This is not supposed to happen on Metformin alone.

[Rosie9876]

Just getting back to this because the researchers had a different conlusion than you paint here. From their study:

"Conclusions: Severe hypoglycemia is clearly indicative of declining health and is a potent marker of high absolute risk of cardiovascular events and mortality."

So it's the other way around, not severe hypos causing increased mortality, but declining health in older diabetics possibly playing a role in people getting severe hypos.
In which case severe hypos can be an early indication that there are serious health issues.

Thank you for this explanation. Unfortunately, it is not reassuring for me. Quite the opposite. Let me explain:

In Sept. 2023, I went to A&E in severe pain. Very large bilateral (Staghorn) kidney stones was diagnosed, and I was kept in for surgery the following day. But it was cancelled. Following that, there was delay after delay. I was told the surgery was elective, so no rush, which isn't quite correct, as they can be life threatening. Then in (I think) October 2024, I was told I couldn't have surgery because my HbA1c was 88.

I was naïve about diabetes until then, but once I understood, I stopped following NHS guidance and thinking diabetes was just something I had to live with, and I set about bringing it down to 43 with a low carb regime. I finally had my first surgery in November 2025, followed by 4 more, one of which was mishandled and had to be aborted due to internal bleeding. Each surgery obviously involved anaesthetics and was followed by prophylactic antibiotics, which left me weakened. That and the hospital stays, including inappropriate food, caused my blood glucose to rise.

The last surgery was in January 2026. I woke up from it, to be told I'd suffered an anaesthesia induced heart attack and was put into intensive care. Then I was told removal of the kidney stones released a septic shower into my bloodstream, from a very rare and deadly fungus, which was immune to most treatment and had a 65% mortality rate. I was given a harsh antifungal IV course, which led to a serious deterioration of my kidneys, so taken off it and another antifungal IV course continued. My eGFR of kidney function recovered somewhat, from close to needing dialysis, although I haven't had recent follow-up tests..

I was discharged after 24 days, in much poorer health, but happy to be alive and determined to fix myself again. And that is what I was doing. And my blood glucose has been improving. But then, in the past 2 weeks, my CGM recorded several lows at night-time, at times in the high 20s, mostly with symptoms, waking me up. This had never happened to me before. Hence, my post. I was reassured by your and @KennyA 's replies, that it was nothing to worry about. Until now. Because if "Severe hypoglycemia is clearly indicative of declining health and is a potent marker of high absolute risk of cardiovascular events and mortality", then the breakdown in my health may have led to these hypos, and it is something to worry about.

I feel lucky to have survived the less than ideal care from the NHS, the Type 2 heart attack, kidney deterioration and sepsis, etc. But I still have kidney stones which were inaccessible, and which may be harbouring the fungus (as before) or a bacteria. Obviously, despite my best efforts, I'm not as healthy as I was before all of this. So suddenly, with the conclusions of that research, I don't feel lucky anymore. I'm scared, but I won't give up.

 

[Lakeslover]

I honestly wouldn’t draw any conclusions from this study without more information.

The key starting point of the study was patients with severe hypoglycaemia requiring hospital admission due to loss of consciousness or a seizure. The episodes you are having are not causing such low blood sugars and if you are not on insulin are very unlikely to do so.

There is no more information in this summary to explain what meds the patients were on, how long they had been diabetic etc.

Before drawing any further conclusions I’d be looking to see what other studies there are and the characteristics of the participants.

 

[Antje77]

I

I honestly wouldn’t draw any conclusions from this study without more information.

The key starting point of the study was patients with severe hypoglycaemia requiring hospital admission due to loss of consciousness or a seizure. The episodes you are having are not causing such low blood sugars and if you are not on insulin are very unlikely to do so.

There is no more information in this summary to explain what meds the patients were on, how long they had been diabetic etc.

Before drawing any further conclusions I’d be looking to see what other studies there are and the characteristics of the participants.

I've been trying to find the full publication, and I haven't succeeded so far.

 

[Antje77]

Wow @Rosie9876 , you've really been through the mill, I'm sorry!

However:

Hence, my post. I was reassured by your and @KennyA 's replies, that it was nothing to worry about. Until now. Because if "Severe hypoglycemia is clearly indicative of declining health and is a potent marker of high absolute risk of cardiovascular events and mortality",

This whole study is on people who experienced severe hypos, which are hypos causing unconsciousness or seizures and needing hospital treatment.
You do not fall in this category, despite having numerous health issues.
I really hope you'll master fingerprick tests so you can let go of this worry!

 

[Pipp]

@Rosie9876 I am so sorry you have had such trauma, repetitively, over such a short period.

I had similar extreme stressful experiences following two successive surgeries in rapid succession, necessitating stays in ICU, where another traumatic incident occurred. It took a long time for me to be able to trust medical professionals again. It was explained to me during counselling sessions that so many people suffer PTSD following such incidents.

PTSD from being in an Intensive Care Unit – PTSD UK

PTSD UK - a community for everyone in the UK affected by Post Traumatic Stress Disorder

www.ptsduk.org

Six counselling sessions, with a really good psychologist, helped me deal with it all. Before the counselling, I had been so anxious about everything about my health and tried to find answers in research papers. That only fed my anxiety.

I hope you can find the answers for you, and some peace, and acceptance and understanding of what you have been through.

 

[Outlier]

It's really reassuring to know this is available. Did you have to arrange your own or was it offered?

 

[niblue]

The only times I've seen readings much below 4 have been from a CGM sensor overnight (and it's happened with both the Dexcom and the Libre when I had them on trial) and I'm pretty sure in my case anyway those were falsely low readings.

I also noticed with the Dexcom that those lows (and other erratic overnight readings) seemed to happen more in the last couple of days before it expired. The lowest reading from the Dexcom was actually 2.3 - and there is not the tiniest chance that's possible.

 

[Pipp]

It's really reassuring to know this is available. Did you have to arrange your own or was it offered?

Hi , @Outlier,
Without wishing to derail the thread, I will add that my incidents were a few years before the NHS changes due to covid, and it took me two years to work out that I needed help. The counselling was provided by NHS, but I had to acknowledge it was needed and ask for it. Things are different now, but if I needed such help again I would seek that from GP, or the hospital where I was receiving treatment via the hospital PALS team. I would not accept online cognitive behavioural therapy, especially if it was a group session. If necessary I would find the resources to pay. It was a therapist using Compassion based psychology that helped me.

The role of self‐compassion in psychotherapy - PMC

pmc.ncbi.nlm.nih.gov

 

[Rosie9876]

The only times I've seen readings much below 4 have been from a CGM sensor overnight (and it's happened with both the Dexcom and the Libre when I had them on trial) and I'm pretty sure in my case anyway those were falsely low readings.

I also noticed with the Dexcom that those lows (and other erratic overnight readings) seemed to happen more in the last couple of days before it expired. The lowest reading from the Dexcom was actually 2.3 - and there is not the tiniest chance that's possible.

Of course I wondered if it was a faulty sensor or an inaccurate reading, and until I manage to get finger pricks to check the accuracy of the sensor, I can't be sure. But it started 2 weeks ago, always at night - most, not every night. And I've been awoken by symptoms - but not every time. And the duration of each episode is increasing, to as much as 3 hours two nights ago. Last night, I had a midnight snack of some hard cheese and an apple, hoping to "fix" the low, and I had a post prandial spike, but it was followed by a drop to c. 2.9 lasting about an hour before rising to just over 4, while I slept. A shorter low, but poorer, less sleep. So it's not erratic, it's a pattern, a new one, and I'm calmly worried.

 

[Rosie9876]

Hi , @Outlier,
Without wishing to derail the thread, I will add that my incidents were a few years before the NHS changes due to covid, and it took me two years to work out that I needed help. The counselling was provided by NHS, but I had to acknowledge it was needed and ask for it. Things are different now, but if I needed such help again I would seek that from GP, or the hospital where I was receiving treatment via the hospital PALS team. I would not accept online cognitive behavioural therapy, especially if it was a group session. If necessary I would find the resources to pay. It was a therapist using Compassion based psychology that helped me.

The role of self‐compassion in psychotherapy - PMC

pmc.ncbi.nlm.nih.gov

Lucky you. I was distressed after the post-surgery complications. I'd lost confidence for various reasons, and wanted to discharge myself and continue treatment at a different hospital. But there was a lot of resistance to my leaving the ICU and I was offered counselling if I stayed, but it never materialised.

 

[Pipp]

Lucky you. I was distressed after the post-surgery complications. I'd lost confidence for various reasons, and wanted to discharge myself and continue treatment at a different hospital. But there was a lot of resistance to my leaving the ICU and I was offered counselling if I stayed, but it never materialised.

Sometimes we make our own luck. Sometimes it comes from unexpected sources.
I didn't feel very lucky at the time.
When you are at your lowest ebb, it can feel very lonely.
It was the worst time of my life, as I imagine you are feeling now.
I have nothing further to add, that may help you, but wish you well, and hope you can start to adjust and regain some quality of life.

 

[Rosie9876]

For the first time, I've had a low during the day. I became aware of my BG only because I suddenly felt woozy to the point of nearly fainting, and nauseous. It went down to 2.9 and lasted about 1/2 hour. I worked at slow deep breathing and relaxing. Now it's come back up to 4.3. I hadn't done anything extraordinary, was at my laptop. I'd had breakfast and lunch, my usual morning coffee, afternoon tea, and intermittent water. I'll try a short walk.

 

[lovinglife]

For the first time, I've had a low during the day. I became aware of my BG only because I suddenly felt woozy to the point of nearly fainting, and nauseous. It went down to 2.9 and lasted about 1/2 hour. I worked at slow deep breathing and relaxing. Now it's come back up to 4.3. I hadn't done anything extraordinary, was at my laptop. I'd had breakfast and lunch, my usual morning coffee, afternoon tea, and intermittent water. I'll try a short walk.

You really need to test with a finger prick to confirm these lows, not doubting what you are saying but CGM are well known not to be always accurate. How do use the info that you get from a CGM to manage your BG?

 

[Lakeslover]

How long before the low did you eat? Any idea how many carbs you had at that meal?

 

[Rosie9876]

How long before the low did you eat? Any idea how many carbs you had at that meal?

I had lunch about 4 1/2 hours before the dip. I had I'd estimate about 20-25 carbs, from sourdough crispbread and 10% fat Greek Yoghurt with a sprinkle of pomegranate seeds. That's about typical for me. I peaked at 7 mmol/L and it went down from there. My breakfast is generally very low carb, apart from some 80-90% dark chocolate with coffee.

 

[Lakeslover]

I had lunch about 4 1/2 hours before the dip. I had I'd estimate about 20-25 carbs, from sourdough crispbread and 10% fat Greek Yoghurt with a sprinkle of pomegranate seeds. That's about typical for me. I peaked at 7 mmol/L and it went down from there. My breakfast is generally very low carb, apart from some 80-90% dark chocolate with coffee.

I was wondering if it was some form of rebound/reactive hypoglycaemia. I’m no expert on that but it seems unlikely that long after eating.

 

[Rosie9876]

You really need to test with a finger prick to confirm these lows, not doubting what you are saying but CGM are well known not to be always accurate. How do use the info that you get from a CGM to manage your BG?

Thanks for your comments @lovinglife. I know I need to test with a finger prick, but my efforts have been unsuccessful. I don't get enough blood, and so many errors with wasted strips that it becomes stressful. I estimate the general accuracy of the sensor by comparing it with nurses' finger prick testing. (I've been in hospital a lot, and as an out patient.) And when I started using a CGM, I had monthly private A1c tests to assess the accuracy of my sensor. (at Boots for £20, but they stopped doing them.) Also the post prandial rises and falls are useful info, even if I can't be certain of the exact number. Over the past few months, my sensors have been surprisingly in line with finger prick results. Previously, it was generally lower, but not always. I wonder if they've improved it or if I've just got better at attaching it. I will try finger prick again this weekend, plus I have a cardiology appointment on Monday and they will likely test my BG. The other thing is I've had symptoms with the lows and I've never had this pattern before. But I get it: if the sensor is reading just 1 mmol/L too low, as it used to, I have nothing to worry about.

 

[MrsA2]

I had lunch about 4 1/2 hours before the dip. I had I'd estimate about 20-25 carbs, from sourdough crispbread and 10% fat Greek Yoghurt with a sprinkle of pomegranate seeds. That's about typical for me. I peaked at 7 mmol/L and it went down from there. My breakfast is generally very low carb, apart from some 80-90% dark chocolate with coffee.

For me (female 5'6" normal bmi, T2 hba1c about 41) that would be too little food. I can get readings in the 3s sometimes and it always coincides with fasting or hunger.
are you losing weight? On purpose or accidentally?
Try increasing portion sizes, perhaps? And try a protein only snack before bed. Only suggestions of what I'd try if it were me.

And I myself wouldn't be worried, a drop into the 3s for me means a bit of weight loss and I could do with being a bit lower weight

 

[Rosie9876]

For me (female 5'6" normal bmi, T2 hba1c about 41) that would be too little food. I can get readings in the 3s sometimes and it always coincides with fasting or hunger.
are you losing weight? On purpose or accidentally?
Try increasing portion sizes, perhaps? And try a protein only snack before bed. Only suggestions of what I'd try if it were me.

And I myself wouldn't be worried, a drop into the 3s for me means a bit of weight loss and I could do with being a bit lower weight

Thank you for your comments. I have a normal BMI and am not trying to lose weight. I suspect I have too much visceral fat, but if I lose weight to try to get rid of it, my arms and legs become too skinny and my waist seems unaffected, so I keep hoping clean eating and exercise will do it. So far no luck.

I only listed the food with carbs, as that's what I was asked. I also had avocado crush on the crispbread and a handful of walnuts. My main meals are breakfast and dinner. I generally don't have a snack before bed. I tried having one last night - an apple and some hard cheese - to avert the low. It did raise my BS, but then it plummeted down to 2.9 for an hour while I was asleep. I wouldn't worry about it, except I wake up feeling woozy with it, it's dropped into the high 2s several times, and it's different from my normal pattern, which almost never dropped below say 3.8, and then not for long periods of time, except with an obviously faulty sensor. But I'm going to make an extra effort to check with a finger prick meter. It's possible the sensor is reading low.

Edited to fix lack of clarity.

 

[Antje77]

I generally don't have a snack before bed. I tried having one last night - an apple and some hard cheese - to avert the low. It did raise my BS, but then it plummeted down to 2.9 for an hour while I was asleep. I wouldn't worry about it, except I wake up feeling woozy with it

Why not have a little something to treat a possible hypo if you have symptoms and your sensor says you're on the low side as well - instead of eating hours before the possible lowish BG happens?

Do you know what your latest hba1c was?
You only mention numbers within and on the low side of the normal range, do you ever hit highish numbers on your Libre?