I have been diabetic for 30 years and still learning new things, I just wanted to know if any one else has had the same experiance as me. My bloods go low from time to time and I always have a warning, sometimes when I test it I have readings fo 2.6, 3.8 and I have even had one at 1.2. and was still able to function quite normally. Is this the lowest before hypo coma gets hold or am I just strange (LOL)
how low can you go?
- Thread starter glitterzoe
- Start Date
Hi,
A lot depends on the situation. I often don't feel any hypo symptoms until I'm below 3.4, but I can sometimes feel like I'm hypo quite a bit higher (and sometimes when I'm not actually hypo). I can also occasionally function perfectly well at very low bloods; I've had a reading of 1.1 before and had to check it with another 2 meters before I'd believe the reading, because I felt completely normal (this was at the end of a long fell run, and I was still able to keep running just fine at this level - I honestly didn't realise my BG was low, I just routinely test after any run).
A lot depends on circulating insulin levels, the speed with which your blood glucose is changing, the activity you're doing etc. - it's hard to nail down all the variables.
A lot depends on the situation. I often don't feel any hypo symptoms until I'm below 3.4, but I can sometimes feel like I'm hypo quite a bit higher (and sometimes when I'm not actually hypo). I can also occasionally function perfectly well at very low bloods; I've had a reading of 1.1 before and had to check it with another 2 meters before I'd believe the reading, because I felt completely normal (this was at the end of a long fell run, and I was still able to keep running just fine at this level - I honestly didn't realise my BG was low, I just routinely test after any run).
A lot depends on circulating insulin levels, the speed with which your blood glucose is changing, the activity you're doing etc. - it's hard to nail down all the variables.
glitterzoe said:
A hypo is officially classed as anything below 4 mmol/l. Hypoglycaemia. If it is good enough for the medical profession, then it is good enough for me. I usually start to feel **** at around 4.5 as my hypo awareness is good. I can then do something about it. I have been as low as 2.9 and felt b***Iy awful for a time. It is not recommended to run at numbers below 4 mmol/l for any length of time. It is not good for you. It is damaging. You may hit even lower levels but you should immediately do something to get back to more 'normal' levels.
When in the hypo zone, there are many things that you might get which would normally let you know what is happening. A warning from your own body. Ignore your body at your peril ? If it doesn't happen then you have quite simply lost the hypo awareness. You could end up being a danger to yourself or even others ? All depends on what you are doing at the time.
You might feel good and you might think that you are fine. It's the little things you might not notice, such as irritability, confusion, lack of concentration, personality changes even. Those are the things you need to consider if you drive. If you have an accident whilst at such low levels, it is no good saying "I felt fine" - that won't get you out of anything ! One of the members on here lost his hypo awareness and crashed while having a hypo at the wheel. He had no recall as to what actually happened. Possibly he blacked out before the accident. I wonder what level that was 3, 2, 1.1....?
Doesn't really bear thinking about. It isn't a competition to see who can get the lowest. It can be a matter of life and death to a T1....
The underlying causes are usually too much Insulin, not enough food, unusual amount of exercise, delayed meal, stress and hot weather. Not all at once of course. So, anybody who does go down to those ultra low levels should be able to see where they were going wrong. Stay out of the 'zone.'
Sorry, I ought to have added that it's not actually desirable to have these lows, just that it does sometimes happen. I'd always prefer to have my BG in the 4-6 range, and if I go below that I try to correct upwards.
That said, 4 is a fairly arbitrary number (and there's no medical concensus on it) and I don't personally agree that I'm hypoglycemic at that level. But it's certainly a useful guide figure. Driving of course is a special situation and even though I'm generally comfortable with bloods of 3.7 or above, there's no way I'd drive below 4 (or if I was trending downwards and looked likely to go below 4) - not because I'm hypo at that point, but because I'm close enough that just a small drop would send me hypo. It's absolutely not worth the risk.
That said, 4 is a fairly arbitrary number (and there's no medical concensus on it) and I don't personally agree that I'm hypoglycemic at that level. But it's certainly a useful guide figure. Driving of course is a special situation and even though I'm generally comfortable with bloods of 3.7 or above, there's no way I'd drive below 4 (or if I was trending downwards and looked likely to go below 4) - not because I'm hypo at that point, but because I'm close enough that just a small drop would send me hypo. It's absolutely not worth the risk.
I wasn't aware that my message read like it was a comp, sorry. Like I said I have been diabetic for 30 years and have see a lot of changes in how the diabetic is monitered, once agin I am sorry if it came across like a joke. I have been on insulin for 30 years and I was diagnosed when I was just 5, I know its not a laughing matter, meny of my friends are diabetic and we find that sometimes letting off steam it the only way to go. There is a lot more to the illness than just monitering your bloods and doing you insulin and watching your diet, conformation of depression (in long term diabetics) has been just one of the "other" side affects of this illness. Once agin I am sorry if this post uopset anyone.
Hi Nick.
What source are you using for the above........no medical concensus ??
I'm interested to know. As there is much medical concencus and evidence from the Endocrinology community as far as I am concerned that 4 mmol/l is 'considered the floor.'
Most people do get some warning that hypoglycaemia is happening.
But for some, hypoglycaemia may cause few or none of the warning symptoms before the start of sudden unconsciousness or convulsions – particularly if you've had diabetes for many years.
glitterzoe.
Nobody is upset. Should have added a smiley....
This is a discussion and you are not being told that it is a competition. That was a generalisation aimed at those who sometimes seem proud of the fact that they are ultra low. As far as I can see this is more to do with either having NO hypo awareness, or losing it. Neither case is very good.
Hi,
Well, 70 mg/dL (which is ~3.88 mmol/L) is most commonly used in the US; 4 is used in the UK. Both are chosen because they're round numbers and therefore convenient; what would be the odds of the exact point of hypoglycemia being exactly 4 (or exactly 70)?
When I talked about medical concensus, I was also referring to the fact that different populations often have different normal ranges of blood glucose (children for example often have lower fasting blood glucose levels than adults), and even in healthy non-diabetic adults the lower limit of normal can be as low as 3.4 without any symptoms of hypoglycemia (about 5% of adults can regularly and safely go this low when fasting with no damage or symptoms). Can these people be said to be hypoglycemic just because their blood glucose dips below a certain level, even though it's within their normal range and they have no signs, symptoms or problems of hypoglycemia? The medical community (outside of diabetes) tends to think not, and only refers to hypoglycemia if symptoms present; so a reading of below 4 would not be hypoglycemic if symptoms were absent, whereas a reading of 4 might be hypoglycemic if there were symptoms.
This becomes more complicated in diabetes because symptom awareness can be eroded, so the arbitrary numbers tend to be adhered to more strictly (and this is a good thing in many cases, and absolutely necessary if someone has impaired hypo awareness). But if the non-diabetic population has variance in the levels they can tolerate before becoming hypoglycemic, why wouldn't the diabetic population? And if someone does have excellent hypo awareness but doesn't present symptoms until, say, 3.7... are they still hypoglycemic at 3.9? I would argue not, and there's similar debate in the medical community. Legally (e.g. if you were driving) you'd be hypo in the UK (and not in the US), but in reality I don't think you are.
By the way, I must make clear that I'm not suggesting it's somehow good to aim for bloods below 4. It's not; but not because 4 is necessarily hypoglycemic for everyone, but more because it's so close to hypo territory that there's no margin for error. And from a practical point of view, as I say I would always treat myself if I dip below 4. I'm only really posting as a point of interest, not to suggest we should all aim for really low bloods or avoid treating until we get too low.
Well, 70 mg/dL (which is ~3.88 mmol/L) is most commonly used in the US; 4 is used in the UK. Both are chosen because they're round numbers and therefore convenient; what would be the odds of the exact point of hypoglycemia being exactly 4 (or exactly 70)?
When I talked about medical concensus, I was also referring to the fact that different populations often have different normal ranges of blood glucose (children for example often have lower fasting blood glucose levels than adults), and even in healthy non-diabetic adults the lower limit of normal can be as low as 3.4 without any symptoms of hypoglycemia (about 5% of adults can regularly and safely go this low when fasting with no damage or symptoms). Can these people be said to be hypoglycemic just because their blood glucose dips below a certain level, even though it's within their normal range and they have no signs, symptoms or problems of hypoglycemia? The medical community (outside of diabetes) tends to think not, and only refers to hypoglycemia if symptoms present; so a reading of below 4 would not be hypoglycemic if symptoms were absent, whereas a reading of 4 might be hypoglycemic if there were symptoms.
This becomes more complicated in diabetes because symptom awareness can be eroded, so the arbitrary numbers tend to be adhered to more strictly (and this is a good thing in many cases, and absolutely necessary if someone has impaired hypo awareness). But if the non-diabetic population has variance in the levels they can tolerate before becoming hypoglycemic, why wouldn't the diabetic population? And if someone does have excellent hypo awareness but doesn't present symptoms until, say, 3.7... are they still hypoglycemic at 3.9? I would argue not, and there's similar debate in the medical community. Legally (e.g. if you were driving) you'd be hypo in the UK (and not in the US), but in reality I don't think you are.
By the way, I must make clear that I'm not suggesting it's somehow good to aim for bloods below 4. It's not; but not because 4 is necessarily hypoglycemic for everyone, but more because it's so close to hypo territory that there's no margin for error. And from a practical point of view, as I say I would always treat myself if I dip below 4. I'm only really posting as a point of interest, not to suggest we should all aim for really low bloods or avoid treating until we get too low.
Hi Nick.
Oh, I see.
Perhaps it might have been better to have posted that previously then ? As for all the stuff about non-diabetics levels, all very interesting, but not really relevant when we are trying to explain things to newly diagnosed Diabetics on this forum. Confusing or what ? :?
There is as I said, much evidence which shows that Hypo unawareness can be a serious problem. Something can frequently be done to counteract it, but you have to accept that it actually happens, otherwise you just carry on regardless.
I suggest for a start that you just 'Google' 'Hypo unawareness.' You might just be surprised at what you find ?
Oh yes this might interest you as well.
As arterial blood glucose falls below about 4.5 mmol/l, serum insulin concentrations fall. With a continued lowering of blood glucose to below about 3.8 mmol/l there is secretion of the counter-regulatory hormones, glucagon, catecholamines, cortisol and somatotrophin (of which the most important in the acute situtuation are glucagon and epinephrine).
With further reductions of blood glucose (at about 3.0 mmol/l) there is symptomatic awareness and at around 2.6 mmol/l cognitive dysfunction is apparent.
However, it is clear that recent episodes of hypoglycemia can alter (increase) these thresholds so that greater reductions in serum glucose concentrations are required before hormonal responses and symptoms are manifest. This is true both for normal volunteers (non diabetic) and diabetics.
The reverse occurs (decreased thresholds) in diabetics who have had a period of high serum glucose concentrations. Thus, depending on preceding blood glucose concentrations, a diabetic may be symptomatically hypoglycemic at a ‘normal’ serum glucose concentration or asymptomatic with a serum glucose of, say, 2.5 mmol/l.
(From an Endocrinology subscription site)
Just a thought ?
Blimey. Can I suggest you check your blood as you seem a bit cranky, you might be going hypo and be unaware.
Given that the original poster has been diabetic for 30 years and therefore isn't newly diagnosed or looking for advice on hypo awareness; and that they appeared just to be asking whether other people had similar experiences to theirs; I didn't think I needed to beat home that message originally. I was only addressing the post as it was written; I wasn't aware every single reply to every thread had to be advice to newly diagnosed members.
You'll note that I said in my second post that I'd always aim for 4 - 6 and correct upwards if I went below 4, and that it wasn't desirable to go lower.
If you're saying that we shouldn't discuss things like this in case they confuse newer members, then I'm afraid I flat out disagree. You're right, if this post were aimed at a newly diagnosed diabetic it wouldn't be appropriate; but it wasn't. It was aimed at someone with 30 years experience asking a related question, and it was information I thought might be of interest. It's discussion of topics like this one that make these forums beneficial, because it's an opportunity for everyone to learn stuff. If every post has to be tempered with the view that a new member wouldn't be confused, then the forums will potentially stop being useful to more experienced members who already know the basics.
I'm also not sure why you're trying to educate me about hypo unawareness, or on the fact that awareness is closely related to control. I'm aware of both of these things, thanks, and talked about hypo unawareness in my last post.
(PS in case it's not clear, the first sentence was a joke)
Given that the original poster has been diabetic for 30 years and therefore isn't newly diagnosed or looking for advice on hypo awareness; and that they appeared just to be asking whether other people had similar experiences to theirs; I didn't think I needed to beat home that message originally. I was only addressing the post as it was written; I wasn't aware every single reply to every thread had to be advice to newly diagnosed members.
You'll note that I said in my second post that I'd always aim for 4 - 6 and correct upwards if I went below 4, and that it wasn't desirable to go lower.
If you're saying that we shouldn't discuss things like this in case they confuse newer members, then I'm afraid I flat out disagree. You're right, if this post were aimed at a newly diagnosed diabetic it wouldn't be appropriate; but it wasn't. It was aimed at someone with 30 years experience asking a related question, and it was information I thought might be of interest. It's discussion of topics like this one that make these forums beneficial, because it's an opportunity for everyone to learn stuff. If every post has to be tempered with the view that a new member wouldn't be confused, then the forums will potentially stop being useful to more experienced members who already know the basics.
I'm also not sure why you're trying to educate me about hypo unawareness, or on the fact that awareness is closely related to control. I'm aware of both of these things, thanks, and talked about hypo unawareness in my last post.
(PS in case it's not clear, the first sentence was a joke
)Hi Nick.
The OP as you say is an experienced Diabetic. I know that.
What you seem to forget here, is that there are an awful lot of very NEW members who read this stuff and need to have it made clear that ultra low numbers are not the norm ? Discussion is fine anywhere, it just comes over as some sort of advice that ultra low is OK. Now I and the bulk of the Medical Profession disagree with that you see.
As for newbies, they frequently get confused, even before they get here - not everybody has a Masters in Endocrinology or similar ?
I wouldn't dream of trying to educate you Nick. You seem to have it cracked ? You obviously do your research. If asking questions to clarify things irks you Nick, sorry. I have loads more if you want ?
However, I think I need to get my Dinner........see below.
As for your first sentence, actually I am getting hypo symptoms at the moment, but then I am very aware of those, unlike some....? :wink: (That's a joke BTW)
The OP as you say is an experienced Diabetic. I know that.
What you seem to forget here, is that there are an awful lot of very NEW members who read this stuff and need to have it made clear that ultra low numbers are not the norm ? Discussion is fine anywhere, it just comes over as some sort of advice that ultra low is OK. Now I and the bulk of the Medical Profession disagree with that you see.
As for newbies, they frequently get confused, even before they get here - not everybody has a Masters in Endocrinology or similar ?
I wouldn't dream of trying to educate you Nick. You seem to have it cracked ? You obviously do your research.
If asking questions to clarify things irks you Nick, sorry. I have loads more if you want ?However, I think I need to get my Dinner........see below.
As for your first sentence, actually I am getting hypo symptoms at the moment, but then I am very aware of those, unlike some....? :wink: (That's a joke BTW)
Fair enough. For what it's worth, I (like I've said three times now) also don't think that ultra low numbers are good. I didn't think my original post came across as saying they were good, and I still don't. But I could be wrong; I know what I meant when I wrote it, but I can't objectively tell if it comes across how I intended it, which is why I clarified in post 2. And 3. And 4. And now 5. I know a lot of newly diagnosed people read this forum, I do get that (and I'd hope that my other posts on here reflect that); like I say though, this was simply a discussion on blood levels and hypoglycemia, and all I did was share my experiences.
As for knowing it all - yeah, I wish. I'm sorry if I come across as an insufferable ****, that's not the intention - what I said earlier about this being a good place to learn because of discussions like this was sincere. I learn a lot from these forums, because - shock horror - I don't know it all, and I want to learn more. I only asked why you were trying to teach me about hypo awareness because it seemed a random thing for you to do - I'd already talked about hypo unawareness and how important it was, so I genuinely didn't know why you were then trying to get me to read up on it (and I still don't).
Enjoy your dinner, I just had mine and it was lush (and low carb paleo of course...)
As for knowing it all - yeah, I wish. I'm sorry if I come across as an insufferable ****, that's not the intention - what I said earlier about this being a good place to learn because of discussions like this was sincere. I learn a lot from these forums, because - shock horror - I don't know it all, and I want to learn more. I only asked why you were trying to teach me about hypo awareness because it seemed a random thing for you to do - I'd already talked about hypo unawareness and how important it was, so I genuinely didn't know why you were then trying to get me to read up on it (and I still don't).
Enjoy your dinner, I just had mine and it was lush (and low carb paleo of course...)
I love reading your posts. My dinner was low carb Chicken Jalfrezi and a miniscule portion of Pilau Rice, together with a couple of pappadoms and some pickle. Heaven.
As for hypo unawarenes, well you mentioned such low numbers as if they were normal. You seem to think they are OK, contrary to medical opinion. I wanted to know why you thought that ? I think I now know.
I promise I wont ask you anything more......maybe ? :wink:
Debloubed
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hee hee, this forum is fun to read!! Back to Glitterzoe's original question however, I have been under 2 and functioned normally, was at the start of my realisation that I was hypo unaware! I've been type 1 for 23 years, so not quite as long as you but I understand your question cos even after so long you still think, uh oh, something new to learn! I tend to think that if you are that low and still walking about and able to concentrate, it's because you have other symptoms that you may not get as much (sweating, trembling perhaps) or vice versa if you are sat still, you may get blurred vision or any number of the other delightful symptoms, but don't notice as you are sat still, if that makes sense?! These are of course just my opinions, based on my own experiences, I don't have any links to add to substantiate them :lol:
Bottom line, as you well know, under 4 is not good and under 2 is 'eek!' level :wink:
I tend to think that if you are that low and still walking about and able to concentrate, it's because you have other symptoms that you may not get as much (sweating, trembling perhaps) or vice versa if you are sat still, you may get blurred vision or any number of the other delightful symptoms, but don't notice as you are sat still, if that makes sense?! These are of course just my opinions, based on my own experiences, I don't have any links to add to substantiate them :lol: Bottom line, as you well know, under 4 is not good and under 2 is 'eek!' level :wink:
tamar
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As a relatively new diabetic, since April 09. Had the pancreas removed. I find that I feel quite unwell when my levels are below 5! So I guess the message is that we are all quite different in our response to lows. I have always taken the advice of my specialist nurse and do regard 4 as the bench mark. It is my understanding that too many lows are not good practice and damage can ensue. Good discussion, keep on talking x
After not very extensive research Wikipedia gives non diabetic readings of 3.6 to 5.8 mMol/L with a mean of readings of 5mMol/L. I would like to maintain non diabetic readings as far as is possible. Does anyone have any more scientific data for non diabetic levels?
phoenix
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The postpandial spikes in a non diabetic person may be much higher than 5.8mmol
These are the thumbnails from a lecture on the levels as found using continuous monitoring on non diabetic subjects
You can listen to the lecture on the site.(figures in mg/dl do divide by 18)
http://www.diabetes-symposium.org/index.php?menu=thumbs&source=topics&sourceid=16&id=322
These are the thumbnails from a lecture on the levels as found using continuous monitoring on non diabetic subjects
You can listen to the lecture on the site.(figures in mg/dl do divide by 18)
http://www.diabetes-symposium.org/index.php?menu=thumbs&source=topics&sourceid=16&id=322
Hello to gbtyke
Thanks for that info, I had in 2008 about 4 Hypo/Coma standing up?
NOT very nice, at around 5.1 mmol But was told by a Prof can't happen?
question the Meter, same with another meter? I was on a nasty analog Insulin Mix.
also I have walked away from a 1.7 Hypo, Yet been very very ill with a 3.6 mmol.
NOW: Here is a Question for the one's who like to argue.
"WHO" has had Phantom Hypo's all the symtoms and some extra But test Reads 10.3 mmol
just as a figure, All this just before a meal time?
Answer's on a Post Card...........................
B
Thanks for that info, I had in 2008 about 4 Hypo/Coma standing up?
NOT very nice, at around 5.1 mmol But was told by a Prof can't happen?
question the Meter, same with another meter? I was on a nasty analog Insulin Mix.
also I have walked away from a 1.7 Hypo, Yet been very very ill with a 3.6 mmol.
NOW: Here is a Question for the one's who like to argue.
"WHO" has had Phantom Hypo's all the symtoms and some extra But test Reads 10.3 mmol
just as a figure, All this just before a meal time?
Answer's on a Post Card...........................
B
Argue.....we don't argue....we discuss. :twisted: No postcards either by the way, so this will have to do.Insulinman said:Hello to gbtyke
Thanks for that info, I had in 2008 about 4 Hypo/Coma standing up?
A Hypo is when you drop below the accepted level of 4 mmol/l. You can have a hypoglycaemic episode whilst walking/standing/sitting/sleeping whatever. I can sometimes hypo whilst out walking, I just treat the symptoms there and then.
NOT very nice, at around 5.1 mmol But was told by a Prof can't happen?
question the Meter, same with another meter? I was on a nasty analog Insulin Mix.
also I have walked away from a 1.7 Hypo, Yet been very very ill with a 3.6 mmol.
The Professor was quite right. 5.1 mmol/l is not a hypo. You are lucky that you safely walked away from a level of 1.7mmol/l, for a type 1 that could have quickly been a major problem, resulting in unconciousness and a Diabetic Coma, then who knows........
NOW: Here is a Question for the one's who like to argue.
"WHO" has had Phantom Hypo's all the symtoms and some extra But test Reads 10.3 mmol
just as a figure, All this just before a meal time?
Answer's on a Post Card...........................
B
I have had phantom hypo's (false hypo's) very recently. This is caused when you are running a high Bg level for a while then drop to a lower level, in my case very quickly due to some medication I have to take. This drop causes the body to think that you are entering a hypoglycaemic state but you aren't, hence the term false hypo. You get all the symptoms and feel awful until the levels stabilise at more normal levels.
I've been T1 for twelve years and generally my control is good, but could be better.
As for lows I can safely say my hypo awareness is good, but I definitely don't fit in with expected ranges. I know when my BS falls below around 3.5 but it really doesn't stop me from doing anything. I've had readings of around 1, which I won't lie in saying I felt good, but it hardly stopped me from doing something about it.
I find it strange to think about a hypo is in the terms that a lot of people describe (i.e. if it's below 4 you’re in serious danger, sorry doesn't seem to work that way for me). If I can still test by BS and do something about it, I'm not too concerned. Generally when I get a really low reading I'm being lazy, as I already know its low but check my BS to confirm (very rare, virtually never will I think I'm ok when I'm not)
What annoys me is when someone reads a text book and tells me how I should react based on the average person or a study. I'm not suggesting that lows should be ignored. Far from it, I aim for 4-6 like most others do, but I really don't care if my BS is 3 or 7, but I do something about it and get it closer to what I want it to be.
I believe it's more to do with how YOU feel and react than it is to worry about what a reading tells you that you should feel like. If you're newly diagnosed then air on the side of caution, but my advice is to be sensible and do what works for you.
As for lows I can safely say my hypo awareness is good, but I definitely don't fit in with expected ranges. I know when my BS falls below around 3.5 but it really doesn't stop me from doing anything. I've had readings of around 1, which I won't lie in saying I felt good, but it hardly stopped me from doing something about it.
I find it strange to think about a hypo is in the terms that a lot of people describe (i.e. if it's below 4 you’re in serious danger, sorry doesn't seem to work that way for me). If I can still test by BS and do something about it, I'm not too concerned. Generally when I get a really low reading I'm being lazy, as I already know its low but check my BS to confirm (very rare, virtually never will I think I'm ok when I'm not)
What annoys me is when someone reads a text book and tells me how I should react based on the average person or a study. I'm not suggesting that lows should be ignored. Far from it, I aim for 4-6 like most others do, but I really don't care if my BS is 3 or 7, but I do something about it and get it closer to what I want it to be.
I believe it's more to do with how YOU feel and react than it is to worry about what a reading tells you that you should feel like. If you're newly diagnosed then air on the side of caution, but my advice is to be sensible and do what works for you.
