Hypo unawareness without changing target range - how often to test

[thewestiesmum]

Has anyone with hypo unawareness been advised by their diabetes team not to change their target range but just to do more testing instead to avoid hypos? If so how often were you advised to test to avoid the hypos?

 

[Juicyj]

Hello @thewestiesmum

It really depends what your target range is set at ?

Yes testing often is really important to catch bg levels before they fall, how are you testing at the moment so with what device ?

 

[thewestiesmum]

Hi @Juicyj, firstly thank you for your reply. Secondly I do have another thread 'hypo unawareness and bringing BGLs back up over target' which you replied on.

My target range was 5mmol - 8mmol then I changed it to 6mmol - 10mmol.

I test with my FreesStyle libre 2 and also my meter. I've also got the diabox app. The low alarm on my fsl is set to 5.6 which is the lowest it will go. Each time my low alarm goes off on my fsl I do a scan and also a bg finger prick.

I've been doing this since the 15th December. I've had a few BGL's in the 3s probably because most likely I've ignored some of the alarms and sometimes because I've not been near my phone and also because some alarms I've simply not heard.

When I do respond to the alarms if my BGLs are in the 3s 4s or 5s in my other thread I mentioned that I was treating with small amounts of fast acting carbs but I've gone back to treating with 'my' normal amount of fast acting carbs ie 5 dextrose tablets then repeating until BGLs are back over 6mmol.

The worrying thing is that I don't think this is working because when I have gone into the 3s I still don't get any hypo awareness and could carry on as normal.

I'm thinking of giving this a better try. I have tried it but I think I need maybe 10g of extra carbs. - It’s what @Hopeful34 suggested on my other thread

The idea is to stop you dropping to below 6, so if:
Monday you drop to below 6 after breakfast and before lunch
Tuesday add 5g extra carbs to breakfast to see if you can stop the drop to below 6 before lunch.
If that works, continue adding the 5g extra carbs every day to your breakfast.

If you still drop to below 6 before lunch, try adding 10g extra carbs to your breakfast to stop you dropping to below 6 before your lunch

I've done this myself ie without speaking to my diabetes team because I don't have a team as such - I just have a practice nurse at my gp practice but if I wanted her to she can put me back in touch with the DSN service again.
Apologies if she does understand about hypo unawareness and ways of treating it but think I would have to write it down on paper for my practice nurse to understand.

 

[In Response]

A few bgs in the 3s in the last month is not something I would get too concerned about.
Remember, people without diabetes can have levels in the 3s and it is not considered to be a hypo.

However, I think you may be misunderstanding the idea of changing your target range to gain hypo awareness. It is not about changing your alarm range on your Libre but it is about changing your bolus dose calculation.

Imagine, for example, your insulin to carb ratio is 1 unit of insulin to 10g carbs and your correction factor is 1 unit of insulin to drop your level by 3mmol/l.
If your current level is 11mmol/l, your target is 8mmol/l and you are eating 30g carbs, your dose will be 4 units.
That is 3 units for your carbs plus 1 unit to reduce your level by 3mmol/l.

If your target level was 5 mmol/l, if you would need another unit of insulin to bring your levels down to your target.

 

[thewestiesmum]

A few bgs in the 3s in the last month is not something I would get too concerned about.
Remember, people without diabetes can have levels in the 3s and it is not considered to be a hypo.

However, I think you may be misunderstanding the idea of changing your target range to gain hypo awareness. It is not about changing your alarm range on your Libre but it is about changing your bolus dose calculation.

Imagine, for example, your insulin to carb ratio is 1 unit of insulin to 10g carbs and your correction factor is 1 unit of insulin to drop your level by 3mmol/l.
If your current level is 11mmol/l, your target is 8mmol/l and you are eating 30g carbs, your dose will be 4 units.
That is 3 units for your carbs plus 1 unit to reduce your level by 3mmol/l.

If your target level was 5 mmol/l, if you would need another unit of insulin to bring your levels down to your target.

Surprisingly with my BG (finger pricks) there have been probably 2 hypos in the last month. There has been 15 on my Leo libre 2 and more than that on diabox.

Re changing my target range
Someone suggested to me to change my target range and try not go below my bottom number (6.0mmol - 10.0mmol) of 6.0mmol and if I do then treat it as though it's a hypo with some fast acting carbs etc. This is also why I've got my low alarm set on my libre to warn me when I'm dropping.

I've reduced my basal dose a couple of times over the last few weeks. I didn't know about changing my bolus doses. Would I need to basal test for the bolus doses. At the moment I'm on 1:10 for everything apart from before breakfast when I'm on 1:8.

 

[In Response]

@thewestiesmum the target range is what you are aiming for when you calculate your bolus.
When calculating your bolus you must consider your current level as well as your insulin to carb ratio.
For example, if your current level is 4.5, you should be taking less insulin than if your current level is 10.5 even if you are eating the same number of carbs.

 

[ert]

If I'm starting to hypo more frequently, it's a sign I need to cut back my basal until my blood sugars stay above 4 mmol/l. I always finger prick my when my Dexcom alarms at 4 mmol/l and react based on how quickly my blood sugars are dropping.

 

[thewestiesmum]

@thewestiesmum the target range is what you are aiming for when you calculate your bolus.
When calculating your bolus you must consider your current level as well as your insulin to carb ratio.
For example, if your current level is 4.5, you should be taking less insulin than if your current level is 10.5 even if you are eating the same number of carbs.

Hi,
I use the MySugr App bolus calculator for calculating my bolus.

 

[Hopeful34]

It worth remembering that it can take longer than a month to regain hypo awareness.
If you've reduced your basal, it's a good idea to do another basal test, to check that your having the right amount of background insulin now, before making any changes to your insulin to carb ratio's.

 

[In Response]

Hi,
I use the MySugr App bolus calculator for calculating my bolus.

What is the target blood sugar level setting in MySugr?
If you have not changed this since trying to regain hypo awareness, you need to. Otherwise, you are dosing the correct amount of insulin to maintain a higher level and doing nothing for your hypo awareness.

I strongly recommend understanding what calculations MySugr is making and the variables of that calculation.

 

[thewestiesmum]

What is the target blood sugar level setting in MySugr?
If you have not changed this since trying to regain hypo awareness, you need to. Otherwise, you are dosing the correct amount of insulin to maintain a higher level and doing nothing for your hypo awareness.

I strongly recommend understanding what calculations MySugr is making and the variables of that calculation.

 

[In Response]

View attachment 53015

I do not use MySugr but that looks like the settings for reviewing levels (the MySugr Log) and not the settings for calculating your insulin dose ( the MySugr Calculator).

 

[mooshk]

I'd also say that the freestyle 2 generally reads up to 2 points higher than I actually am (many others say the same) so like it says I'm 2.9 all night when actually when I finger prick test it's just 4. So deffo check with a prick tester because you may not actually be going low

 

[mooshk]

I'd also say that the freestyle 2 generally reads up to 2 points higher than I actually am (many others say the same) so like it says I'm 2.9 all night when actually when I finger prick test it's just 4. So deffo check with a prick tester because you may not actually be going low View attachment 53026

This may explain what I mean a bit more https://www.diabetes.co.uk/forum/threads/freestyle-libre-sensor-highly-inaccurate.137681/

 

[Jollymon]

I am hypoglycemic unaware. In terms of feeling hypoglycemic I feel nothing. I test 20 times per day.

I prefer to measure glucose level with blood. It’s way more accurate and more reliable. So that’s what I use.

I have been on all the cgm systems. Not interested in using them. Found when they don’t work reliably we’re supposed to check blood sugar with a meter. If the meter is the more reliable method then that’s what I use.

 

[StewM]

This may explain what I mean a bit more https://www.diabetes.co.uk/forum/threads/freestyle-libre-sensor-highly-inaccurate.137681/

One thing I just want to note about this thread, if your Libre is really inaccurate (I think Abbott defines this as 20% higher or lower than a Blood Test frequently) then you can tell Abbott and they will replace your faulty sensor. This topic comes up a lot, and I feel like a lot of people don't realise this.

 

[mooshk]

One thing I just want to note about this thread, if your Libre is really inaccurate (I think Abbott defines this as 20% higher or lower than a Blood Test frequently) then you can tell Abbott and they will replace your faulty sensor. This topic comes up a lot, and I feel like a lot of people don't realise this.

Thank you , didn't know that so cheers. They're putting me onto dexcom to see if it's better for me but will keep this in mind if I stay on libre

 

[thewestiesmum]

I do not use MySugr but that looks like the settings for reviewing levels (the MySugr Log) and not the settings for calculating your insulin dose ( the MySugr Calculator).

Hi @InResponse
Here is a copy of the MySugr settings for calculating my insulin dose and you can see that my target blood sugar level is set to 6mmol - 10mmol for all day.

 

[thewestiesmum]

I'd also say that the freestyle 2 generally reads up to 2 points higher than I actually am (many others say the same) so like it says I'm 2.9 all night when actually when I finger prick test it's just 4. So deffo check with a prick tester because you may not actually be going low View attachment 53026

Thanks @mooshk when ever I get a high or a low on my libre I always do a finger prick test. Also when I'm bolusing for food I always do a libre scan first then a finger prick test and it's the finger prick test I go by for bolusing.

 

[thewestiesmum]

I am hypoglycemic unaware. In terms of feeling hypoglycemic I feel nothing. I test 20 times per day.

I prefer to measure glucose level with blood. It’s way more accurate and more reliable. So that’s what I use.

I have been on all the cgm systems. Not interested in using them. Found when they don’t work reliably we’re supposed to check blood sugar with a meter. If the meter is the more reliable method then that’s what I use.

Hi @Jollymon wow you test 20 times a day! There's nothing wrong with doing that though. Can you give me a rough idea of when you do the tests please?

Like you say 'they' say blood glucose testing is much more accurate and reliable and it was after all the very first way of testing blood glucose. Even with all the cgms which are coming out and are supposed to be becoming more reliable I don't think blood glucose testing will ever be taken away.