Just to be clear, I am type 2, but I have a type 1 friend who does not seem to be getting helpful advice from his healthcare professional. He is not the best at monitoring his blood sugars, and guesstimates how much he should inject for a meal. Obviously not that well. Finally he shared some readings with me. 32 on waking, and 24 before dinner tonight. If he goes below 20 he gets symptoms of a hypo. He has problems with his eyes and stomach, and is worrying about it affecting his heart. He has been interested in me putting type into remission through the keto diet, but I don't think he should make drastic changes at the moment. I think reducing his level of blood glucose should be done gradually, but no one has any advice on if it is safe to have hypo symptoms if blood glucose is in the high teens, and give him some guidance on what levels to aim for. I was wondering if anyone has been in this type of position and how they improved things if they were.
I am sure that if your friend does go to his appointments and is honest about these readings, then his team would be rightly advising him that running this high will damage him in the long term. I imagine he must feel rough running this high but it is easy to get used to feeling bad like this and to get a sensation of 'hypo' when your blood sugar goes below what your body is used to.
As he's on insulin he obviously needs to be careful when reducing carbs so as to get his bolus dose right however the first step is for him to get the basal right otherwise he'll be fighting a losing battle.
This is done by not eating carbs for 24 hours and testing to see what happens usually including some night time tests. No bolus dosing obviously.
You don't say how old your friend is or why he is taking such lax care of himself? Diabetes type 1 is really about self management and getting used to how your body reacts to food/exercise/stress so its an N of 1 experiment.
Personally I find it almost impossible to achieve normal blood sugars (4-7) when eating carbohydrates and guessing insulin doses. If he is willing to eat the same foods/portions daily then this might be possible but I find it easier to minimise starches and sugars.
As for hypo symptoms at blood sugars between 5 and 20, I'd say they are safe and would lessen when his blood sugar normalises. They are not a good enough reason to risk his sight, kidneys, heart and nervous system by running high. Sometimes I mistake a rapid drop in by bgs for a hypo but it is usually a sensation. Again if you are not taking much insulin to cope with carbs you get less of those big drops and rises that can cause panic eating of carbs!
Agree that a ketone check is imperative but it should be noted that some of us can have scary high bgs like this without going into ketosis