'going lower' trend worries

[Grazer]

My docs have also warned me that going too low is just as dangerous as going too high.... apparently too many lows can affect your brain and other organs long term my endocrinologist advised me. I wasn't even aware of that!

Bear in mind that the OP, Lucy, is on diet-only and minimum dose metformin, so your issues with lows and hypos on insulin are entirely different to hers.

 

[phoenix]

It is very different if you are taking insulin, your body can't switch off whats already been delivered as rapid insulin continues to work for up to five hours. For many people with T1 very low 2 hour levels mean hypos in the next hour or so. (shopping hypos seem to be very prevalent !)

For T2s it is different, but if someone is relatively insulin insufficient it may be almost impossible have low post prandial levels on diet alone, or with just metformin. It is then that they and their doctors need to take into account the evidence from the ACCORD and ADVANCE trials.

The amount of damage that short spikes after meals cause is undefined (as opposed to overall HbA1c). It seems that transient high levels should cause changes but long term trials are needed that show they actually do, the evidence is lacking.
Not so long ago people with T1 must have had a lot of spikes. They were taking once or twice daily insulin, the only tests told if glucose was above 10mmol/l through testing urine. They couldn't tell that they were transiently high and they couldn't have 'corrected anyway.
People who have reached 50+ years only had those methods in their youth. Those who have survived with no complications don't actually have very low HbA1c s(7.2%) on average. Low glucose levels can't be the only factor.

Personally I think that striving for 'normal' levels can be dangerous for some T1s and impossible for some T2s without using medication(and then the caveats apply) .
On forums I think that a perception that everyone can do it may possibly lead to them'giving up'... does this forum end up only supporting those who are able to be 'successful in terms of very low glucose levels? I don't know but I think I see more very long term diabetics on some of the other forums .

 

[Anonymous]

yep... I know all about it :lol: Been on all the treatments for diabetes. Oh... I still had hypos without insulin and on metformin only by the way... so you're not completely out of the woods on that one.

 

[Grazer]

yep... I know all about it :lol: Been on all the treatments for diabetes. Oh... I still had hypos without insulin and on metformin only by the way... so you're not completely out of the woods on that one.

I think it's wrong to worry people needlessly about hypos and Metformin. If you had "hypos" on metformin, you'd have had them without Metformin. As said many times on this site, ANYONE can experience a "hypo", which is simply low blood sugar causing dizziness, potential fainting, etc, diabetic or not. DANGEROUS hypos requiring 3rd party assistance or hospitilization, with risks of coma and death, are the province of insulin use and, to a lesser degree, insulin promoting drugs. Diabetics on metformin are ALSO likely to be on restricted diet with increased exercise to lose weight, and this is what can cause them to have more low blood sugar episodes than a non-diabetic. Here's a link:-
http://www.google.co.uk/url?sa=t&rct=j& ... GBdDZoQbJw
Diabetes in itself doesn't cause hypos, nor does Metformin, which is WHY the NHS justifies not giving testing strips to people on Metformin.

 

[Anonymous]

sorry... don't agree with you on that one Grazer. Hypos happen anywhere under 4 mmol... and can be very dangerous. Just to give you an idea... I headbutted a wall with my head on my first what you consider just "low blood sugar episode". My endocrinologist certainly hasn't told me anything of the sort what you've just posted and he advises me that it's important to understand what your 'safe' level is and that ANY low is no good for you.... if you have symptoms with a low, it's a hypo... your body can't tolerate it... your brain cells are being drained, etc. So that means you need to be aware of what your body is doing and can tolerate. There's no such thing as a pretend hypo or whatever... I've read this before. This has never been my experience and it's certainly never discussed by an endocrinologist in those terms.

 

[Grazer]

Head butting a wall with low blood sugar does not mean metformin causes hypos!
Here's an article from the Canadian college of physicians if you weren't convinced by the NHS info and american info I sent you:-

"Gastrointestinal side effects of metformin are observed in 10% to 15% of patients, depending on the dose, and include abdominal discomfort, anorexia, bloating, and diarrhea. Because insulin secretion is unaltered, hypoglycemia is not a side effect of metformin used as monotherapy."

What it's saying, is what we've all said, that metformin used on it's own does NOT cause hypos because of how it works. It only REDUCES the highs (marginally), it doesn't induce LOWS because it has no effect on insulin secretion. It can ONLY work by limiting how high a high can go.

I'm sorry you suffered from hypos (low blood sugar). My daughter does too. She's not diabetic and takes no drugs therefore. But that's not the same as hypos requiring third party assistance or hospitilization that insulin users can endure.

 

[Grazer]

Hypos happen anywhere under 4 mmol... and can be very dangerous. Just to give you an idea... I headbutted a wall with my head on my first what you consider just "low blood sugar episode". My endocrinologist certainly hasn't told me anything of the sort what you've just posted and he advises me that it's important to understand what your 'safe' level is and that ANY low is no good for you...

Your endo may well tell you that - you're on insulin! Anywhere under 4 ISN'T "dangerous"; non-diabetics spend a lot of time under 4. They wouldn't have a norm of 4.6% as an HbA1c if they didn't. 4.6% is their AVERAGE, allowing for rises after meals, so pure maths says they will have a lot of time under it.

This is a quote from the other link I gave you in case it woulodn't open for you:-

"Metformin is an oral diabetes medication used to help control blood glucose (sugar) levels by working in several ways. It helps to reduce glucose absorption and production and it also helps the body respond better to insulin. This is called insulin sensitivity. Metformin is used to treat type 2 diabetes, either alone or in combination with insulin or other oral diabetes medications. Common side effects of metformin include headache, nausea, vomiting, diarrhea, gas, stomach pain, and indigestion. This is not a complete list of side effects that can occur with metformin. Metformin is not likely to cause hypoglycemia when used alone. This is based on the way it works. Diabetes medications are more likely to cause hypoglycemia when they work by increasing the amount of insulin the body produces.

Same message. It's the drugs that work by stimulating insulin production that can cause hypos.

 

[Mileana]

I've had reactive/pseudo/perceived hypoglycemia that required 3rd party intervention because I was so confused I didn't know what was good for me, nor could I stand. My blood glucose was 6. The reaction is exactly the same in your brain, really.

What you are saying, Grazer, is that a hypo in people not on insulin will not progress into coma and death, right? Or?

-M

 

[shop]

Head butting a wall with low blood sugar does not mean metformin causes hypos!
Here's an article from the Canadian college of physicians if you weren't convinced by the NHS info and american info I sent you:-

"Gastrointestinal side effects of metformin are observed in 10% to 15% of patients, depending on the dose, and include abdominal discomfort, anorexia, bloating, and diarrhea. Because insulin secretion is unaltered, hypoglycemia is not a side effect of metformin used as monotherapy."

What it's saying, is what we've all said, that metformin used on it's own does NOT cause hypos because of how it works. It only REDUCES the highs (marginally), it doesn't induce LOWS because it has no effect on insulin secretion. It can ONLY work by limiting how high a high can go.

I'm sorry you suffered from hypos (low blood sugar). My daughter does too. She's not diabetic and takes no drugs therefore. But that's not the same as hypos requiring third party assistance or hospitilization that insulin users can endure.

I think what Grazer is getting at here is that an insulin caused hypo (t1) if left untreated could result in coma and god forbid death as the body cannot halt the continuous lowering of BG. Where as in a T2 / non diabetic hypo the symptoms may be as disturbing ( I have experienced non diabetic and T1 hypos ) the body will not allow you to continue into the dangerous lower levels.

Is that right Grazer?

 

[Anonymous]

I think the main point here is that you can't ignore your body when it's giving you signals... you must check your BGLs and you must act. You really can't do much when you're in a coma can you? You have to be responsive and know what your 'safe' level is with BGLs... everyone has a 'safe' level before their BGLs drop really quick. When I go below my safe level I can be seriously low quick... and this has always been the case for me regardless of what treatment I've been on. In my experience (bear in mind I've been on all the treatments for diabetes... so don't just assume I'm talking from an insulin user perspective here)... a hypo is a hypo and I must act fast! Also you realise the first thing that goes is your judgment? That means you're not allowed to drive or operate machinery if you're suffering from a hypo and for half an hour afterwards. It's dangerous to think you're not at risk if you're not on insulin. Also I think my original point was that you have to find the right BGL balance and that going too low is just as bad for you as going too high.

 

[Grazer]

Shop and Mileana, yes in effect.
In summary:-
1) ANYONE can have a hypo; this is short for hypoglycaemia and simply means low blood sugar. It can make you dizzy, nauseous and is unpleasant. It can be caused by your body THINKING you're low because it's used to high BGs,(diabetics coming down from long term high BGs) or by having a demand for fuel not met by the fuel it receives, such as loads of exercise when dieting (applies to anyone) Left untreated, your liver will releasae glycogen (unless you've run a marathon and have none left) and restore levels. You won't die.
2) Insulin and other insulin-stimulating drugs can cause DANGEROUS hypos, because they will drive sugar levels down even when they are already low. Levels can reach the 1's. People can die. This is how people can be murdered by insulin.
3) Metformin doesn't stimulate insulin production. It doesn't lower blood sugars when they are not high. It improves our insulin sensitivity so that insulin PRODUCED WHEN BGs ARE RISING, works a bit better. It also stops the liver releasing quite so much sugar into the bloodstream, it doesn't REDUCE blood sugar FROM the bloodstream.
4) A diabetic taking metfortmin only has the same risk as a diabetic on no meds of experiencing low blood sugar, which is the same as a non-diabetic except T2s are more likely to be restricting food intake and exercising than many non-diabetics.
5) A person, diabetic or not, could have other medical conditions that cause excessive low blood sugar, that is a different game again. For example, a person who cannot produce glucogen from the alpha cells in the Pancreas could not use that to stimulate glycogen release from the liver which is what restores normal blood glucose levels when they fall. This is not relevant to metformin use and hypos..

Hope this clarifies things. Not sure what more I can say. There are a million articles that you can google which explain how metformin works, and explain that on it's own it doesn't cause hypos. Once again, it's use of the word "HYPO" that causes problems. Would be helpful to use Low blood sugar to differentiate between that and insulin induced dangerous hypos.

 

[borofergie]

I think the main point here is that you can't ignore your body when it's giving you signals... you must check your BGLs and you must act.

But as T2s on diet and/or metformin we're not any more prone to a dangerous hypo than Joe Public. The NHS doesn't (in general) deem that our condition is worthy of testing equipment so, just like any regular person, it seems a bit peverse to use our valuable strips to make sure that we aren't going too low, when for the vast majority of people, there are no consequences.

When you first get your BG undercontrol, ignoring the signals that your body is giving you is an important first step (I can still remember the pain of false hypos).

Also I think my original point was that you have to find the right BGL balance and that going too low is just as bad for you as going too high.

If you're on insulin (or some other non-metformin medication) perhaps, but for a T2 the worst consequence of a mild hypo is a headache and a liver dump. I induce one every Saturday morning when I race.

 

[Anonymous]

Too low is too low... you can't debate that. Anything under 4 mmol is too low. Do you know your 'safe' level. If you don't, you should. I'm sharing my experience... I'm into my 14 year with diabetes. You need to know you're at risk if you're too low, not only that... it's no good for your body (and you could well be a danger to others). I've been seeing my endocrinologist for years.... it's not a new thing for me. Plus I've already mentioned I've only been on insulin since 2010 and I've had plenty of hypos prior to that..... no difference with the experience of a hypo I must say.

 

[borofergie]

Too low is too low... you can't debate that. Anything under 4 mmol is too low. Do you know your 'safe' level. If you don't, you should. I'm sharing my experience... I'm into my 14 year with diabetes. You need to know you're at risk if you're too low, not only that... it's no good for your body (and you could well be a danger to others). I've been seeing my endocrinologist for years.... it's not a new thing for me. Plus I've already mentioned I've only been on insulin since 2010 and I've had plenty of hypos prior to that..... no difference with the experience of a hypo I must say.

How am I supposed to know that I am too low without test strips?

If my BG drops much below 4mmol/l my liver will dump - exactly like it's supposed to - and then it won't be at less than 4mmol/l anymore. I'm not hypoglycemic so there is no risk to me.

 

[Grazer]

Anything under 4 mmol is too low.

How can it possibly be when that's the norm for a non-diabetic?

 

[Sid Bonkers]

Anything under 4 mmol is too low.

How can it possibly be when that's the norm for a non-diabetic?

You have just answered your own question, you are diabetic so stop comparing yourself to non diabetics. For diabetics 4 is the floor any less is on the way to a hypo. Less worrying for diet only or diet and met user perhaps but never forget you are diabetic.

I have never to my knowledge suffered a hypo since stopping insulin treatment but thats not to say it wont happen or that it may not happen to others, insulin users or not. To ignore hypo symptoms is just plain ridiculous and you do so at your peril.

 

[Grazer]

If my BG drops much below 4mmol/l my liver will dump - exactly like it's supposed to - and then it won't be at less than 4mmol/l anymore. I'm not hypoglycemic so there is no risk to me.

Exactly the point. Just like a non-diabetic's would. I frequently go into 3's when I play golf; there's no magic barrier about "less than four" if you're on diet/metformin. It always goes back there anyway.

 

[Paul1976]

Hi Sid,Yes never forget you're a diabetic,true BUT,unless you are on insulin or pancreas stimulating drugs,then why would you be at any more risk of a Hypo then anyone else? Diabetes is a condition of HYPERGlycaemia.

 

[desidiabulum]

Some points seem to be getting confused here.
Grazer's point that metformin doesn't CAUSE hypos is RIGHT, RIGHT, RIGHT.
The suggestion being made elsewhere in the thread that hypos for T2s are not dangerous is WRONG, WRONG, WRONG. They may not send you into a coma like T1s, but the disorientation caused in T2s by pancreas-stimulating drugs can in some circumstances be very dangerous indeed, and for many of us the after-effects of a hypo are not a mild headache but complete prostration for 24 hours or more.

 

[smidge]

Hey all!

I completely agree with Grazer on this.

'4s the floor' is just aimed at insulin users. Below 4 isn't actually a hypo - it is just on its way to one and they don't want insulin users to go any lower for fear of a quick fall into dangerous levels. I'm on insulin (Insuman basal and Apidra) for LADA. I will happily maintain my levels in the 4s and let them drop a little lower on occasions depending on: when my last bolus was, whether my basal has passed its peak, what I am doing at the time, when my next meal is due etc. I know that my BG can go to the high 3s and stick there for ages (unless I have a lot of active insulin in me at the time). On the other hand, if I fall to the low 5s/high 4s within 2 hours of a meal and my basal is strong (usually after breakfast if it's going to happen), I take a preventative jelly baby to push them up a bit to avoid dropping too low. It is about understanding how your body is likely to react and taking into account the other relevant factors. You learn and you get better at it. The insulins we have these days allow us pretty good control. Other choices like type of diet also help. So for me, I'm happy to run low levels and assess the risks for myself - I don't tell other people to do it, but I do tell them not to fear mild hypos too much - they are easily corrected and prevented. In fact, pregnant women are advised to keep their's down as low as 3.6 - they wouldn't be told this if it was dangerous would they? There's a lot of margin built into 4!

Just my views

Smidge