Many of us who use insulin to tame our diabetes know the rage bolus concept: this instinct to throw quadruple the amount of insulin you’d normally take at a high blood sugar. It’s an instinct that does not ever bode well for us. And yet, it persists. Why?
There are all sorts of backstories as to why rage bolusing exists. We’ve been told time and time again how detrimental it is to our health if we sit in that high state for too long; maybe we’ve been sitting at that high for 48 hours and all of the correct insulin dosing hasn’t worked yet; it’s already been a rough day with all sorts of other extraneous life circumstances and there’s no room for a high blood sugar on the agenda.
Whatever the case may be, you know the scenario. That moment when there is absolutely no hesitation or second thought of giving yourself what (in your right mind) you know is an unhealthy (re: too much) dose of insulin.
We’ve also been on the opposite end of the spectrum. The lows that come out of nowhere, without any good scientific logic or explanation.
And, again, for the infinite amount of reasons and background info, we overeat to treat the low. Not to mention, when you’re in that place of utter low blood sugar darkness (when that ominously dark and stormy cloud hangs overhead and there’s no crawling out from beneath it), it’s as if the monster from within is let out and you can’t help but consume everything in sight.
The moment of terror is real. Even just the frustration -- if it’s not a dramatically low low, it’s still a low. It’s still foggy, disorienting, and (at the very least) uncomfortable. The only way out of it -- out of the rage, resentment, and gloom -- is to eat everything in the kitchen cabinets.
You know where both of these scenarios lead. The rage dosing ends up being too much. Immediately after you’ve pushed in all your insulin from your pen button (or you’ve let all your insulin from your bolus tick in), you’ve got the sinking feeling in your stomach. You know you’re headed for a low, it’s just a matter of time.
Likewise, as you’re eating that 4th bowl of Cap’n Crunch or shoveling down your 6th peanut butter spoon, you’re coming to. You’re realizing what you’ve done; you’ve made it out from beneath the low blood sugar cloud, but now there’s another storm looming: you’re about to skyrocket.
And the whole cycle begins again.
Learning to Safely Come Down (or Go Up)
As uncomfortable as high and low blood sugars are, if we allow ourselves to succumb to the emotions that we attach to those current numbers, then we only prolong the already-negative circumstance we’re in.
What does it mean to submit to blood sugar emotions? We aggressively treat ourselves (either with medication or food) in a way that leads to further treatment needed. There is absolutely no logic involved. We know the consequences, but once we reach this point, we’re flying on emotions.
It’s in these moments that diabetes has overtaken perception. We sense that we are high much longer than we really are; we feel that the world is ending and we’re headed into the abyss. Every minute remaining high (or low) is more and more dangerous, and it’s going to ruin our lives -- these are all the feelings and emotions and perceptions going on.
Those are some hardcore notions! Consequently, these perceptions cause us to respond in unhelpful ways (like rage bolusing or overeating).
But this moment is not forever. The HI you’re experiencing is not forever; the 26 mg/dL is not forever. Realizing this -- that these high and low blood sugar moments are only one moment in time, they will not derail the rest of your life -- is key in salvaging the moments thereafter, ones that you may be more likely to control.
Of course, low blood sugars happen fast and hard, and we should always be prepped with our go-to low stash; likewise, highs are hurtful to our bodies. As people with diabetes, we should absolutely understand the consequences of both high and low blood sugars. But that’s a broader conversation.
This post is about learning to get outside of your own diabetes brain (the high/low blood sugar brain spiral) so that you can make sensible, considered, and wise decisions in a split-second moment.
Diabetes brain is when we become so fixated on the outcomes (what many refer to as “complications”) that may or may not happen years down the road because of the situation we’re in now, that we make decisions that ultimately hurt us.
Knowing and understanding the complications from high and low blood sugars are necessary. But when we become fixated on hypothetical complications that don’t yet exist, we can create our own current complications, by overdosing or overeating.
Because it’s the choices that you make in that moment of dealing with the actual high or low that will either send you down another immediate rollercoaster, or save you from your current one.
How to Stop Diabetes Brain Spiraling
First, know when it’s happening. When you’re taking off your pen cap and getting ready to dial up your dose, take a moment to think about the dose you’re about to give. Is it appropriate, given your current number? Or are you dosing out of spite for your diabetes? Are you eating this second cookie because it’s truly what your body needs to stabilize your blood sugar, or is it comfort eating out of frustration? Is it really the monster within that’s making the decision for you?
If you find yourself caught on a downward diabetes brain spiral, take another moment to pull yourself away from this current situation. Know that this is not forever. Right now -- this high, that low -- will not last forever. It may feel like it will, but it will not.
Use mantras to calm your mind and slowly pull yourself back to reality:
This, too, shall pass.
Now is not forever.
Wait and watch.
Check yourself, before you wreck yourself.
Find your proverb, and live it. Be patient, trust the process, and enjoy your deliberate, purpose-driven choices. You will create such better outcomes for yourself and your diabetes!