Going Low on the Road with Prediabetes


Randy Ritchie has never shied away from taking charge of managing her health. That’s not a small task since Ritchie, 70, lives with multiple chronic conditions. 

When Ritchie was first diagnosed with prediabetes in 2006, her healthcare provider suggested some lifestyle interventions. Otherwise, she didn’t get much diabetes education, despite a family history of type 2.

Ritchie had seen her mother, uncle and two siblings live with type 2 diabetes (T2D). Yet, after her prediabetes diagnosis, she realized she didn’t know much about diabetes or diabetes management.

Finding education and support online

Ritchie is a natural researcher. She went to her insurance to ask to be paired with a nutritionist or certified diabetes educator. 

“I was told I could have one visit per lifetime,” she said. So she hesitated.

“I was afraid I was gonna need it later,” Ritchie said. “I mean, how do you throw that away and then all of a sudden you’re insulin-dependent and possibly have other health issues?”

The bulk of the information she was finding online was focused on T2D, not prediabetes, and sometimes didn’t feel specific to her circumstances or needs. 

Ritchie poured over online forums, which were more scarce 15 years ago than they are today—where there’s a thriving, connected community on platforms like Beyond Type 2.

“It was the practical experience” shared by others that really helped Ritchie, she recalled. She learned when to check her blood glucose to make the most of her test strips, and was told about the dawn effect.

Living with multiple health conditions

Ritchie lives with a number of chronic health conditions, including lung and kidney disease. Changes in how she manages one of those conditions often affect another, like her prediabetes.

Sometimes she’d have to argue her case for changing or discontinuing treatment to a doctor who wasn’t treating her diabetes because of how it was affecting her blood glucose. 

At one point while taking a steroid medication for a lung condition, her A1c rose into the 7s. “My fasting blood sugar was up in the diagnostic range for type 2,” she said. Despite this, she was never formally diagnosed with type 2 diabetes. 

Looking back, she thinks her healthcare team was focused on her lung disease and wonders if her diabetes deserved more attention. After discontinuing the treatment, her A1c dropped again.

Certain medications can increase your risk for severe hypoglycemia. If you are experiencing lows, speak up to your healthcare team. It’s important to always advocate for yourself and that your concerns are addressed. 

Watching for low blood sugar

Despite her lower A1c results, Ritchie experiences big swings in her blood sugar levels. Her levels are often high in the mornings and she also has to watch for signs of low blood sugar, or hypoglycemia.

Hypoglycemia is when your blood sugar level drops below 3.9 mmol/L70 mg/dL. Severe hypoglycemia is when your blood sugar level drops below 3 mmol/L54 mg/dL. Having low blood sugar is dangerous and needs to be treated right away. Left untreated, hypoglycemia can lead to unconsciousness, seizures and though rarely, death. It’s important that people around you know how to help.

Looking back, Ritchie can remember episodes consistent with hypoglycemia in the years before she understood what it was.

“I’d come in from gardening and I would just be sweating and shaking,” she said. Back then, she attributed the symptoms to another medication because she’d never been educated on what to look out for and how to treat low blood sugars.

As someone with prediabetes, she wasn’t warned that she may be at risk until she had blood glucose readings that showed she was, in fact, going low.

Going low on the road

Ritchie and her husband moved away from Ohio for her husband’s job in 2000. Over the last two decades, she’s made regular trips back to Ohio to see family, including her grandchildren. She became used to making the 15 to 17-hour drive from Georgia or Florida back home by herself. 

After a while, she found herself frequently experiencing low blood sugar while on the road. There would be times when “all of a sudden, I’d have to pull over. I felt like I was going to pass out,” she said. “I would start to get the narrow tunnel vision and sweat and shaking, palpitations and sure enough, I take my blood sugar and it would just be horrific.”

So Ritchie started to plan ahead. She’d load up her car with snacks and make hourly stops to check her blood sugar levels.

“I would keep it a little bit high when I traveled so that I wouldn’t go too low. If I was starting to skate down around 5.6mmol/dL100ml/dL I would snack while I drove,” she remembered. 

Nonetheless, blood sugar would sometimes drop into the low 2.2-2.8 mmol/dL40s.

“I got stuck at the side of the road at night more than once. I almost blacked out and I thought, can’t do this, it’s just way too dangerous.”

Recovering from a severe low

Her husband and children often don’t take these low blood sugar episodes seriously, even when it takes her one or two days to regain her strength.

“I feel very weak. Like I have the flu—vomiting and fever,” Ritchie said. “It’s like a malaise. I don’t feel safe to get in the car and even go buy myself a cup of coffee.”

Severe low blood sugar is hard on your body—it can take up to a day and a half to recover from the impact on your mood, mental state and cognitive function.

Even when corrected quickly, hypoglycemia has lasting effects. Research shows low blood sugar events can trigger inflammation in the body that can last up to a week—regardless of if you have diabetes or not.

When this happens, Ritchie focuses on resting and reestablishing the day-to-day routines that help her manage her prediabetes.

Adapting her life for health and safety

For Ritchie, making the long trips is no longer worth the risks. Staying close to home means her diabetes and health feel more manageable, though she misses her grandchildren. 

“All you need to do is find yourself on some Georgia back road after you’ve gotten off of a highway and you haven’t got a clue where you are because you’re so stinking confused and dizzy—It doesn’t take much to scare the bejesus out of you,” she said.

Managing multiple chronic conditions can have a big impact on your daily life. You are your own best expert on understanding your specific needs and knowing what is best for your wellbeing.  Your health and safety should always come first. Making those tough decisions isn’t easy, be proud that you’re doing your best to live with prediabetes or diabetes!

Editor’s note: Educational content related to severe hypoglycemia is made possible with support from ​Lilly Diabetes, an active partner of Beyond Type 2 at the time of publication. ​Editorial control rests solely on Beyond Type 2.

WRITTEN BY Julia Sclafani, POSTED 08/18/22, UPDATED 01/07/23

Julia Sclafani is a writer, editor and multimedia producer whose work on human rights and public health topics lead her to Beyond Type 1. She received a bachelor’s degree from Columbia University and a master’s degree from the Newmark Graduate School of Journalism at the City University of New York. An award-winning journalist, Julia cut her teeth at her hometown newspaper. You can find her past work in print, on the radio and across the web.