I'm already using dextrose in my Rockets candy. (Called Smarties in the US.) Much cheaper than Dex4 tablets. One roll is 7g CHO. But I will try to hold it in my mouth. Thanks for the great tip.
Such a great explanation of what WORKS---BEST---and why!! I totally agree with you....the holding method is such a funny concept but it is so effective. I've done it for a very long time but I'm so happy you explained why and how it iS the fastest method for recovery...and also, importantly, how a little can go a long way. Knowing the amount of carbs you need to raise your blood sugar by so much with this is key. Dan, you are a GIFT ---thank you!!
I keep natural brown sugar cubes around because the dextrose tabs usually are filled with garbage. Never used a juice box in my life , gross. TID 35 years. Chocolate chips are convenient because you can customize dose.
I’ll echo another commenter: Dan, you are a GIFT! Thank you for this article and all the others - I love your Substack and so grateful for your writing. Just one Q: does honey work the same as dextrose (ie absorbing thru oral mucosa)? Thanks and be well!
Nope -- neither honey or any other type of sugar can be absorbed through the oral mucosa. the molecules are too big to penetrate the membrane. Only dextrose (pure glucose) is small enough.
Great understanding, I use glucose tablets, chewing them up and putting it sublingual and in cheeks before swallowing
. The one other thing I find helpful for me is to drink water. I first did this to rinse the glucose from damaging my teeth. With a CGM I learned that it sped up BG rise.
I’m a T2 on a pump. I learned to use tablets which are measured and fast. In the past I would give into hangry rage eating, leading to high BG . Never eat a hypo until you feel better, because you will go hyper.
I've been hearing a lot more from T2Ds lately. One guy told me he reads my newsletter to gain a better understanding of techniques that T1Ds use to gain tighter control. I wonder if T2Ds have some sort of impression that we have it all figured out because our circumstances require it by comparison. I dare say it ain't that simple! :-)
Going in the other direction, I believe T1Ds would learn a lot by studying T2D, not for the management techniques, but more for the underlying physiology. Aside from the beta cell differences, there's a lot more overlap than what most in the T1 community is aware of. (I only lightly allude to it in some of my articles.)
Ain't nottin' simple about diabetes regardless of type. The issue I see with my tribe is, it's like chronic hypertension. We don't have something like DKA that forces us to accept and take it seriously.
I'm lucky blurry vision got me diagnosed and I had excellent doctors and nurse educators. Having a blind stepmother kept me motivated and compliant.
BTW- T1s can have high insulin resistance like us T2s. This was called double diabetes now Type 1 with insulin resistance.
yup -- I cite double-diabetes (DD) a lot in my articles. My next one (on basal insulin) cites DD as one of the main effects of over-insulinizing with high basal rates/doses. My articles will always focus on T1, but I endeavor to be mindful of the T2 readers out there.
No, I am not back on basal insulin. But I didn’t want to call that out directly. I just edited that whole section to make it clearer and more complete. It's longer (unfortunately), but I figured readers would appreciate it.
Dextrose tablets are damaging to tooth enamel. The disease is aptly named diabetes “melitis” after the French word “miel’- the ancient Ebers papyrus records that patients urine smelled like honey. So low blood sugar is best treated with the one food that is otherwise off limits- a teaspoon of honey! It has a psychological effect of calming the body and is rapidly absorbed . Sadly most honey today is tainted by glyphosate that bees ingest. Honey is an ancient medicine and so undervalued and understudied.
YES! you certainly raise some very good points regarding sugar, diabetes and oral health. However, let's clarify some things in greater detail.
First, ALL sugars affect tooth enamel, though the time it takes and the level of severity varies by a lot of factors. Dextrose is not nearly as bad as most sugars because of its simpler molecular structure. But the sugar you take in for hypo correction is negligible in the grand scheme of things.
Remember, THIS article is about correcting for hypos, and one does not need that many grams of carbs to correct most hypos, nor do you expose your mouth to it for a long period of time. So, while both dextrose and honey contain sugar, the amount you actually consume is (and should be) a lot less from dextrose given the manner of administration I described.
Honey, by contrast, has huge amounts of carbs, so the exposure quantity and quality are far worse for your mouth. The sugars cannot be absorbed through the mucosa, so they hang around much longer. And, when you swallow honey, it now goes through that sloweed digestive tract mentioned in the article.
Still,, your point is valid that, as a general rule, carbs feed the bacteria, so you should always drink something that flushes it out---anything that doesn't have carbs is better than nothing. If you can also do a quick brush, that's good too. Sugarless gum is effective because it causes your mouth to flush itself repeatedly because you're swallowing the fluids.
Now, all of this pales in comparison to having T1D in the first place. Persistently elevated glucose levels leak into saliva (hence, the "sweet breath" that people notice), and saliva deposits far more sugar into the oral environment over weeks, months and years than any amount of sugar you may consume to treat hypos.
T1Ds show decreased pH, buffer capacity, and antimicrobial peptides in saliva, which allows more acidic conditions and greater bacterial colonization.
Recent studies have found that just the inflammation itself from all this may elevate *systemic* inflammation, exacerbating insulin needs.
So, I'm very glad you raised this because oral hygiene is a vastly overlooked aspect of diabetes management, and these factors really do need greater exposure. I will add it to my queue of articles to write!
Brilliant! As coming up on 55 years T1D this is the first I've heard of this method- its been effective on my recent 4 hypo events. I've struggled long with the roller coaster, and while rationally know better, when the shakes are happening and the alerts keep clanging its hard to wait.
It's easy to suggest being patient if you've never experienced the panic of not having sweets or enough. Like hoping for the school bus to drive faster so you can get home to some juice, squeezing the sugar out of a soggy roll of lifesavers from a plastic bag in a pocket on a raft trip, cresting the hill while biking a remote road in Arizona and stumbling to the porch of a closed diner where the owner for some reason walks out and hands you a coke.
I'm a bit better at havng tubes of tablets, but still manage sometime to not have them on me. At least now, I know the better way to absorb them. Thanks again for this.
The only thing I haven’t been doing is keeping the glucose tabs in my mouth to absorb before swallowing. That makes sense.
I'm already using dextrose in my Rockets candy. (Called Smarties in the US.) Much cheaper than Dex4 tablets. One roll is 7g CHO. But I will try to hold it in my mouth. Thanks for the great tip.
Such a great explanation of what WORKS---BEST---and why!! I totally agree with you....the holding method is such a funny concept but it is so effective. I've done it for a very long time but I'm so happy you explained why and how it iS the fastest method for recovery...and also, importantly, how a little can go a long way. Knowing the amount of carbs you need to raise your blood sugar by so much with this is key. Dan, you are a GIFT ---thank you!!
I keep natural brown sugar cubes around because the dextrose tabs usually are filled with garbage. Never used a juice box in my life , gross. TID 35 years. Chocolate chips are convenient because you can customize dose.
I’ll echo another commenter: Dan, you are a GIFT! Thank you for this article and all the others - I love your Substack and so grateful for your writing. Just one Q: does honey work the same as dextrose (ie absorbing thru oral mucosa)? Thanks and be well!
Nope -- neither honey or any other type of sugar can be absorbed through the oral mucosa. the molecules are too big to penetrate the membrane. Only dextrose (pure glucose) is small enough.
You’re the best. 🙏🏼
Thanks so much for this useful information! I am type 1 for 79 years, but there is still so much I do not know.
79 years! wow!! that's longer than the expiration date on my birth certificate!
well done.
Great understanding, I use glucose tablets, chewing them up and putting it sublingual and in cheeks before swallowing
. The one other thing I find helpful for me is to drink water. I first did this to rinse the glucose from damaging my teeth. With a CGM I learned that it sped up BG rise.
I’m a T2 on a pump. I learned to use tablets which are measured and fast. In the past I would give into hangry rage eating, leading to high BG . Never eat a hypo until you feel better, because you will go hyper.
I've been hearing a lot more from T2Ds lately. One guy told me he reads my newsletter to gain a better understanding of techniques that T1Ds use to gain tighter control. I wonder if T2Ds have some sort of impression that we have it all figured out because our circumstances require it by comparison. I dare say it ain't that simple! :-)
Going in the other direction, I believe T1Ds would learn a lot by studying T2D, not for the management techniques, but more for the underlying physiology. Aside from the beta cell differences, there's a lot more overlap than what most in the T1 community is aware of. (I only lightly allude to it in some of my articles.)
Ain't nottin' simple about diabetes regardless of type. The issue I see with my tribe is, it's like chronic hypertension. We don't have something like DKA that forces us to accept and take it seriously.
I'm lucky blurry vision got me diagnosed and I had excellent doctors and nurse educators. Having a blind stepmother kept me motivated and compliant.
BTW- T1s can have high insulin resistance like us T2s. This was called double diabetes now Type 1 with insulin resistance.
yup -- I cite double-diabetes (DD) a lot in my articles. My next one (on basal insulin) cites DD as one of the main effects of over-insulinizing with high basal rates/doses. My articles will always focus on T1, but I endeavor to be mindful of the T2 readers out there.
As I can see you're back on basal insulin..? I wonder if basal-free didn't work out for you after all or is it just temporary?
No, I am not back on basal insulin. But I didn’t want to call that out directly. I just edited that whole section to make it clearer and more complete. It's longer (unfortunately), but I figured readers would appreciate it.
Thanks for the thorough explanation. Time to get some glucose tablets at the grocery store.
Dextrose tablets are damaging to tooth enamel. The disease is aptly named diabetes “melitis” after the French word “miel’- the ancient Ebers papyrus records that patients urine smelled like honey. So low blood sugar is best treated with the one food that is otherwise off limits- a teaspoon of honey! It has a psychological effect of calming the body and is rapidly absorbed . Sadly most honey today is tainted by glyphosate that bees ingest. Honey is an ancient medicine and so undervalued and understudied.
YES! you certainly raise some very good points regarding sugar, diabetes and oral health. However, let's clarify some things in greater detail.
First, ALL sugars affect tooth enamel, though the time it takes and the level of severity varies by a lot of factors. Dextrose is not nearly as bad as most sugars because of its simpler molecular structure. But the sugar you take in for hypo correction is negligible in the grand scheme of things.
Remember, THIS article is about correcting for hypos, and one does not need that many grams of carbs to correct most hypos, nor do you expose your mouth to it for a long period of time. So, while both dextrose and honey contain sugar, the amount you actually consume is (and should be) a lot less from dextrose given the manner of administration I described.
Honey, by contrast, has huge amounts of carbs, so the exposure quantity and quality are far worse for your mouth. The sugars cannot be absorbed through the mucosa, so they hang around much longer. And, when you swallow honey, it now goes through that sloweed digestive tract mentioned in the article.
Still,, your point is valid that, as a general rule, carbs feed the bacteria, so you should always drink something that flushes it out---anything that doesn't have carbs is better than nothing. If you can also do a quick brush, that's good too. Sugarless gum is effective because it causes your mouth to flush itself repeatedly because you're swallowing the fluids.
Now, all of this pales in comparison to having T1D in the first place. Persistently elevated glucose levels leak into saliva (hence, the "sweet breath" that people notice), and saliva deposits far more sugar into the oral environment over weeks, months and years than any amount of sugar you may consume to treat hypos.
T1Ds show decreased pH, buffer capacity, and antimicrobial peptides in saliva, which allows more acidic conditions and greater bacterial colonization.
Recent studies have found that just the inflammation itself from all this may elevate *systemic* inflammation, exacerbating insulin needs.
So, I'm very glad you raised this because oral hygiene is a vastly overlooked aspect of diabetes management, and these factors really do need greater exposure. I will add it to my queue of articles to write!
Brilliant! As coming up on 55 years T1D this is the first I've heard of this method- its been effective on my recent 4 hypo events. I've struggled long with the roller coaster, and while rationally know better, when the shakes are happening and the alerts keep clanging its hard to wait.
It's easy to suggest being patient if you've never experienced the panic of not having sweets or enough. Like hoping for the school bus to drive faster so you can get home to some juice, squeezing the sugar out of a soggy roll of lifesavers from a plastic bag in a pocket on a raft trip, cresting the hill while biking a remote road in Arizona and stumbling to the porch of a closed diner where the owner for some reason walks out and hands you a coke.
I'm a bit better at havng tubes of tablets, but still manage sometime to not have them on me. At least now, I know the better way to absorb them. Thanks again for this.
What a great way of explaining a very complicated and frustrating problem that people with T1D face! 💕🙏👍