Hypo unawareness (HU) questionnaires

[Jasmin2000]

Just some info for reference after reading the HU threads here. I found 4 different methods for determining HU - some are shockingly simple!

The Gold scoring method is based on the response to a single question, “Do you know when your hypos are commencing?” with responses expressed on a scale.
Similarly, the Pedersen Bjergaard method uses the question,“Can you feel when your blood sugar is low?” and assigns responses to three categories.
The Clarke questionnaire is composed of 8 questions that examine the glycemic threshold at which subjects develop symptoms of hypoglycemia.
The HypoA-Q questionnaire has 18 questions with weighted answers.
All are subjective, i.e. patient responses only - no physio data.

Now we have the Libre's hypo scores and these are already being used to 'infer' hypo unawareness, although the connection is speculative at best.
My DSN said likely hypo unresponsive based on Libre and I scored 'normal' on all four methods. Hmm..

 

[Jaylee]

Just some info for reference after reading the HU threads here. I found 4 different methods for determining HU - some are shockingly simple!

The Gold scoring method is based on the response to a single question, “Do you know when your hypos are commencing?” with responses expressed on a scale.
Similarly, the Pedersen Bjergaard method uses the question,“Can you feel when your blood sugar is low?” and assigns responses to three categories.
The Clarke questionnaire is composed of 8 questions that examine the glycemic threshold at which subjects develop symptoms of hypoglycemia.
The HypoA-Q questionnaire has 18 questions with weighted answers.
All are subjective, i.e. patient responses only - no physio data.

Now we have the Libre's hypo scores and these are already being used to 'infer' hypo unawareness, although the connection is speculative at best.
My DSN said likely hypo unresponsive based on Libre and I scored 'normal' on all four methods. Hmm..

Hi,

I’m “old skool.”

Am I hypo aware. Yep.
Have I ever in my 48 year T1 history been “blue lighted.” No.

What I know is meters can have a lag suggesting I dropped lower before the rise.
The Libre does the same but takes longer to recover on the graph… (up to 45 minutes?) Due to interstitial fluid being the last priority recovering from a low. Brain being the first?

A DSN judging from a Libre graph on hypos is the equivalent of “Mary Whitehouse” assessing on something broadcast she heard from the trailers..
But I’m afraid a DSN will only go on the “text book” in my experience. I hope this doesn’t undeservedly amount to me being revoked on the privaledge to drive? I’d sooner risk loose a limb in an attempt to hold onto my livelyhood..

As ironic as it sounds..

 

[Jaylee]

Actually… This reminds me a little of the time I took my mum to a “memory clinic” for a diagnosis of Alzheimer’s. They were correct in the assessment.
However.. There was a tast with “clip art” images she had to identify? A crown a barrel & a lizard. (Actually, the lizard looked more anatomically like a ghecho.)
She identified the images, except the ghecho (or lizard as she named it.) was a “crocodile.”
When I pointed out this looked nothing like an a-typical crock or alligator.

The response I got was, “yes. It’s usual for relatives or loved ones to cover for a cognitive impairment..”

I don’t deny there is an issue.

But Hmmmm..

 

[Jasmin2000]

Hi,

I’m “old skool.”

Am I hypo aware. Yep.
Have I ever in my 48 year T1 history been “blue lighted.” No.

What I know is meters can have a lag suggesting I dropped lower before the rise.
The Libre does the same but takes longer to recover on the graph… (up to 45 minutes?) Due to interstitial fluid being the last priority recovering from a low. Brain being the first?

A DSN judging from a Libre graph on hypos is the equivalent of “Mary Whitehouse” assessing on something broadcast she heard from the trailers..
But I’m afraid a DSN will only go on the “text book” in my experience. I hope this doesn’t undeservedly amount to me being revoked on the privaledge to drive? I’d sooner risk loose a limb in an attempt to hold onto my livelyhood..

As ironic as it sounds..

Not only the lag and the relevance of different tissues but I've plotted BG over an hour with 12 fingerpricks to see if the curve is recapitulated on Libre later - and guess what? It isn't. The peak is reproducibly narrower and never gets as low as the Libre - sometimes 1-2 mmol/L difference.
This is data awaiting my Mrs. Whitehouse-DSN - I'll get excommunicated for heresy against the Libre!

 

[EllieM]

I use a dexcom rather than a libre but find it can significantly under read, particularly during the first 12h of a sensor. Also compression lows can indicate false hypos. I'd be very unhappy to be declared hypo unaware on the basis of readings from a cgm.

 

[Jaylee]

Not only the lag and the relevance of different tissues but I've plotted BG over an hour with 12 fingerpricks to see if the curve is recapitulated on Libre later - and guess what? It isn't. The peak is reproducibly narrower and never gets as low as the Libre - sometimes 1-2 mmol/L difference.
This is data awaiting my Mrs. Whitehouse-DSN - I'll get excommunicated for heresy against the Libre!

What I found over the years using a meter to monitor hypos.
Is after an initial test of say 3.6 then treating (my lower field of vision starts flickering around 3.9.) if I test again 10 minutes later? There can be a further drop to 2.6, before a rise?
I normally wait 20/25 minutes before testing again & I’m also feeling more human.

I’ve know others panic testing so soon after, seeing a lower score then over treating.

For the Libre I also use a third party app called “Diabox” which can be calibrated.
But to be fair, the librelink interpretations haven’t been that far out to the meter. Around 0.6mmol.

What an HCP makes remotely of the Libre lag on a low (which can show for 45 minutes) when I effectively detected & treated it is concerning.

It would be great to be offered something like a closed loop system if they thought I was unaware. But not at the unwarranted expense of my privilege to drive.