Daily hypos
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What kind of hypos are we talking about?
Just dipping below 4 or something in the 2's or lower?
If you are having persistent hypos you should discuss it with your health care team. It could be a sign that your insulin needs to be adjusted. As far as I know losing hypo awareness is the biggie.
Otherwise, and I am open to correction on this, but I was told soon after my diagnosis that hypos as long as they are treated quickly are not a danger. There is the immediate danger from passing out, but if you are able to recover without assistance, you should be fine. I was also told by the same doctor that it's persistent hypers were the cause of the long-term side effects - retinopathy etc.
I will caveat that by saying that I was diagnosed in rural France by a non English speaking GP and while my French is good enough to work and socialise the diagnosis opened a whole new vocabulary to learn so some of what I was told in the early days may have been lost in translation.
To be honest, I'd not thought too much beyond hyper bad, hypo okay so long as it's treated. I've just done a quick Google and it would seem that indeed, the classic long-term side effects of our condition we are all told about are all caused by hypers rather than hypos. Even the NHS website is more concerned about the immediate rather than long-term implications of hypos.
Otherwise, and I am open to correction on this, but I was told soon after my diagnosis that hypos as long as they are treated quickly are not a danger. There is the immediate danger from passing out, but if you are able to recover without assistance, you should be fine. I was also told by the same doctor that it's persistent hypers were the cause of the long-term side effects - retinopathy etc.
I will caveat that by saying that I was diagnosed in rural France by a non English speaking GP and while my French is good enough to work and socialise the diagnosis opened a whole new vocabulary to learn so some of what I was told in the early days may have been lost in translation.
To be honest, I'd not thought too much beyond hyper bad, hypo okay so long as it's treated. I've just done a quick Google and it would seem that indeed, the classic long-term side effects of our condition we are all told about are all caused by hypers rather than hypos. Even the NHS website is more concerned about the immediate rather than long-term implications of hypos.
Hiya - this sounds really worrying if you’re having them every day - have you tried reducing your long acting insulin? Daily hypos will certainly be impacting your cognition and mood, not just your hypo awareness.
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Though I can say fairly confidently that hypos are caused by too much insulin, as we don't know @Roppa 's insulin regime or when the hypos are occurring it's not possible to say whether it's the basal or bolus that needs adjusting. (Maybe Roppa is on a pump?)
And I would like to remind everyone of forum rule A11, which means we can't instruct on the alteration of any medication. (Rules in the greetings and introduction forum and in the signature of every moderator).
As regards the original question, I don't think a drop to 3.5 is a health issue, plenty of non diabetics go that low. But from personal experience hypo awareness can go if you have frequent hypos, and that is really bad news. (I luckily got mine back by keeping my blood sugar above 6 for a few weeks, but life without hypo awareness is grim).
Here's an interesting study about blood sugar levels for non diabetics.
Continuous Glucose Monitoring Profiles in Healthy Nondiabetic Participants: A Multicenter Prospective Study
Use of continuous glucose monitoring (CGM) is increasing for insulin-requiring patients with diabetes. Although data on glycemic profiles of healthy, nondiabetic individuals exist for older sensors, assessment of glycemic metrics with new-generation CGM ...
www.ncbi.nlm.nih.gov
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Usually in the afternoon. If my blood sugar is around 5 before a meal then it's usually about 2.5 to 3 hours after a meal. I take the amount of insulin my Aviva expert says but sometimes I will do things like empty the washing machine and put stuff on the clothes horse or walk down 4 flights of stairs to front door and back (if I'm expecting a parcel). I usually have extra carbs if I've done this but sometimes I forget to and can have a hypo. Other times I do little things that could all add up to probably cause a hypo. My libre meter is supposed to warn me but it rarely goes off and the readings are that far out. I'd say it's almost correct only 10%of the time, readings can be out by 1 to 4mml compared with a fingerprick test. Times I have planned to do stuff I take less mealtime insulin and everything is usually fine (no hypos) if I had done lots of stuff in the evening I would take less background insulin (at bedtime) and everything is fine (no hypo).
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I haven't used an insulin calculator but I assume the advice you get is based on an algorithm using specific o you insulin ratios and basal rates?
I personally find that my ratios (I just do basic bolus calculations in my head) can change with time so if you aren't confident to adjust the rates yourself then it sounds like you do need to talk to your team quite urgently.
Can I ask how long you have been T1? (If only for a short time then the honeymoon effect could be in play, which might be reducimg your insulin needs.)
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HI Roppa,
I did some research on this and found many reports from mainly Canadian and American Universities which I could send to you if I knew how to attach a list to this note.
In summary these reports gave mixed views as to the long-term impact of hypos but the overall picture is that minor hypos (<3.8 mmol/l say) have no adverse effects upon the brain, irrespective of how many you have. However if you have more than 2 serious hypos/yr (requiring third party assistance to recover) it is possible that there will be some adverse effects. As you can see there is little definitive agreement and the reason is of course that there is very little hard data available over the long term. I have no records of my hypos, mild or severe, over the last 50 years or so and I imagine that few diabetics will have kept such data!
I became a T1 diabetic during my finals at Cambridge some 52 years ago, and I decided many years ago that the consequences of minor hypos are preferable to the problems caused by poor blood sugar control. My Hba1c is consistently less than 6% and clinicians no longer tell me that hypos cause brain damage. I think that this is a hangover from when they attended medial school many years ago - if indeed they did.
Hi,
I'm 30 and have had type 1 diabetes 28 years. My DSN is a matron now and told me that as I have mutliple hypos a day and have done for many years, mostly due to stress and anxiety that is making my levels eratic, you suffer cognitive function impairment and will eventually have heart problems. I have a slight irregular heartbeat at present, no hypo awareness, and short term memory is very bad. This has gotten worse this year apparently. It is best to not have "bad" hypos, anything below 3 but you need to see your diabetes specialist and get their help as everyones condition is different and some things, like excercise, make some people drop in levels whilst others don't so it needs to be specialist to your situation. Hope you get it sorted as sounds as though you're in the early stages still of having it and the sooner the better.
Waggytails
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Having had my friend since 1961 I've grown up following low sugars good, highs bad. I'm now 65yrs and have been told by a diabetes GP that I mustn't keep my sugars so low, 4's 5's...get it to 7 and above! Otherwise I am at risk of developing dementia and any other memory/cognitive functions. It's logical I suppose as we are starving our brains of sugar. My memory is fine in the shorter term but things I've experienced and places I've been in all these years are erratic in recalling, if at all. Perhaps he's right then. But it makes even more of a juggling act and is hard to do as I've spent 63yrs following the opposite mantra!
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Marie 2
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There is very little research on what "Lows" can cause and what that level is. In the US they prefer you to keep the "below" 3.9 (70) to less than 3% or 4% of the time. That's less than about 45 minutes in a 24 hour period. Under 3.0 (54) is considered very low and they don't like it. I'm sure preferences do vary some per doctor but that is the general rule of thumb here. And if you have ever passed out and needed help or medical attention it will be a whole different story. As you get older, some doctors might raise the recommended levels if they feel there is a risk. After all if you are alone or in more danger of falling and breaking a bone, strokes etc., they would rather play it safe than sorry.
Exercise forces the body to use insulin better. I purposely get on my exercise bike to stall a climb until my insulin kicks in. A little more exercise or moving around will lower your insulin need. I also have a different basal program in my pump for heavy exercise days. My basal and I/C ratio needs also go lower at night, they are the highest for me in the morning. Exercise bike riding in the am takes a lot longer to get a result than the nitro it is in the evening.
It's unfair we have to allow for deciding to walk down the street to a neighbors, running more errands or just deciding to do housework or gardening by taking less insulin or eating something extra. But it's just the way it is.
And it still comes down when dropping too low, too much insulin hitting versus food eaten at that particular point in time.
Exercise forces the body to use insulin better. I purposely get on my exercise bike to stall a climb until my insulin kicks in. A little more exercise or moving around will lower your insulin need. I also have a different basal program in my pump for heavy exercise days. My basal and I/C ratio needs also go lower at night, they are the highest for me in the morning. Exercise bike riding in the am takes a lot longer to get a result than the nitro it is in the evening.
It's unfair we have to allow for deciding to walk down the street to a neighbors, running more errands or just deciding to do housework or gardening by taking less insulin or eating something extra. But it's just the way it is.
And it still comes down when dropping too low, too much insulin hitting versus food eaten at that particular point in time.
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Hi,
HCPs are always concerned about losing hypo awareness. I’ve been T1 for 47 years & have never lost consciousness in that time. (To date.) Though my Libre helps with advance warning, coupled with a 3rd party app.
For me it’s monitoring & safe guarding on any thing that could affect my cognitive function & treating before it come to that “stage.”
I did hear of one case of long term “damage” from a hypo coma in a program years ago regarding head injury?
It was a documentary about behavioural changes in subjects. (One young guy from memory was in a car accident.)
However, there was this young woman who changed after being hospitalised & pulled out of a coma from a bright educated individual to someone who needed to be put in a “vulnerable register” due to her extreme inappropriate behavioural changes?
Hi,
That’s interesting. I’ve had a family member with dementia (T2.) I was always under the impression prolonged high BGs were a contributory factor? Though, I can appreciate that not enough glucose to the brain could start it waving the “white flag.”
Early warnings for me are the cognitive with stuff like maths or measuring. “Walking into a room & not remembering why,” what was that tool I’m looking for…? (Usually at my feet…) Hello? I’m low….
@Roppa , from a personal experience I find my insulin sensitivity changes in warmer weather? (Especially with my work.) Talk to your HCP regarding a review on insulin dosage, which hopefully will make things more manageable for you..
Best wishes.
HCPs are always concerned about losing hypo awareness. I’ve been T1 for 47 years & have never lost consciousness in that time. (To date.) Though my Libre helps with advance warning, coupled with a 3rd party app.
For me it’s monitoring & safe guarding on any thing that could affect my cognitive function & treating before it come to that “stage.”
I did hear of one case of long term “damage” from a hypo coma in a program years ago regarding head injury?
It was a documentary about behavioural changes in subjects. (One young guy from memory was in a car accident.)
However, there was this young woman who changed after being hospitalised & pulled out of a coma from a bright educated individual to someone who needed to be put in a “vulnerable register” due to her extreme inappropriate behavioural changes?
Hi,
That’s interesting. I’ve had a family member with dementia (T2.) I was always under the impression prolonged high BGs were a contributory factor? Though, I can appreciate that not enough glucose to the brain could start it waving the “white flag.”
Early warnings for me are the cognitive with stuff like maths or measuring. “Walking into a room & not remembering why,” what was that tool I’m looking for…? (Usually at my feet…) Hello? I’m low….
@Roppa , from a personal experience I find my insulin sensitivity changes in warmer weather? (Especially with my work.) Talk to your HCP regarding a review on insulin dosage, which hopefully will make things more manageable for you..
Best wishes.
BruceT
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Comment re Waggytail
Yep, I'm with you. I'm 70 now and have been Type 1 for 63 years. For most of that time, the mantra was high bad, lows better, but of course, science changes. I find the Libre 2 really helpful, in that I set my alarm at 4.9, and catch the little s.d before it goes too low, and can still try and avoid too many highs. I still gym five days a week, walk most days and play golf (badly) a few times a month. I also occasionally eat the wrong things, and (possibly) even drink too much niw and then!
It's not perfect. Life is not perfect, but when I consider life with Clinitest, long needles, sterilisation with surgical spirit of kit, etc, and no blood test kits....heck !!
We're all different. Like you, hot weather in particular affects dosage and ratios. But we do it, we tweak our doses, we watch pur sensors, and we try our best.
There is certainly no perfect solution, we're all different, our reactions to influences are all different (exercise, stress, infection etc), but that's why its important we're in charge of 'it', not 'it' us!
For newly or recently diagnosed Type 1s, I suspect sometimes our discussions on the Forum can seem frightening or confusing. Don't be. It's your individual challenge. There is no absolute right, but we can each of us load the odds, by trying our best, and accepting we won't always get it right.
As a Rock fan I'm reminded of the Airbourne track " No way but the hard way....get on with it". I try, and we can all do it.
Yep, I'm with you. I'm 70 now and have been Type 1 for 63 years. For most of that time, the mantra was high bad, lows better, but of course, science changes. I find the Libre 2 really helpful, in that I set my alarm at 4.9, and catch the little s.d before it goes too low, and can still try and avoid too many highs. I still gym five days a week, walk most days and play golf (badly) a few times a month. I also occasionally eat the wrong things, and (possibly) even drink too much niw and then!
It's not perfect. Life is not perfect, but when I consider life with Clinitest, long needles, sterilisation with surgical spirit of kit, etc, and no blood test kits....heck !!
We're all different. Like you, hot weather in particular affects dosage and ratios. But we do it, we tweak our doses, we watch pur sensors, and we try our best.
There is certainly no perfect solution, we're all different, our reactions to influences are all different (exercise, stress, infection etc), but that's why its important we're in charge of 'it', not 'it' us!
For newly or recently diagnosed Type 1s, I suspect sometimes our discussions on the Forum can seem frightening or confusing. Don't be. It's your individual challenge. There is no absolute right, but we can each of us load the odds, by trying our best, and accepting we won't always get it right.
As a Rock fan I'm reminded of the Airbourne track " No way but the hard way....get on with it". I try, and we can all do it.
Thanks for your response. I too contracted type 1 in my 2nd year at university 52 years ago. I have just been to the diabetic clinic where the consultant told me that my reading today of around 7per cent aic (60 mmol) is not bad for someone our age which surprised me as I always aim lower! But I am also becoming a bit wary of the 'hypos' I am getting using my newly prescribed libre. Maybe I have always been suspect to them but never finger prick tested enough! It was such a pain - so much better with a libre meter.
