Basic BGL/Hypo/Hyper Questions

[gavin86]

A few things nobody has ever mentioned to me, despite having seen endo, nurses, dietitians, educators and reading extensively since being diagnosed...
(I'm asking from a type1 perspective but I guess they're not limited to just that.)

Also preemptively, thanks to everyone who keeps answering my questions!

1) At what point does Hypo/low BGL become a serious issue/unable to self-treat?

I've been to mid 2's and felt a bit rough, but was still capable, besides some difficulty with shaky hands doing a BGL. I'm guessing things change rapidly from 2 and downward though?

2) what kind of BGL range is achievable in time, for someone who is pretty good, but not perfect?

3) How high do I have to be to cause long term damage?

4) Does everyone suffer long term consequences eventually?

Thanks.

 

[therower]

Hi @gavin86 . All my answers are on a personal level from my perspective.
Q1. Low BS levels vary from person to person. As an individual you may go as low as -3 and still be able to self treat, yet the next day with the same BS level you could come around in the back of an ambulance. There are far to many factors to be able to give a definitive answer.
Q2. You should be able to achieve whatever long term BS level you desire. Like everything in life, the more you give, the more you get. Personally I'm "good" 90% of the time and my BS levels stay exactly where I want them.
Q3. Again not an easy one, it's not how high you go, but how long you stay there. Going 15+ twice a week wouldn't be a concern to me. Being at 10 for 6 days a week would be far more worrying.
Q4. I've been T1 27yrs with no complications other than slight retinopathy in left eye. Others have had T1 far longer and are doing just fine.
As a footnote. Diabetes,should,when controlled make you a better, healthier person.

 

[Mugwump]

I'm no expert, but I think most of these will vary from person to person.

Relating to hypos and hypers, the person I care for has been quite high-functioning into the high 2's at times, and yet at others I can see that she is becoming 'foggy-headed' in the mid to low 4's. It seems to depend on a multitude of factors - time of day, what activities we've been doing, what she had eaten, her state of mind at the time, etc.

Sorry it's not an overly helpful answer!

Take care

 

[Scott-C]

) At what point does Hypo/low BGL become a serious issue/unable to self-treat?

Hypos, even the mild ones, are always serious issues, requiring immediate treatment, because they might seem mild but can rapidly become way more messy if not treated. The treatment to stave that off might be as little as 5 to 10g, but don't ever think, ooh, bit low, leave it till later, I'll be fine.

There's a surprisingly thin line between feeling a bit low, and being on the pavement, but if you pay attention to the initial onset symptoms and get some sugar in your face quick, you can turn it round pretty quickly. Don't be terrified of hypos: they will happen, it's inevitable and sometimes they'll be messy but there's nothing some heavy duty sugar can't sort out.

Don't view it in terms of numbers or points - you'll know when it becomes untreatable, because you'll be unable to treat it.

Actually, it's not as easy as that. Sometimes, you'll be so far out of it, you'll not know you're needing treatment. On those occasions, unless you're away camping in the wilds of Alaska, rest assured that people will step in and help.

If you're on your own, that can get messy, but the usual outcome is that the insulin on board will wear out after 4 to 5 hours, adrenalin kick/liver dump will raise it, and you'll wake up soaked in sweat thinking what the **** just happened there.

 

[gavin86]

Hey guys thanks.. yes I didn't mean to give the impression I thought mild lows were nothing serious..
If anything my problem is over-treating - if I've just gotten an unexpected low reading, I don't feel confident enough to say whether I've bottomed out or will keep dropping.
I'm hoping when I get a Libre this will become easier as if I can see how fast things are changing, until I have a bit better sense of it myself.
I think maybe I've been trying a bit too hard to get a good range.. perhaps I shouldn't worry so much about high bgl for now and try to avoid even mild lows? It's probably not good that I get "rewarded" with sugar whenever it happens.

Also thanks, good to hear some personal experiences. despite everyone being different it gives an idea of things generally.

 

[Snapsy]

Hi @gavin86 , I find I have hypos which differ due to speed of drop, amount of insulin on board, post-exercise scenarios to name but three.

My most alarming type of hypo is without fail on the occasions where I have misjudged my carb intake, resulting in quite simply having too much bolus insulin in one go. I can be on my way to gaga in the 5s, and can then drop very very quickly into the 2s.

Other times I can feel 'fine' sub-2! My husband was horrified on a hill walk when I was 1.6, completely lucid and still walking.

So as others have said, it varies.

As far as BG range is concerned, I'm pretty happy with mine at the moment, but every so often (not for a while recently) I swing the other way and get very very cross about things and have in the past let things slide. Now I've got my pump and my Libre, and being so so much better educated about diabetes in the last 10 years than I had been before, I am very well controlled, and I find eating lower carb suits me in this respect.

I don't know specifically in terms on numbers, what levels cause complications. I have background retinopathy (with absolutely no symptoms - just two tiny out-of-the-way dots) but otherwise no complications.

I have a tendency towards anxiety and hyper micromanagement of my diabetes, and a desperate psychological 'need' to be between two certain numbers on my meter. But I would not necessarily recommend this approach as a lifestyle choice, as I fully accept I am far, far too hard on myself.

 

[catapillar]

1) At what point does Hypo/low BGL become a serious issue/unable to self-treat?

When you are unable to self treat it. If you are looking for an answer that gives a number you have to be below, you aren't going to get one. It will vary between people, it will vary on the speed of the drop and what is causing it.

2) what kind of BGL range is achievable in time, for someone who is pretty good, but not perfect?

I don't understand the question. There are target ranges. NICE provides a target hba1c of <48, fasting 5-7, pre meal 4-7, at least 90 minutes post prandial 5-9. But obviously someone who is not perfect (ie a real life person) will fall outside these ranges, probably often. Aiming to stay in the range and actually being in the range are two different thing, but it's good to have somewhere sensible to aim for.

3) How high do I have to be to cause long term damage?

I don't think there's a certain number you go over and it's guaranteed you get complications. It's a cumulative thing. The DCCT study shows a link between increased hba1c and increased risk of complications: the graph curve up. But that's an increase in the risk of complications, not a guarantee you will get them.

4) Does everyone suffer long term consequences eventually?

I would hope not. DCCT is the key study on the risk of complications. And that was done before continuous glucose monitoring, insulin pumps were common, faster acting insulin, it ended in 1993. We are lucky to have advances in treatment options and diabetic technology coming out that should make staying in range more achievable and reduce the risk of complications.