The topic of looking #BeyondA1C is a hot one these days. Advocates are working alongside regulators and groups like the JDRF to help improve lives by focusing more on time in range and other factors that impact our quality of life with diabetes.

The diaTribe Foundation held a landmark meeting July 21 on establishing consensus and standards for new measures of patient success; the FDA will be holding a public workshop Sept. 12 on the topic of hypos in older populations; and at the big AADE conference in Indianapolis this past week, several sessions focused on this point.

Hypoglycemia lies at the heart of this issue -- in particular, how low is low? And what do low episodes really mean to PWDs?

Today, our New York-based correspondent Dan Fleshler shares his own (light-hearted) take on dealing with low blood sugars.

How to Recognize Hypos, by Dan Fleshler

Dan FleshlerI have impaired awareness of hypoglycemia and often don’t recognize the normal symptoms of low blood sugar, like fatigue or crankiness. But it’s been many years since I’ve blacked out or needed to be rescued by other people because of a hypo, which used to happen too often.

What’s my secret?

An alarm on my continuous glucose monitor (CGM) that beeps when I’m very low has helped. But experts also urge people with diabetes to develop personalized internal cues, telltale signs that they need some sugar. Perhaps the ones that always work for me will work for you too. Or maybe not, as 'Your Diabetes May Vary,' but who knows...

I can tell I’m having a bad hypo whenever:

  • Instead of just politely refraining from eating cake after someone serves it to me, I snarl at the cake and shout: “I’ll never forgive you, Mommy! Why didn’t you let me take the car and go to the ZZ Top concert?!
  • I tell my wife that I don’t want to go furniture shopping because I’m afraid my socks will catch fire. That’s always a sure sign of a hypo, a dead give-away.
  • I find myself leaping to my feet and applauding during a press conference by President Donald Trump. Danger! Danger! Grab the glucose tablets! Impaired judgment is a common feature of hypoglycemia.
  • I tell my cats, Sammy and Johnny, that before they leave for college, they need to clean their rooms, put the books they no longer want in a box, and donate them to our local library. This was their response to one of those lectures, BTW:
  • Another reliable food-and-music cue: I pick up two heads of lettuce from a supermarket bin, call them “Paul” and “Ringo,” and chastise them for the break-up of the Beatles. (Note: I mentioned this one in a piece I did for SixUntilMe in 2013. Am sharing it again because it’s helped me stave off many disasters. Please feel free to use it.)
  • I burst into tears at a jewelry store counter, very upset because they won’t let me trade my Medic Alert necklace for an expensive watch.

Now, there is no reason to fight this battle all by yourself. If you live with someone, consider sharing your low blood sugar “tells” with them. And if you’re lucky, they will develop their own internal cues.  Heads of lettuce

My wife, for example, has a sixth sense for my hypos. It’s uncanny. Somehow, she knew I needed more glucose when she found me down on my knees and howling like a wolf on our bedroom rug, and once mumbling Slavic-sounding gibberish to myself on a New York City subway train (people mumble gibberish to themselves all the time on subway trains, so I was very lucky she was with me).

In all seriousness (seriously!), if you’re having trouble detecting hypoglycemia, you should also consider taking a blood glucose awareness course -- something called BGAT (Blood Glucose Awareness Training) that offers online training about all the various factors that lead to hypos and cues for detecting when it's imminent.

Even if you a have CGM, I don’t think people with diabetes should rely solely on technology to give warning signals about hypos. We must learn to listen to our own bodies, to take stock of our behavior, and to watch the concerned faces of other shoppers in the supermarket when we talk to lettuce. I hope that’s helpful.


Thanks for sharing, Dan! Humor helps with... everything, no? And we'll never look at heads of lettuce in the grocery store the same way! :)

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.