Don’t Let Diabetes Stand in the Way of Your Dreams

Sheri and Steve at UVI (brighter)

I had to wait more than half my life to overcome the only thing I had never been allowed to do with type 1 diabetes…but I finally prevailed.

You can do almost everything you want to with diabetes.  One blaring exception is scuba diving through any NAUI (National Association of Underwater Instructors) organization.

My story is that when I was a graduate student back in 1987, I signed up at the University of California, Davis for a scuba diving certification course.  I didn’t know about NAUI or much of anything scuba-related, but got a rude awakening when I was booted out of the class after having a required physical exam and admitting that I had type 1 diabetes.  I was devastated.  Despite having had diabetes since the age of four, I had never let it stand in my way of reaching my goals (even though I didn’t have a blood glucose meter back then).

So, I went with the UC Davis scuba class to Lake Tahoe and waited lakeside while everyone else in the class got to dive.  I guess I was just a glutton for punishment!

What I didn’t know at the time was that the other primary scuba diving organization (PADI, the Professional Association of Diving Instructors) lets people with type 1 diabetes dive, and thousands of individuals with diabetes have dived safely over the years.  The Divers Alert Network (DAN) has also advised people with diabetes about staying safe while diving, and many of their recommendations are based on the extensive experience with diving with adults with type 1 diabetes amassed by Steve Prosterman, a diving instructor at the University of the Virgin Islands (who also happens to have type 1 diabetes).

I met Steve at a diabetic athletes’ meeting I attended back in 1990, and after hearing my story, he graciously invited me to come to UVI anytime to learn how to dive with him.  I waited 27 years to take him up on his offer, but I finally fulfilled my almost lifelong dream of going scuba diving–on my 50th birthday!  It was the best way I could have ever celebrated a half-century of life and almost 46 years living with type 1 diabetes.  Thank you, Steve, for helping me make my dream come true!

Sheri, 1; type 1 diabetes and NAUI, 0. Finally!!

Scott Dunton Walking

Exercise: It Does a Body Good!

Athletes around the world are now competing (and competing well) with diabetes. Scott Dunton, a professional surfer with type 1 diabetes, is just one example of how exercise does a body good!

However, there are some things I wish I had always known about exercising with diabetes…

Being active has always made me feel better, physically and emotionally.  But here are some other things about exercise that I wish someone had told me years ago.

1) Exercise can help erase your blood glucose “mistakes”

  • Exercise acts as an extra dose of insulin, figuratively.
  • At rest, insulin is the main way to get glucose into muscle cells, but during exercise, glucose goes muscles without insulin (caused by muscle contractions).
  • Being regularly active makes your muscles more sensitive to insulin, so you will need lower doses of it overall.
  • What better way to help erase a little overeating of carbs (or some insulin resistance) than a moderate dose of exercise to lower your blood glucose?

2) Exercise doesn’t always make your blood glucose go down

  • It doesn’t always make your blood glucose come down, at least not right away.
  • During intense exercise, the glucose-raising hormones your body releases can raise your blood glucose (think high-intensity interval training).
  • Over a longer period of time (2-3 hours), it usually comes back down.
  • If you take insulin, take less than normal to correct a post-workout high or your blood glucose will likely be crashing low a few hours later.
  • A cool-down of less intense exercise (like walking) can help bring it back to normal, though.

3) Your muscle mass is critical to managing blood glucose levels

  • Exercise helps you build and retain your muscle mass, and muscles are the main place you store carbs after you eat them—like a gas tank.
  • Exercising helps use up stored carbs, but can also increase the size of the tank.
  • When you eat carbs post-exercise, they can easily go into storage with a little insulin (or sometimes none at all).
  • Being sedentary keeps the tank full and makes you resistant to insulin.
  • Aging alone can cause you to lose muscle mass over time.
  • Resistance training and/or high-intensity intervals build muscle more, so you need to include these activities regularly as part of your workouts.

4) It’s the best medicine there is

  • Control stress and stave off depression with exercise—and it has no bad side-effects!
  • Exercise is a natural antioxidant—better than supplements!
  • Being active prevents all sorts of cancers, including prostate and breast.
  • It will help you feel better and look younger than you are (and we can all use help with that).
  • You’ll be even less likely to catch a cold, if you exercise moderately.
  • Don’t forget your daily dose of exercise “medicine”
  • Standing more, taking extra steps, and fidgeting help–just be active all day long any way that you can!

Diabetes Motion: Practical advice about exercise and fatigue solutions

Whether you’rDiabetes Motione new to exercise or a sports enthusiast, diabetes can get in the way of being physically active. To deal with this problem, I founded a new information web site called Diabetes Motion (, given that I’m one of the world’s leading experts on diabetes and exercise. The mission of Diabetes Motion is to provide practical guidance about blood glucose management to anyone who wants to be physically active with diabetes.

Without a doubt, being physically active is good for the body, heart, and mind. If you are already an avid exerciser, then you know the benefits of exercise for your health and diabetes control. If you are just thinking about getting serious about sports or fitness activities, then you have a lot of positive changes to look forward to.

Exercise can help you build muscle and lose body fat, suppress your appetite, eat more without gaining fat weight, enhance your mood, reduce stress and anxiety, increase your energy, bolster your immune system, keep your joints and muscles more flexible, and improve the quality of your life. For many people with diabetes, being physically active has made all the difference between controlling diabetes or letting it control them.

What you may not know is what type of exercise or physical activity you should you be doing or how much of it is recommended for optimal health and the best blood glucose control. The good news is that you can get different (but all good) benefits from doing a variety of types of daily movement, which gives you a lot of options. In fact, exercising regularly is likely the single most important thing you can do to slow the aging process, manage your blood sugars, and reduce your risk of diabetic complications.

Need help with revving up your exercise? If your exercise performance been less than you’d hoped recently, here are some potential causes of fatigue (and solutions):

Inadequate rest time: You may be getting through your workouts well, but then fail to perform when you have races and events simply because you didn’t take enough rest time to restore glycogen and fully recover. It’s critical to cut back on your workouts (“taper”) for at least 1-2 days before a big event and keep your blood glucose in good control so your glycogen levels will be as full as possible on race/event day.

Blood glucose and glycogen stores: It’s harder for your body to restore your muscle glycogen (stored carbs) between workouts unless you’re eating enough carbs and have functioning insulin available. Your carb intake doesn’t have to be tremendous—probably just 40% of your total calories coming from carbs will suffice—but your blood glucose absolutely needs to be in good control for your muscles to restore carbs optimally.

Iron: Having low iron stores can cause you to feel tired all the time, colder than normal, and just generally lackluster. You can get a simple blood test done to check your hemoglobin (iron in red blood cells) and your overall iron status (serum ferritins). If your body’s iron levels are low (due to diabetes or non-diabetes causes), taking iron supplements can help, along with eating more red meat with lots of absorbable iron.

Magnesium: You may have a magnesium deficiency, especially if you take insulin or your blood glucose levels are not optimal. Magnesium is involved in over 300 metabolic pathways. If you’re deficient, your exercise will be compromised and you may even experience some muscle cramping. To correct a deficiency, eat more foods with magnesium in them—such as nuts and seeds, dark leafy greens, legumes, oats, fish, and even dark chocolate—but taking a supplement may also help.

B vitamins: For people with diabetes, thiamin (vitamin B1) deficiency is also a likely culprit in exercisers and can be further depleted by alcohol intake. People who take metformin to control diabetes can also end up deficient in vitamins B6 and B12, both of which are essential to exercising well. Consider taking a vitamin B complex daily.

Thyroid issues: Having lower levels of functioning thyroid hormones can cause fatigue and poor exercise performance. Have your main thyroid hormones (TSH, T3 and T4), but possibly also your thyroid antibodies if your thyroid hormones levels are normal and nothing else is helping your exercise (specifically antibodies to thyroid peroxidase), especially if you have celiac disease.

Still stumped? If you’ve been through this list and had everything check out okay, then consider other possible issues like your hydration status, daily carb intake (adding even just 50 grams per day to your diet may help), other possible vitamin and mineral deficiencies (vitamin D, potassium, etc.), statin use (some statins taken to lower blood cholesterol cause unexplained muscle fatigue), and frequent hypoglycemia.

Please visit for more helpful information about being active with diabetes.

Should You Just Do Intense Exercise for Less Time?

Just when everyone was already confused about what types and amounts of training people with diabetes should be doing, along comes yet another study to muddy the waters some more. This latest exercise research was undertaken by faculty at McMaster University in Hamilton, Ontario, and appeared in the December 2011 issue of Journal of Applied Physiology (1).

The study involved eight individuals with type 2 diabetes (mean age of 63 years) who agreed to endure six sessions of high-intensity interval training done on a cycle ergometer over a two-week period. The training sessions consisted of 60 seconds of cycling done 10 times at ~90% of maximal heart rate, interspersed with 60 seconds of rest—for a total of only 10 minutes of actual exercise and 10 minutes of recovery. In other words, it involved almost an all-out sprint for a minute at a time, repeated 10 times with very little rest in between. Some call this low-volume, high-intensity interval training (HIT); others call it pure torture.

Before training and from ∼48 to 72 h after the last training bout, blood glucose responses were monitored using 24-hour continuous glucose monitoring. The exercise definitely had a positive effect on blood glucose levels: both the average levels over 24 hours and the 3-hour postprandial values after all three daily meals were improved significantly even 2-3 days after each training session, suggesting that low-volume HIT can rapidly improve glucose control and induce adaptations in skeletal muscle that improve metabolic health in people with type 2 diabetes.

While interval training is routinely used by sports teams and athletes, I have to question whether doing only this type of training would be beneficial for most individuals with diabetes. It certainly saves time—who can’t fit in 10 minutes of exercise three days per week?—but would it benefit weight control in the average person with type 2 diabetes? Probably not, as it simply doesn’t burn that many calories. Actually, it doesn’t save that much time either: when you add in the interspersed rest intervals and a warm-up and cool-down period, it still takes at least 25 minutes per session and 75 minutes per week. Current recs from the American Diabetes Association suggest that people with diabetes should try to get at least 150 minutes of moderate to vigorous exercise each week—an average of 30 minutes a day if done five days a week—so you’d only really be saving time on the two extra days you’re not doing the HIT routine.

There is no doubt that doing HIT training does have some benefits. This research suggests that doing thrice-weekly short intensive workouts may help lower blood sugar levels similarly to more frequently performed moderate activities. The sessions themselves dropped blood sugar levels from 137 mg/dL to 119 mg/dL, on average, which isn’t bad for only 10 minutes of exercise. In addition, overall and post-meal blood sugar levels were reduced long after training sessions were completed, which may or may not happen with more moderate workouts.

On the flip side, others who wrote articles about this training regimen also commented that “it requires so much suffering that you’re almost destined to quit.” Unless it’s regularly done with others, a coach, or a personal trainer to ensure motivation and positive feedback, most individuals will not have the drive to continue doing this type of training on their own long-term. What’s more, doing really intense exercise can actually cause a short-term elevation in blood glucose instead of a decrease, especially if the intense activity is not repeated enough times (such as the 10 sessions in this study) due to the effects of glucose-raising hormones released by sprinting. (So, you probably couldn’t stop early and gain the same benefits.)

If you can only do five to 10 minutes of exercise, that’s certainly better than nothing, but you really start to see the effects of exercise if you can regularly exercise harder and longer—for 20 to 30 minutes at least a few times a week. Another drawback of doing low-volume HIT is simply that not everyone is going to be able to do it, and it’s certainly not the best routine to start with when you’ve been sedentary for a while. It’s also more likely to result in overuse injuries and other joint problems that will stop you from doing anything after a while.

However, I’m totally in favor of routinely interspersing harder intervals into any regular training session—regardless of how easy or hard it is—both to increase cardiovascular fitness and to use up more blood glucose and stored carbohydrate (glycogen) in muscles, just like was done in one pilot study a few years back (2). Starting with easier workouts and interspersing slightly harder intervals into them is a lot more realistic for the majority of folks out there just getting started.

The bottom line: Just get up and off the couch to do any type of physical activity regularly, and your blood glucose levels will thank you.

References Cited:

(1) Little JP, Gillen JB, Percival ME, Safdar A, Tarnopolsky MA, Punthakee Z, Jung ME, Gibala MJ. Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. J Appl Physiol. 2006;111(6):1554-60.

(2) Johnson ST, McCargar LJ, Bell GJ, Tudor-Locke C, Harber VJ, Bell RC. Walking faster:  distilling a complex prescription for type 2 diabetes management through pedometry. Diabetes Care 2006;29:1654-5.

Taking Insulin? Avoid Getting Fat!

A lot of people with type 2 diabetes delay going on insulin for as long as possible because they’ve heard horror stories about how much weight it can make them gain (or maybe they just don’t like shots), but people with type 1 don’t have a choice.  While it is true that insulin treatment is often associated with weight gain and more frequent bouts of hypoglycemia (low blood sugar), the real question is, why?

Some theories to explain insulin-induced weight gain are that when using insulin, your blood sugar is (usually) better controlled and you stop losing some of your calories (as glucose in your urine when your blood sugars exceed your urinary threshold) and that you may gain weight from having to eat extra to treat any low blood sugars caused by insulin. If you’re taking oral medications to lower your blood sugar and they are not working, however, insulin may be your main option for better control.

A few research studies have looked at whether weight gain is simply a result of eating more when you’re on insulin. One such study found that weight gain was not due to an increase in food intake, but rather that your body may increase its efficiency in using glucose and other fuels when your glycemic control improves—making you store more available energy from the foods you eat as fat (even if you’re eating the same amount as before you went on insulin) (1).  

So, what can you do to avoid weight gain if you have to take insulin?  First of all, you should try to keep your insulin doses as low as possible because the more insulin you take, the greater your potential for weight gain is.  The best way to keep your insulin needs in check is to engage in regular physical activity.  By way of example, some people with type 2 diabetes who were studied gained weight from insulin use while others did not.  Interestingly, the main difference between the “gainers” and the “non-gainers” was that the gainers were less physically active (2). Moreover, in people with type 1 diabetes, taking insulin doses that effectively manage blood sugars can also lead to weight gain, but increases in activity levels have been shown to prevent getting fatter (3).

During any physical activity, your muscles can take up blood glucose and use it as a fuel without insulin and then following exercise, your insulin action is heightened for a few hours and as long as 72 hours—meaning that you will need smaller doses of insulin to have the same glucose-lowering effect.  It is my personal experience that regular exercise is the best way to prevent insulin-induced weight gain, but your insulin doses will also need to be adjusted downward to prevent low blood sugars that cause you to take in extra calories to treat them.

Second, you may be able to avoid weight gain by taking a look at the type of insulin(s) that you are using.  For example, in overweight type 2 diabetic subjects, use of once-daily Levemir (detemir) caused less weight gain and less frequent hypoglycemia than use of NPH (4), even combined with use of rapid-acting injections of a separate insulin for meals (and the same is likely true when using Lantus, or insulin glargine).  Anyone taking basal insulin alone (once or twice daily) or following a basal-bolus regimen can benefit by making sure that insulin doses are regulated effectively to prevent blood sugar lows and highs—while using as little insulin as absolutely necessary to get the desired glycemic effect.

In other words, the type of insulin you use and the doses you take are both important to consider in the overall management of your diabetes and your body weight, regardless of which type you have. Just as importantly, though, is how you choose to manage your lifestyle, both your exercise and your dietary choices.  Changes in your lifestyle, such as cutting back on refined carbohydrates that require larger doses of insulin to cover them and exercising regularly, are likely your best bets to counteract any potential weight gain caused by insulin use.  An added side benefit is that if you have type 2 diabetes and start exercising regularly, you may actually lose fat weight and be able to lower your insulin doses more or get off of insulin injections completely.

References cited:

  1. Jacob AN et al. Weight gain in type 2 diabetes mellitus. Diabetes Obes Metab. 2007 May;9(3):386-93.
  2. Jansen HJ et al. Pronounced weight gain in insulin-treated patients with type 2 diabetes mellitus is associated with an unfavourable cardiometabolic risk profile. Neth J Med. 2010 Nov;68(11):359-66.
  3. Jacob AN et al. Potential causes of weight gain in type 1 diabetes mellitus. Diabetes Obes Metab. 2006 Jul;8(4):404-11.
  4. Fajardo Montañana C  et al. Less weight gain and hypoglycaemia with once-daily insulin detemir than NPH insulin in intensification of insulin therapy in overweight Type 2 diabetes patients: the PREDICTIVE BMI clinical trial. Diabet Med. 2008 Aug;25(8):916-23.

Why Everyone Is Getting Diabetes (and Prediabetes)

The latest statistics about diabetes released by the Centers for Disease Control and Prevention are staggering: 25.8 million Americans have diabetes, and another 79 million with prediabetes are waiting in the wings to develop it. This rise in cases is exponentially greater than what was predicted even a decade ago, and the increase in diabetes a worldwide trend, not just a North American one. At current rates, everyone around the globe will have diabetes or prediabetes before the end of this century.

People are quick to point their fingers at weight gain, fast food gluttony, and slothful lifestyles as being the main culprits, but what if it’s more than that? Is there anything that can be done to abate this looming health crisis? In his recent book, Diabetes Rising, author and journalist Dan Hurley examines five potential reasons behind what has become a modern pandemic. At this point, his five hypotheses—revolving around weight gain, cow’s milk, persistent organic pollutants (POP), vitamin D, and hygiene—warrant further discussion.

The first is the Accelerator Hypothesis, which revolves around body weight and insulin resistance. Some researchers are actually beginning to believe that type 1 and type 2 diabetes–heretofore considered to be caused by autoimmune destruction of insulin-producing beta cells and a high level of insulin resistance, respectively–may actually be the same disease. He postulates that the recent rise in cases of both types of diabetes have been accelerated by weight gain (an environmental factor), but are modulated by genetic factors, including the tendency to have a highly reactive immune system and the tendency to develop insulin resistance in response to weight gain. The jury is still out on whether weight gain is a direct casual factor, but we do know that type 2 diabetes risk can be lowered greatly by even a small (5-7%) decrease in body weight.

The Cow’s Milk Hypothesis relates more directly to the development of type 1 diabetes and could more accurately be called the Foreign Protein one. In essence, early exposure in infancy to any proteins other than the ones found in human breast milk appears to make the body’s immune system more permissive toward autoimmunity and the ultimate destruction of the insulin-producing beta cells in the pancreas. An easy (and economical) approach is to promote the breast feeding of all infants as long as possible during the first year of life.

Hurley’s discussion of the risks associated with organic pollutants in the POP Hypothesis is quite compelling and is picking up steam. POPs originate from pesticides, but also from solvents, pharmaceuticals, paints, pollution, and even plastic. These compounds accumulate in body fat, so levels are higher farther up the food chain. One study actually showed a 38-fold increase in diabetes incidence when comparing the lowest and highest quartiles of POP exposure, and a follow-up study suggested that obesity leads to diabetes only when a person has POPs above a certain level—which are stored in body fat. In that case, keeping body fat lower may actually be quite effective in lowering diabetes risk by decreasing the amount of POPs stored in the body.

The Sunshine Hypothesis is not a new one where type 1 diabetes is concerned as it was noted several decades ago that its incidence is higher at northern latitudes compared to southern ones. However, the role of the sun (and vitamin D) in type 2 diabetes development (and even in prediabetes) is a more recent hypothesis. Most vitamin D is manufactured in the body following exposure to sunlight, and the rise in diabetes parallels greater use of sunscreen and less time spent outdoors. The evidence is compelling enough that recommended vitamin D intakes were recently raised for the population as a whole, based on age: 600 International Units (IU) daily for children and adults up to 70 years old, 800 IU a day for ages 71 and older.

Finally, the Hygiene Hypothesis suggests that making our environments too sterile may actually be increasing our risk of developing diabetes. In fact, people living in lesser developed regions around the world have a lower incidence of type 1 diabetes, allergies, and asthma. Exposure to some bacteria and other germs appears to strengthen the immune system and keep it less likely to start attacking parts of the body.

While these theories are interesting, what we really need to know is how to reverse the potential tsunami of diabetes cases while there is still time. Hurley postulates on “curing” diabetes with an artificial pancreas and with bariatric surgery, but neither of these solutions is really a cure, nor is either feasible on a worldwide scale.

At this point in time, the ultimate key to ending the diabetes pandemic is prevention, and that “cure” is only going to come through united action to make living healthier. Collectively, we are going to have to make personal choices to eat healthier foods and demand access to healthier (and less caloric) fare; make physical movement a requirement rather than an option (in schools and in the workplace); find government-directed ways to reduce our exposure to environmental pollutants of all types; stop oversterilizing our personal environments; and spend a little more time in the sun without overdoing the sunscreen. Furthermore, it’s likely going to take community uprisings and the use of political clout to change some of the policies in place. Time to get busy!

Are Exercise-Induced Lows Making You Fat?

Over the years, I have had many exercisers with diabetes ask me why they’re gaining weight instead of losing it. There are two possible answers to that question. One answer, which is more applicable to new exercisers, is that muscle weighs more than fat (for an equivalent amount). Consequently, if you are gaining muscle while losing some fat weight due to your new exercise regimen, then your scale weight is likely not reflective of the positive changes in your body composition (i.e., less fat, more muscle).

 The second possible answer is more applicable to people who are not new to exercise, especially anyone who may have recently changed the amount or intensity of training that they’re doing. I first ask them, “Have you been treating a lot of low blood sugars recently?” When they invariably reply, “Yes,” then I know to tell them that they have simply been taking in too many extra calories while treating hypoglycemia.

Of course, you have to treat a low if you have one! However, every calorie counts, even the ones that boost your blood sugar back to normal (and beyond). People with diabetes often reach for candy, cola, juice—or other high calorie, high fat, and high sodium foods—to correct lows, which can lead to rebound high blood sugars, unhealthy eating, and weight gain. What you use to correct a low is often just extra calories not accounted for in your daily meal plan.

What can you do to avoid gaining weight when you have to treat frequent lows? The best advice is to treat them with something low in calories, but with enough glucose to bring your sugars back to normal. When you have a hypoglycemic reaction, do not binge on candy bars, cookies, and other high calorie, high fat foods. These “treats” take longer to raise your blood sugar than pure glucose and usually contain calories (like ones from fat) that do not raise blood sugar levels effectively. You are almost certain to eat too much of them waiting for your blood sugar to rise and consume unnecessary extra calories that will cause weight gain—and excess weight gain can lower the ability of your insulin to keep blood sugars in check. You can also end up with rebound hyperglycemia, which may increase your insulin needs and promote fat storage.

I’m going to sound like a walking advertisement for glucose products from here on out, but I fully understand from both professional and personal experience how critical making smart choices is when you want to keep exercising regularly and avoid weight gain. Using fast-acting glucose to raise your blood sugars is likely to contribute the fewest extra calories. Why? Pure glucose contains only 4 calories per gram, so a 15-20 gram treatment has 60-80 calories, and every single calorie goes directly to rapidly correcting your blood sugar levels.

Hypothetically speaking, if you’re correcting just two lows per week with 15 grams of carbs, you will take in an extra 6,240 calories a year, or the equivalent of almost 2 pounds of body fat (one pound of fat is 3,500 calories). By way of comparison, getting 15 grams of carbs from other foods usually results in your consumption of way more calories, especially if any of the foods contain calories coming from fat (9 calories per gram) or protein (4 calories per gram), neither of which will rapidly correct a low blood sugar.

Here are just a few other food comparisons:

  • A 2-ounce bag of Skittles candy contains almost 60 grams of carbohydrate and four times the calories of a 15-gram glucose dose. Likewise, just one ounce of Smarties contain 25 grams, which if you consumed them all would probably raise your blood sugar too much and cause you to take in extra calories.
  • A candy bar like Snickers contains about 100 extra calories for every 15 grams of carbs. Correcting lows with Snickers or other candy bars adds another 3-pound weight gain a year.
  • A regular soda that contains high-fructose corn syrup may take longer to correct a low (fructose has to be converted into glucose first),  and it’s easy to consume more than 15 grams—which is the amount in only 4 ounces of a soda (one third of a 12-ounce can).
  • Even choosing orange juice or a banana to correct a low is less effective because the fructose (fruit sugar) is much more slowly converted into glucose. You probably won’t be able to stick to only 4 ounces of juice or half of a medium banana (15 grams of carbs) while you wait for your low to be corrected, and end up consuming more calories than necessary.

 Check out some calorie intake comparisons using Dex4’s new Hypo Smart Choice Calculator, at You’ll likely be surprised how many extra calories you may be consuming just treating low blood sugars with the usual things like orange juice and soda!

There is nothing worse than exercising and trying to lose weight, but ending up gaining some instead due to all the extra calories you eat to correct low blood sugars. If you can prevent lows with diet and medication changes before, during, and after exercise and avoid taking in those extra calories in the first place, certainly do that!  But when you do have to treat an occasional low, keep in mind that using food rather than pure glucose can add a lot of calories to your total yearly intake and your lows may take longer to correct.

In short, pure glucose is always best for rapid treatment of lows, although pure sucrose (table sugar, as found in hard candies) is second best. For prevention of lows during longer bouts of exercise or overnight, however, consider taking in a low-calorie bedtime snack with a balance of carbs, protein, and fat that will keep your blood sugars stable for longer. Some examples are Balance bars, low-fat and reduced sugar yogurt, or low-calorie ice cream. An ounce of prevention is always worth a pound of cure, especially if a hypoglycemic episode leads you to eat everything in sight!