Feel Better When I’m High
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Monday, February 13, 2006 |
Q: "I have read your answer on glucose goals. I am fairly new to diabetes and am not yet at the target goals, in fact my levels are often still in the 180-250 range. I start to feel terrible whenever my glucose gets even close to what is supposed to be a good level, like 120. In fact, I feel as if I am hypoglycemic at times, but when I check, I can be 130 or even 150—and just so you know, when I think I’m low, I do test on my finger. So I’m wondering if maybe some people are just meant to run a little higher than others? Maybe my body needs a different target range?"
A: You bring up a very good point-your question has been asked of me literally hundreds of times during my years doing diabetes education and management. The problem you describe has loosely been called "pseudohypoglycemia" or false hypoglycemia, meaning you are falsely thinking you have a low glucose even when the glucose level is normal or high. No, you aren't imagining the symptoms-they are a very real, but temporary nuisance. I have heard this condition discussed at various diabetes conferences and on audiotapes, but could not find adequate documented references for you. But let me explain what experts think is happening.
Target goals
First of all, I want to dispel any misconception that you might be meant to have higher target goals than others. The answer is NO, proven by many studies, especially the DCCT and UKPDS.
Brain Adaptation
When your glucose had been too high for awhile (especially common in newly diagnosed people who may have had diabetes for several years without knowing it), your brain got used to a higher glucose range and so now it thinks this is "normal." The term for this is brain adaptation. Think of brain adaptation as being like a thermostat set too high-i.e. if you have your heat set at a target of 90 degrees, then the heat will come on every time the room temperature drops below 90.
Counter-Regulatory Hormones
As soon as you started changing your diet and /or taking diabetes medication, your glucose level began to fall. The brain, sensing this sudden "change from normal," released counter-regulatory hormones. Their job is to alert you when your glucose is dropping, and to stimulate the liver to temporarily release glucose to help protect you. One of the hormones released during this drop is epinephrine, and it is the effect of this hormone that can cause you to have symptoms such as palpitations, sweating, and nervousness.
So what should you do when this happens, and how can you resolve it?
- Test your glucose: First, it is always important to test your glucose and verify that you are not low. If you are below 70 mg/dl (or whatever level your healthcare team has designated as being too low for you), you should treat this as hypoglycemia.
- As long as your glucose is not low, then try having a diet soda, or a very small low calorie, low carbohydrate snack. Typically your symptoms will resolve on their own in a very short time, with or without the snack.
- You will "reset your perception": As you slowly and gradually get your diabetes in better control, you will find that you have "reset" your body's perception of what is normal and what is low. It is not uncommon for this process to take a few weeks. But eventually you will feel fine at normal glucose levels, hopefully recognize legitimate lows, and in contrast, will notice that you might not feel as great when your glucose goes too high.
- Talk to your healthcare team: As always, please print this and discuss it with your healthcare team.
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Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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