What numbers do you consider to be a hypo...?

[Spiker]

For me a hypo is a symptomatic thing, not a number on a meter. It is also a functional thing - a warning to take some kind of action.

Adrenalin symptoms are triggered by a combination of 3 factors - the current BG level, the BG level you are used to having recently, and the rate of drop. In this sense the adrenalin warning is "smarter" than any meter or CGM - when it is working properly.

I have had hypo warning symptoms with meter readings above 8, verified with multiple tests, that turned into bad hypos. The adrenalin response detected what the meter did not. My BG probably was around 8, but dropping *very* fast. At other times I have been functional at 3.1, when I have been low carbing and my ketoadapted brain actually needed significantly fewer carbs. So not only does the "hypo point" vary from one individual to the next, it varies in the same individual depending on their recent diet history.

I should really distinguish between a "hypo warning" which is when adrenalin or a test device prompts me to take action, and a "proper" hypo when I get neurological symptoms - as the brain starts to conserve glucose by shutting things down. I tend to call both things "hypos" and a lot of us do, but I suppose that is not very helpful, as they are quite different things.

 

[Spiker]

under 3.5 isn't good for anyone

I would agree apart from people who are ketoadapted on low carb diets who actually need less glucose in their blood because their neurons have shifted to get more energy from alternative sources.

 

[phoenix]

I would agree apart from people who are ketoadapted on low carb diets who actually need less glucose in their blood because their neurons have shifted to get more energy from alternative sources.

Um, before I went on the pump I lost hypo awareness and had no physical symptoms other than a reduction in energy. I had some very low levels without a perceptible change in cognitive function. On a couple of occasions the meter just said lo. I was functioning fine, even riding a bike on one occasion. On another I decided to try one of those reaction games when my levels were in the 3s , I did better than I normally did! Once, in the interests of science, I got my OH to administer a 'Stroop test ' (try it here )and did fine.
I didn't eat a ketogenic diet, far from it . As I did a lot of exercise and I was low within 10 mins of starting I had overall very low levels and an HbA1c of 4.9%.
Eventually prudence reigned, though I could seemingly cope with those low levels, I decide that I might not always be able to do so. Luckily I was offered a pump and could then make the necessary adjustments in basal (ie I use almost none for exercise) .

So personally, I didn't have to be keto adapted to function at a low level. This isn't that odd, as it seems that both humans and animals have the capability of adapting to subnormal levels. In one study, they induced hypoglycemia in normal subjects and kept levels low at 2.9mmol/l, except for at meal times, for the next 56 hours . On the first day cognitive function deteriorated at just over 3mmol/l by the 4th day this didn't occur until below 2.5mmol/l. ( they also used the Stroop test for one of their tests )
they had an interesting conclusion
The current studies document the plasticity with which the CNS adjusts its acquisition of fuel to permit survival from natural and
induced alterations in systemic glucose provision. Extrapolating our findings to patients with diabetes, the response thatwe. describe is adaptive, given that it preserves glucose homeostasis and cognitive function in the face of recurrently limited fuel resources. However, from the standpoint of
patient safety, symptoms and counterregulation may be triggered so late in the development of hypoglycemia that a seizure or loss of consciousness occurs prior to, or even after, adequate treatment has been completed. As such, this alteration may be viewed as maladaptive.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC44810/pdf/pnas01142-0165.pdf

ie it is possible (at least for some people) to adapt to lower than normal levels and function fine, just as I did However being able to cope at low levels with a loss of warning signals means that there is no safety margin and eventually critical levels may be reached with no warning. ( of course it would be totally unethical to experiment on lowering levels even further than this experiment did because of the dangers)

 

[dtennant9]

I have always been told anything below 4 is when to treat a hypo. I was also told that if I'm away to have a meal 3.9 is ok but any lower I should treat the hypo before the meal.

 

[Spiker]

@phoenix we are talking different phenomena here. I've seen a study where ketoadapted subjects are taken down to 1.0 mmol/L blood glucose in controlled conditions without any cognitive impairment, demonstrating their brains are running largely on ketones. This was a clamp study.

So yes there is also pure adaptation to low BG without ketogenesis but that's not what I am referring to.

Sorry for the lack of link. :-(

 

[noblehead]

I have always been told anything below 4 is when to treat a hypo. I was also told that if I'm away to have a meal 3.9 is ok but any lower I should treat the hypo before the meal.

Personally what I do with a level in the late 3's (with no active IOB) is to have a jelly baby and wait 5-10 mins and then inject/eat or have my food then inject afterwards, making a small reduction in the dose so my bg would be higher when I next ate.

 

[dtennant9]

Personally what I do with a level in the late 3's (with no active IOB) is to have a jelly baby and wait 5-10 mins and then inject/eat or have my food then inject afterwards, making a small reduction in the dose so my bg would be higher when I next ate.

Thats what I have been doing lately.

 

[Nyxks]

Is this a little like drinking where other people know you are drunk long before you do? Has anyone ever spotted it before you did?

Actually the 2,1 was in the dentist chair after a root canal - and not a single person knew I was low, not even my dad who'd driven me to the office (I was going to drive but though after that wort of stuff better to have him do it if possible - good thing as well). My dad was shocked at how low I got and the ppl in the dental office where clueless and useless about it - my dad was less then pleased since the dentist actually had a hissy fit that I popped four gluco tabs when I wasn't suppose to have anything for an hour after, she and they where cluless about treatment (needless to say I reported them to the medical board around here, and refuse to use them again as being unsafe ppl to be near).

 

[Spiker]

Actually the 2,1 was in the dentist chair after a root canal - and not a single person knew I was low, not even my dad who'd driven me to the office (I was going to drive but though after that wort of stuff better to have him do it if possible - good thing as well). My dad was shocked at how low I got and the ppl in the dental office where clueless and useless about it - my dad was less then pleased since the dentist actually had a hissy fit that I popped four gluco tabs when I wasn't suppose to have anything for an hour after, she and they where cluless about treatment (needless to say I reported them to the medical board around here, and refuse to use them again as being unsafe ppl to be near).

I suspect that under conditions of shock or trauma glucose may be withdrawn from the peripheral blood and conserved in the core, just as blood itself is conserved in the body core in those conditions. So your core BG would have been higher than the 2.1 measured at the periphery.

I don't know any academic evidence for this but it might explain how we can sometimes get fingerprick tests near or below 2.0 mmol/L and still be conscious.

 

[phoenix]

Interesting idea.
I've sometimes thought this when I test after swimming in cold water. My levels are often far lower than I would have thought them to be by the amount of exercise I've done.

 

[Ilya83]

4 is hypo. Don't forget glucose meter has error in measurement like 20%

 

[anna29]

For me with great hypo awareness
I will start to sweat at 4.6 then rapidly feel quite hungry
When get lower than 4 a hypo is well kicking in with me

Need my kiddies pack of jelly babies or glucose tablets .
Slurred speech will kick in too .

I rarely have any hypo's - but know the signs and symptoms
well . With being so hypo aware .

 

[Jaz253]

I agree with Spiker on the fact that ur body warns u better than a meter. But this relies on a regular near-normal BS entirely. This week I turned 4 weeks on a lowC, and can't help but to stress the benefits of it. Me too I suspect a hypo only when I get sleepy (cant test very often) but all this after years of ups and downs of sugar levels. What Id like to say is that it depends on how many years u've been with type 1 and how has it been adjusted to u. I can be perfectly fine on 2(36) but if I determine this on the meter I get scared and eat a small apple or drink some milk. The same on 46(2.5) so to be on a hypo, for me, is a 1.6(30) if feeling sleepy Maybe also the way u spend energy has a lot to do with this...

 

[anna29]

Agree the great body hypo awareness symptoms
are and can be the bodies pre-warning alert function .

I find my head switches into a real 'fight' mode
Craves food with excessive hunger within lowered
BG levels .
Thus makes me seek out something to eat 'fast'
to prevent my own BG levels crashing lower .

I do find I have to act according to my bodies trigger signals
quickly .
This is when hypo awareness is the bodys pre warn system on .

Some people don't have this at all - how 'do' they cope ?
With the lack of this built in - body function
I would be very interested to hear

 

[Flowerpot]

Agree the great body hypo awareness symptoms
are and can be the bodies pre-warning alert function .

I find my head switches into a real 'fight' mode
Craves food with excessive hunger within lowered
BG levels .
Thus makes me seek out something to eat 'fast'
to prevent my own BG levels crashing lower .

I do find I have to act according to my bodies trigger signals
quickly .
This is when hypo awareness is the bodys pre warn system on .

Some people don't have this at all - how 'do' they cope ?
With the lack of this built in - body function
I would be very interested to hear

Life becomes very frightening and difficult when you lose all your in built early warning hypo signs. Until you lose them you don't realise what a vitally important and to some extent unrecognised role they play in safe diabetes management. At first when I started to go unconscious without warning I thought it must be a one off but after numerous episodes where I lost consciousness it became more obvious that something had gone seriously wrong with my hypo awareness. There are various reasons for losing awareness including length of time since diagnosis, autonomic neuropathy, frequency of hypos and changing to a different insulin.

There are recognised ways to try and restore some of your own awareness by running slightly higher blood glucose for a period of time and in some cases this works well. In my case this had no effect and I became terrified of going anywhere on my own as it's like living on a knife edge waiting for the next serious episode. I started to use a pump 13 years ago to try and achieve as good control as possible and reduce circulating insulin to a minimum but I was still going unconscious. I thank goodness for technology in the form of CGM in which I have to put total trust along with many finger bg tests. I did get referred to consider a pancreas transplant which if successful does restore hypo awareness but for various reasons I chose not to pursue it at that time.

Living without hypo awareness puts diabetes at the front of my mind all the while, relying on CGM has made my life infinitely safer but it doesn't replace self awareness. I would welcome the chance to shake and sweat again with a bg in the 3's, in fact I think I'd really enjoy it!

 

[Tinkle]

@Flowerpot it must be hard - have you considered a hypo aware dog? You must be a good candidate?

 

[Spiker]

Yours is a tough story @Flowerpot. :-(

 

[-Artemis-]

... well - after switching my insulin, I now understand the saying "four is the floor"....!!

Two and a half weeks off Levemir and four days off Novo - and all of a sudden I can feel anything around / lower than a 4.5.... prior to this I was in the 3's and not noticing - which was worrying after only being on insulin 2.5 months!

Thanks so much for all your replies - has helped convince me I was on the wrong insulin (for me) and helped me make the decision to try another.... long may this new hypo-awareness last!

 

[anna29]

... well - after switching my insulin, I now understand the saying "four is the floor"....!!

Two and a half weeks off Levemir and four days off Novo - and all of a sudden I can feel anything around / lower than a 4.5.... prior to this I was in the 3's and not noticing - which was worrying after only being on insulin 2.5 months!

Thanks so much for all your replies - has helped convince me I was on the wrong insulin (for me) and helped me make the decision to try another.... long may this new hypo-awareness last!

Artemis the porcine insulin has a kick like a mule with hypo's
The symptoms ARE strong but rapid
They can kick in hard plus 'fast and rapid' like .
Sounds like your senses are more sharpened on the porcine Artemis


I find levemir leaves me more fuzzy/muggy headed feeling initially
Now after few months - have adapted to it well now .
Maybe become more lesser sensitive to this and more alert feeling
being a gradual thing ?
The real perk of the swap back to levemir for me is its quicker
onset performance of its 2hour onset .
Compared to the porcine being delayed onset performance with myself .

 

[Erin]

Life becomes very frightening and difficult when you lose all your in built ea

Life becomes very frightening and difficult when you lose all your in built early warning hypo signs. Until you lose them you don't realise what a vitally important and to some extent unrecognised role they play in safe diabetes management. At first when I started to go unconscious without warning I thought it must be a one off but after numerous episodes where I lost consciousness it became more obvious that something had gone seriously wrong with my hypo awareness. There are various reasons for losing awareness including length of time since diagnosis, autonomic neuropathy, frequency of hypos and changing to a different insulin.

There are recognised ways to try and restore some of your own awareness by running slightly higher blood glucose for a period of time and in some cases this works well. In my case this had no effect and I became terrified of going anywhere on my own as it's like living on a knife edge waiting for the next serious episode. I started to use a pump 13 years ago to try and achieve as good control as possible and reduce circulating insulin to a minimum but I was still going unconscious. I thank goodness for technology in the form of CGM in which I have to put total trust along with many finger bg tests. I did get referred to consider a pancreas transplant which if successful does restore hypo awareness but for various reasons I chose not to pursue it at that time.

Living without hypo awareness puts diabetes at the front of my mind all the while, relying on CGM has made my life infinitely safer but it doesn't replace self awareness. I would welcome the chance to shake and sweat again with a bg in the 3's, in fact I think I'd really enjoy it!

rly warning hypo signs. Until you lose them you don't realise what a vitally important and to some extent unrecognised role they play in safe diabetes management. At first when I started to go unconscious without warning I thought it must be a one off but after numerous episodes where I lost consciousness it became more obvious that something had gone seriously wrong with my hypo awareness. There are various reasons for losing awareness including length of time since diagnosis, autonomic neuropathy, frequency of hypos and changing to a different insulin.

There are recognised ways to try and restore some of your own awareness by running slightly higher blood glucose for a period of time and in some cases this works well. In my case this had no effect and I became terrified of going anywhere on my own as it's like living on a knife edge waiting for the next serious episode. I started to use a pump 13 years ago to try and achieve as good control as possible and reduce circulating insulin to a minimum but I was still going unconscious. I thank goodness for technology in the form of CGM in which I have to put total trust along with many finger bg tests. I did get referred to consider a pancreas transplant which if successful does restore hypo awareness but for various reasons I chose not to pursue it at that time.

Living without hypo awareness puts diabetes at the front of my mind all the while, relying on CGM has made my life infinitely safer but it doesn't replace self awareness. I would welcome the chance to shake and sweat again with a bg in the 3's, in fact I think I'd really enjoy it!