working with a Diabetic
Daily activities, from meal times & content to lifesaving intervention. You’re not diabetic but know someone who is — your life just changed.
Synopsis
- Sometime in your life, you will need to know about diabetes. My wife and I, coworkers, neighbors and strangers have had to contend with everything here. This article covers everything you need to know. It’s already changed the life for two early reviewers.
- Most articles offer advice to the diabetic. This is for everyone else…
My introduction to diabetes
My wife of 20 years is Type 1 diabetic and we, coworkers, neighbors and strangers have had to contend with everything in this article. I knew nothing about it in the beginning. Diabetes was just an impersonal term. My examples come from personal experience.
Most articles offer advice to the diabetic. This one is for everyone else...
Your partner is diagnosed with diabetes or the new person you are dating has it. Perhaps your child was just diagnosed. A diabetic may work in your office. You, yourself, may have just been diagnosed.
So, what is diabetes?
There are two types:
Type 1: The body does not produce insulin which is required to process sugar for energy. The diabetic must take insulin shots. About 1.25 million in the US.
A Type 1 diabetic may suffer from both high and low blood sugars. She can’t use the pump since it might inject insulin when the blood sugar is low, essentially an overdose.
A 14-day sensor attached to the arm sounds good, but it doesn’t measure low or high enough to be truly effective, at least not yet for us, and the diabetic must be alert enough to use the separate reader.
Type 2: The body produces insulin, but does not process it properly. The diabetic may have to take extremely large insulin shots. About 33 million in the US.
A Type 2 diabetic most often contends with high blood sugars since their body’s normal insulin production is not enough. An insulin pump may work for them, especially if it can detect when the blood sugars are increasing and not being processed.
Sugar is fuel for the body
The ‘blood sugar” number from a blood test measures the amount.
- Extreme high level — fried brain, convulsions.
- Extreme low level — starved brain, convulsions, unconscious.
- A Grandmother coworker was worried about taking the diabetic grandchild to the park. She can give the child candy if the child is still conscious and it’s been discussed in advance with the parents. Otherwise she should just call 911 immediately.
- Thanksgiving dinner is 3 hours late. You just screwed your diabetic guest who couldn’t wait while everybody else is eating chips and watching football.
- Meal timing is important.
The diabetic’s life revolves around the blood sugar levels. Yours does, too, but you don’t have to think about it.
The doctor worries about long term high blood sugars which can cause blindness, kidney failure, stroke, nerve damage and amputations.
Your immediate concern is low blood sugar (hypoglycemia) and then emotional support for the required life changes.
The diabetic may not even know the drop is happening
In my experience, the diabetic recognizes that their blood sugar has dropped less than 20 percent of the time.
How to recognize low blood sugar
Sugar is fuel for the body. When blood sugar drops, the body pulls sugar from the brain to keep the heart going.
You will realize what that means when you come home to find your partner collapsed on the floor, watch your partner slowly turn into a zombie while watching TV, notice full-body sweats at 3 am, or your partner does not wake up in the morning. Maybe a coworker collapses in the chair or you find a neighbor lying in your yard.
Books and articles contain a standard list of symptoms, but you need to be very observant to find the specific ones for your partner. Anything can be a symptom since the brain is short of fuel. I can’t take anything she said personally - good, bad, or mean - since the brain is not normal.
For example, I can tell by speech patterns, facial expressions, cadence while walking, sitting posture, hostility, affection, the same answer no matter the question, plus the normal published symptoms. Your list may be different.
If it happens in a public place like the airport, you need to remain calm while everyone else panics. You must to be alert at all times.
A symptom may not always mean low blood sugar. Sometimes you cannot tell the difference between normal sleepiness and a low blood sugar symptom. You have to check it.
What do you do when their blood sugar is low
You won’t know until you do a blood test. Then, you have to know what to do with the results - without causing harm.
The cure for hypoglycemia is sugar measured in grams, but like any medication, you do not want to give an overdose.
Doctors recommend 15–20 grams of glucose but any fast acting carbohydrate will work. You just need a small, measurable quantity. Note: The standard for our EMTs if you call an ambulance is 50 grams by IV, an overdose for us.
Check the nutrition labels for carbohydrates. We keep M&Ms, 3/4g, and candy kisses, 3g, to treat low blood sugars.
Stores sell special glucose tablets, but they tend to be larger and much more expensive. If you are an employer, ask the diabetic for advice in advance.
Honey and raisins work for more severe problems.
If nothing works, call an ambulance.
To avoid that, you need to calibrate your partner. Sugar levels of 70–100 are normal, 200+ is very high. For us, low numbers start appearing in the 50s and below. That may differ by patient.
Our calibration is in candy kisses. Anything in the 50s requires 1 kiss, high 40s — 2, low 40s — 3, etc. with 5 as the normal maximum.
Too much may cause a rebound. The doctor’s 15–20 grams is usually too much and pushes a rebound number way too high. Extremely high blood sugars can cause kidney damage.
If the person cannot chew the candy, we try honey in very small quantities like ¼ teaspoon at a time. Honey is 4 times as sweet as pure sugar. It can be absorbed through the gums.
However, we prefer the candy if at all possible. I soften it slightly in the microwave.
Quantities vary by person, so you need to work out your own scale.
Don’t expect an instant return to normal. The doctors say 15 minutes, but our experience is closer to 30 minutes. Everyone is probably different. You just wait and recheck if necessary.
Eventually you will discover how long normal is
You have to factor that time into your daily life if you need to be somewhere on time. If I have to be at an 8 am meeting, I get up one hour earlier than normal and make sure my wife is up and eating breakfast before I leave.
If she does not wake up, I stay until she is fully functional. Walking into the bathroom is not enough. She must walk back out and start breakfast.
Recently, something changed. Suddenly, the calibration did not always work. I called an ambulance when the blood sugar went from 24 to 22 instead of going back up after 5 candy kisses.
They brought it back up on the scene. We determined what happened and tested the theory on the next similar low.
Each insulin has a point in its period where it spikes, i.e., has the highest effect. The original calibration was on or after the spikes. The low was before the spike and the spike used up the additional sugar. I had to add extra candy, based on the time in the insulin cycle, and recheck about 45 minutes later.
Frequency & Responsiveness
Fortunately, extremely low blood sugar levels don’t happen often or people would be dropping on the street like flies.
The diabetic rarely passes out completely. They just slow down and may take many seconds to understand what you say and respond, if they can at all. If they notice the drop themselves, they can eat their candy and wait.
Other people are the problem. They panic or are impatient. Some, like the police, cannot expect someone with low blood sugar to respond instantly to their commands. My police-chief friend said that was part of their early training.
A very low episode may be days, months or years apart. They usually occur when balancing the fast and slow insulin’s, but can occur at any other time with no apparent reason.
Employer’s responsibility
Experience with diabetes is important, especially in the workplace.
For example, another diabetic in 2014 got fired over a $1.69 (plus tax) drink and Dollar General had to pay her $277,656. Mr. Employer, this could happen to you:
In our case, the hospital employee health services told my partner that her A1C level was too high and had to be reduced or she would have to pay the non-preferred insurance premium. The A1C measures long term average blood sugar levels.
All diabetics try to reach my partner’s low level, but few do. In my opinion, a lower number than hers is nearly impossible.
My partner, with her doctor, started adjusting the insulin balance to meet that goal. My partner works in an office without any direct patient care.
She had two low episodes at work. Her manager, who never answered emails and canceled the first 8 monthly project status meetings, refused even to discuss what happened.
He concluded, on his own, that she was unconscious (she wasn’t and had already taken candy to offset the low) and, along with HR, tried to put her on disability. He even changed her paycheck without following the hospital’s standards published in the employee handbook.
Her doctor refused to sign the disability papers and she returned to work.
Had it stood up, she would probably have been covered by the Americans with Disabilities act. The hospital might have had to declare all diabetics disabled since they are all potentially subject to low blood sugar levels sooner or later.
Diabetics can work most anywhere, like driving for NASCAR. Some are even pro athletes.
Coworkers just need to know what to be aware of and not to panic.
However, HIPPA regulations kick in and the coworkers may not be aware unless the diabetic informs them.
Retirement
Outside factors, such as stress from work and other sources, can push blood sugar up. We had insulin levels and candy calibrated to the normal stress level.
Then we retired and almost all stress was gone! Insulin had to be reduced and the calibration changed. It took over a year to learn to cut the candy to less than half and we are still working on the insulin amounts.
Meals change dramatically
Meal timing and content require rigid control compared to everybody else.
Diabetics can eat about anything — but not in any quantity
They must know the exact number of carbs. You can modify recipes, mostly by cutting added sugar, and then calculate the serving size.
For us, one unit of insulin before the meal covers 15g of carbohydrates or “one carb”. That varies and must be worked out with the doctor. A meal is usually 3 carbs.
Since diabetics can eat about anything but not in any quantity, they must know the exact number of carbs. You need to read labels when shopping.
For example, 15 grapes, ½ banana, one orange, 12 potato chips, 7 French fries, 1/3 bag of microwave popcorn, one ounce of bread, ½ cup of ice cream and one tablespoon of sugar are all one carb.
Starchy vegetables like potatoes, beans and corn have to be counted whereas leafy vegetables don’t.
We have also found that some foods work faster than others — i.e. “fast” carbs and “slow” carbs. White rice and white bread are faster than whole wheat bread and brown rice due to the fiber.
Usually, highly processed foods, sugars and syrups are the fastest. Foods with higher fiber content are slower.
Insulin taken before meals lasts about 4 hours. So, meals need to have a combination of fast and slow carbs.
Navigating restaurants
Restaurant meals present challenges just because of serving size and hidden carbohydrates.
The average restaurant serving of spaghetti with meat sauce has 7 carbs — more than two meals. One breadstick is two carbs. The main dish of one meal covers all three meals for the day.
Web sites, like calorieking.com, list carbohydrates for specific restaurants and by brand name.
We usually split meals just to control carbs. We also look for restaurants that have fresh fruit since we know the carbs and quantities.
We frequently went to one Mexican restaurant where we took our own grapes. They also had margaritas with fresh lime juice and no sugar. Some places advertise fresh lime juice but actually use a mix with a lot of syrup (hidden carbs). You have to ask and be precise.
YOUR meals
Surprising things can influence blood sugar, both up and down
You need to provide emotional support, too. That means eating at the same time if possible and eating pretty much the same things. Nobody should be cooking two separate meals.
However, they do not always need to be exactly the same. You could have a regular sandwich while your partner’s is open-faced with one slice of bread or you have cereal while your partner has yogurt for breakfast. Whatever is practical.
You also should not keep many high-carb snacks in the house or insist on a lot of sugary desserts. That does not mean “no desserts”. You can modify recipes.
I have modified an apple pie recipe replacing one cup of sugar with one tablespoon. It acts as a carrier for the spices to keep them from clumping. You have to add the carbohydrates for the apples, the crust and one tablespoon of sugar for the whole pie, then divide by one carb to get the number of slices.
My mother-in-law who usually does not like sweets asked for seconds — shocked everybody. For more food hints and recipes, check http://www.rd.com/diabetes/.
What to do with an insulin overdose
If your partner takes insulin, you always have to watch for an overdose. The pre-meal insulin has a life of about 4 hours. It covers the carbohydrates for the meal.
The long term stabilizing insulin, or “night” insulin, has a life of 24 hours. The night dosage may be much larger than the meal dosage.
No matter how careful, how disciplined, or how methodical a person is, they can make a mistake, even if it is only one in 10,000 times.
My wife is more disciplined than a marine drill sergeant, but one night she switched the day and night insulin. We had about an hour to cover 15 carbs, or about 5 meals.
The sheer volume was daunting and it had to be fast acting carbohydrates. That would have been 75 candy kisses.
Raisins worked well but it took almost a cup. In a case like that, you have to check blood sugar frequently and be prepared to go to the emergency room. You may want to do that anyway.
Friends, Family, Employers and Coworkers
Other people’s attitudes can be a problem for the diabetic.
* Meals need to be spaced normally. Too close together, the insulin shots overlap. Too far apart, blood sugar may drop too much. Snacks are out.
* Some people actually get offended when the diabetic does not eat what they serve or when they want to eat.
On one family occasion, the meal was supposed to be served at 1:00 pm. It was 3 hours late. Everybody snacked while watching TV.
That does not work for someone on insulin. We ate breakfast based on lunch being served on time. We had to go out to lunch. Everyone was upset when we did not join them for lunch when it was finally served. I could have waited or eaten a second lunch, but I support my partner. Her health comes first.
Coworkers can be just as clueless. The company sponsored lunch may not be at the right time, may not have any carbs at all, may be all carbs, or may not have the right mix.
One group was actually very considerate and had grapes along with the birthday cake. Unfortunately, the party was too soon after lunch and my partner could not eat them at that time.
Finally, don’t you be a problem
Make sure you provide support for meals, crosscheck all measurements without becoming a hovering pest, and generally give encouragement.
Outside influences, like a new meter & other things
Some are normal and well known. Others are odd and may impact only one person.
For example, stress has pushed it up; OTC and prescription drugs both directions; and exercise pushes it down. The diabetic may even have to adjust insulin dosages for a sinus infection or a high-stress job.
You always have to be alert for odd influences. For example, a hot shower after the night shot caused the blood sugar level to drop dramatically. The same shower an hour before the shot does not seem to have any effect.
You may decide to change meters or your insurance may stop covering your meter test strips, thus forcing you to change meters. Meters generally agree inside normal ranges, but all instructions state that highs and lows may not be accurate.
When we changed meters and compared them, the new one was off by one candy kiss on the low side and one unit of insulin on the high side, thus causing overdoses on both ends. We had to change both insulin dosages and candy calibrations.
You or the insurance company saving on the cost of strips could cause a trip to the emergency room due to an insulin overdose. We have not had it happen, but it could.
Another’s experience
You can learn a lot from an article like this, but nothing is like being there.
An adult diabetic diagnosed one year ago and her mother reviewed this article.
The mother said that none of this had occurred with her daughter. The daughter said that ALL of it had occurred in the last year.
Conclusion
Finally, “in control” is a nebulous term. For doctors, it is the average value.
For the diabetic, it can be fairly high, pretty low and everywhere in between. At one time, we had a 24-hour monitor. Occasionally, the blood sugar dropped 50 percent in a 30 minute time span.
Sometimes, the same meal, same shot, same time, and same starting blood sugar number will produce a high one day, a low another day, and normal the third day. Our mantra is:
That makes no sense
I ran a statistical analysis over one year’s measurements. I have never seen anything so random. So, you and your partner can only do your best. Your partner needs your support just to have a more normal life.
Good Luck.
December 2022: Our main problem was overnight lows, a couple requiring calls for the EMTs.
The Libre 2, a continuous sensor, changed things. It issues an alarm when the blood sugar starts to drop, usually about 2 hours earlier and at a higher number. It is not consistently accurate enough to replace blood tests for insulin calculations, off one unit of insulin in either direction about 39% of the time. but it has greatly reduced the risk of having dangerous lows and highs.
Disclaimer: This article is the author’s opinion based on one subject and does not constitute medical advice. Each diabetic is different and Type 2 differs significantly from Type 1. The diabetic should consult their diabetes doctor about their own case.
