'going lower' trend worries

[Dillinger]

But let us say a type2 has a bad hypo and is .... mountain-biking on a slope, tending to machinery...

If you are a Type 2 and you are mountain biking whilst tending to machinery please be careful. Also, please consider another job; that one sounds like a nightmare...

I would say though; on insulin or other glucose lowering medication; worry about it as necessary. Not on such medication; don't worry about it.

Don't forget also that your body basically operates on watching out for changes; that's how the eyes work for instance; you mainly 'see' edges and your brain makes up the stuff in the middle. You will notice changes in blood sugar in a similar way; if you constantly run high you will feel a drop to 'normal' levels, if you constantly are on low blood sugar levels you can get below the 4.00 mmol/litre level without noticing. Does that matter? Not really as long as you can tell when you are getting to a level at which you have problems functioning.

Also keep in mind that if the non diabetic HbA1c is between 3.5-5.5%. then at the 3.5% end of the range people will be running at an average of 2.6 mmol/litre. Of itself then that is not doing them any harm; as diabetics taking glucose lowering medication you would probably find it very difficult to get by with that sort of level as you would have absolutely no room for error, but the fact remains of itself that level of blood glucose isn't a problem.

Dillinger

 

[shop]

I think it's wrong to be so totally dismissive even though it's relatively rare.
You may even be more likely to find people on forums that have hypos whilst on met; their diabetes doesn't conform so they start looking for answers.
Here's one case . It may have had a contribution from an ACE drug, which many people also take.
http://www.japi.org/june2007/Corr2.htm
The UKPDS also found a very small number of cases but they were a few.
http://www.jdcjournal.com/article/S1056-8727(05)00119-4/fulltext
Interestingly one group who were more likely to have hypos (with any treatment) were those who who were antibody positive (ie they probably had LADA but were being treated as T2; this trial was one of the studies that led to differential diagnosis) This makes sense with the sort of roller coaster presence/absence of insulin that seems to characterise early LADA.

Borofergie: No-one should stuff themselves with anything when hypo, Even with the 15g advice this would be only 3 jelly babies

Pheonix I can see your point, however I also think that it is wrong to suggest that all non insulin taking diabetics can experience a hypo that would occur in an insulin taking diabetic with the result being unconciousness unless treated. I agree that to encourage someone to take jelly babies etc when there is no need is unnessasary!

I am a little concerned here as I wouldnt want to dilute the seriousness of a true untreated hypo, afterall without knowledge a passer by could quite easily assume that a person is simply drunk!

I have supported the T2 argument about strips and education.

My bugbear from a T1s point of view is that the general public have little knowledge of the dangers of a true insulin induced hypoglycemia episode!

It is clearly wrong to suggest that all diabetics are simply prone to these, as paul said Diabetes is a HYPERGLYCIEMIC PROBLEM. It is the over injecting/ undereating/ too much excercise ............Lack of balance between the 3 that causes it.

Sorry guys rant over!

 

[Grazer]

Phoenix, seems to be looking for exceptions to the rule! If you tried hard enough, I bet you could find an article showing non-diabetics suffering the same.
To put numbers in perspective for those concerned about "4" being a magic number for diabetics on diet only:-

"Research in healthy adults shows that mental efficiency declines slightly but measurably as blood glucose falls below 65 mg/dL (3.6 mM) in many people. Hormonal defense mechanisms (adrenaline and glucagon) are normally activated as it drops below a threshold level (about 55 mg/dL (3.0 mM) for most people), producing the typical hypoglycemic symptoms of shakiness and dysphoria.[18]:1589 Obvious impairment may not occur until the glucose falls below 40 mg/dL (2.2 mM), and many healthy people may occasionally have glucose levels below 65 in the morning without apparent effects. Since the brain effects of hypoglycemia, termed neuroglycopenia, determine whether a given low glucose is a "problem" for that person, most doctors use the term hypoglycemia only when a moderately low glucose level is accompanied by symptoms or brain effects.

Determining the presence of both parts of this definition is not always straightforward, as hypoglycemic symptoms and effects are vague and can be produced by other conditions; people with recurrently low glucose levels can lose their threshold symptoms so that severe neuroglycopenic impairment can occur without much warning, and many measurement methods (especially glucose meters) are imprecise at low levels.

Diabetic hypoglycemia represents a special case with respect to the relationship of measured glucose and hypoglycemic symptoms for several reasons. First, although home glucose meter readings are often misleading, the probability that a low reading, whether accompanied by symptoms or not, represents real hypoglycemia is much higher in a person who takes insulin than in someone who does not.[19][20] Second, because injected insulin cannot be "turned off," diabetic hypoglycemia has a greater chance of progressing to serious impairment if not treated, compared to most other forms of hypoglycemia. Third, because glucose levels are often above normal for long periods of time (hours, days, or months) in persons with diabetes, hypoglycemic symptoms may sometimes occur at higher thresholds than in people whose blood sugar is usually normal. For all of these reasons, higher meter glucose thresholds are often considered "hypoglycemic" in people with diabetes."

I've highlighted the bits I think are particularly pertinent, such as "obvious impairment may not occur until below 2.2..". The last highlighted section is interesting because, as well as confirming the "insulin use" message, it also refers to what we call "false hypos", which is why I think a lot of people THINK they're having "hypos" when they start to get back to normal levels.

 

[lucylocket61]

I have had episodes of low blood sugar all my life. This is what happens

I am going along quite normally, then within seconds I start to tremble, I go very cold, I feel dizy. I cant move or talk clarly or think. I have to stop what I am doing and quickly move to a safe place and position. I mean very quickly, while i still can. Within 20 seconds. i get a wave of nausea and my head pounds.

This cpontinues until I have something like orange juice or something sweet. Then it gradually passes over about 15 minutes, until I feel human again and am able to function, but feel very tired.

I have always had this. It used to be that I had to eat every 3-4 hours or this would happen. It was worse when I was pregnant or before my periods. This would happen 2 or 3 times a week. More if i was very busy.

It has gradually got worse over the years. Since I started low carbing after my diagnosis it has gradually become less of a problem and I have now gone a whole week without it happening.

It may not be life threatening or dangerous, although if i couldnt get in a safe place quickly it used to be scary and in crowds or shopping I had to sit on the floor and hope I didnt get trodden on.

It was/is horrible and stops me in my tracks. My doctors never did find out what was going on. They think I have a very sensitive insulin tolerance. it happened at my surgery once and my levels were 4. They now say i do have a form of hypo and should be aware of this at all times and treat it like a diabetic hypo.

If i dont have anything sweet or orange juice, then it gets worse until I faint for about 3 minutes. Its scary.

 

[Paul1976]

Yes indeed,after running high levels for a long time,the first time I got a reading in the 6's i had a brief feeling of weakness,nausea,struggling to think clearly and sweating and had to sit down for a couple of minutes but it passed very quickly without any intervention.I'm now used to lower levels and it hasn't re-occured since.My body was telling me "Where's all my lovely sugar gone?"

 

[Grazer]

I have had episodes of low blood sugar all my life. This is what happens

I am going along quite normally, then within seconds I start to tremble, I go very cold, I feel dizy. I cant move or talk clarly or think. I have to stop what I am doing and quickly move to a safe place and position. I mean very quickly, while i still can. Within 20 seconds. i get a wave of nausea and my head pounds.

This cpontinues until I have something like orange juice or something sweet. Then it gradually passes over about 15 minutes, until I feel human again and am able to function, but feel very tired.

I have always had this.

Which I guess is the point we're making - you've always had it, since before you were diagnosed, which was recent, and since before you took metformin. I know it's horrid. As I said earler in this thread, my non-diabetic daughter gets it if she doesn't eat regularly enough - I mean VERY regularly, although she seems to be getting better noweadays a little. Our issues aren't always about diabetes.

 

[xyzzy]

The UKPDS figures divide hypo's into 4 strengths.

(1) transitory symptoms not affecting normal activity - person just got on with life
(2) temporarily incapacitated but patient able to control symptoms without help - ate some jelly babies then got on with life
(3) incapacitated and required assistance to control symptoms - presumably fainted, ate some jelly babies then got on with life.
(4) required medical attention or glucagon injection - real hypo.

For diet only diabetics

8 in 1000 report a hypo of some description
1 in 1000 report a hypo where they actually needed to do something about it i.e level 2 to 4

For metformin diabetics

17 in 1000 report a hypo of some description
3 in 1000 report a hypo where they actually needed to do something about it. i.e level 2 to 4

NOT worth worrying about and I bet if similar statistics were done for "diet only NON diabetics" who were told what to look out for you would get pretty similar results.

It also doesn't say how many really were level 4 full blown hypos so for example in the case of the 3 in 1000 people who had a level 2, 3 or 4 hypo they could all have just eaten a jelly baby and got on with their lives.

... and of course the evidence is mostly anecdotal as apart from the some of the level 3's and all the 4's no one but the person themselves witnessed it. We are constantly told on this forum that anecdotal evidence is no good.


I rest my case your honour.

 

[Mileana]

I have had episodes of low blood sugar all my life. This is what happens

I am going along quite normally, then within seconds I start to tremble, I go very cold, I feel dizy. I cant move or talk clarly or think. I have to stop what I am doing and quickly move to a safe place and position. I mean very quickly, while i still can. Within 20 seconds. i get a wave of nausea and my head pounds.

This cpontinues until I have something like orange juice or something sweet. Then it gradually passes over about 15 minutes, until I feel human again and am able to function, but feel very tired.

If i dont have anything sweet or orange juice, then it gets worse until I faint for about 3 minutes. Its scary.

This.

Then I don't care the amount of science that says the oppossite - I would not be driving a car while mountain biking down a slope and operating machinery :lol: :lol: Sorry about the previous grammar/punctionation error, still learning the language.

It may be very unlikely it will happen, but if it does, stop and treat, I would say.

 

[lucylocket61]

But my point is:

I am very unusual with this

I had it since I can ever remember - not since my diabetes started

Metformin, along with low carbing, has helped to control it

If it was a true serious life-threatening condition such as Types 1's have, no amount of dietary control or metformin would have helped. They need insulin. So, whilst it is a form of mini-hypo, it is not a true hypo and has nothing to do with taking Meformin.

 

[Mileana]

True, I was arguing against the 'not dangerous' because it is.

Metformin or not, diabetic or not. Depending where you find yourself when it happens.

 

[xyzzy]

My bugbear from a T1s point of view is that the general public have little knowledge of the dangers of a true insulin induced hypoglycemia episode!
Sorry guys rant over!

As a Type 2 diabetic with a Type 1 son then although I am never likely to have to worry about a real life threatenning hypo I do hope I know excatly where you're coming from and agree 100% with the sentiment behind your rant.

 

[shop]

But my point is:

I am very unusual with this

I had it since I can ever remember - not since my diabetes started

Metformin, along with low carbing, has helped to control it

If it was a true serious life-threatening condition such as Types 1's have, no amount of dietary control or metformin would have helped. They need insulin. So, whilst it is a form of mini-hypo, it is not a true hypo and has nothing to do with taking Meformin.

Yes Lucy I agree. I had this once years before diagnosis and a friend of mine had several episodes of hypoglyciemia as you did before becoming diabetic. Her doctor actualy told her at the time that she had the opposite of Diabetes! ( which is correct )

My point was that It seemed that certain posts were suggesting that ALL diabetics are at risk form a hypo (the same as an insulin induced one )

Anyone can have low blood sugar and some are worse as you and my friend discovered.

It was only when i had an insulin induced one that I realised that I hd had one before ( prior to diabetes )

Anyway I think Ive gone on a bit much now !

Lucy :roll:

 

[shop]

My bugbear from a T1s point of view is that the general public have little knowledge of the dangers of a true insulin induced hypoglycemia episode!
Sorry guys rant over!

As a Type 2 diabetic with a Type 1 son then although I am never likely to have to worry about a real life threatenning hypo I do hope I know excatly where you're coming from and agree 100% with the sentiment behind your rant.

Thanks xyzzy

 

[Anonymous]

Here in Australia we have the following advice from Diabetes Australia (and it's standard advice that I've always received from all my medical team):

Symptoms of hypoglycaemia vary from person to person, however common feelings are:

Weakness, trembling or shaking

Sweating

Light headedness

Headache

Dizziness

Lack of concentration/behaviour change.

Tearful/crying

Irritability

Hunger

Numbness around the lips and fingers.

If you feel any of these symptoms, test your blood glucose level if time and circumstances permit. If you are unable to do so, treat as hypoglycaemia.

Treat low or dropping glucose levels even if you feel fine.

Link: http://www.diabetesaustralia.com.au/en/ ... glycaemia/

 

[xyzzy]

My bugbear from a T1s point of view is that the general public have little knowledge of the dangers of a true insulin induced hypoglycemia episode!
Sorry guys rant over!

As a Type 2 diabetic with a Type 1 son then although I am never likely to have to worry about a real life threatenning hypo I do hope I know excatly where you're coming from and agree 100% with the sentiment behind your rant.

Thanks xyzzy

No problem. This discussion always makes me a bit cross as you can probably tell.

I never dispute that anyone can get symtoms like dizziness or nausea or even fainting from having low blood sugars but that is NOT the same as a full on insulin induced life threatenning hypo that insulin using diabetics face every time they inject. As a parent one of the worst days of my life was seeing my son begin to hypo at the bottom of a cliff when we were holidaying in Cornwall. It was soon after his diagnosis and he was just a learner. The feeling of uselessness I got as a parent will stay with me forever. In the end two of my other children literally ran up the cliff and returned with some glucose just in time. So please remember that when you refer to feeling a bit dizzy or even fainting as a "hypo".

 

[phoenix]

Grazer, I'm not looking for exceptions.
I looked to see how frequently they happened, found that there were some but that they were rare so reported that.
I would suggest that neither you nor I are capable of knowing how real a persons hypos are on an internet forum which is why I said that people shouldn't be dismissive.
I accept that the low blood glucose level in itself is unlikely to lead to harm however if someone becomes disoriented in certain circumstances then they may do themselves or others harm.

 

[Mileana]

It's pointless, sorry.

I'll go take my insulin now, it's dinner time.

I'm sorry for faking a hypo and pretending to be disorientated and not be able to stand even before starting insulin. I will refrain from this in the future as now I realize some people have real problems.

 

[shop]

Thanks xyzzy [/quote]

No problem. This discussion always makes me a bit cross as you can probably tell.

I never dispute that anyone can get symtoms like dizziness or nausea or even fainting from having low blood sugars but that is NOT the same as a full on insulin induced life threatenning hypo that insulin using diabetics face every time they inject. As a parent one of the worst days of my life was seeing my son begin to hypo at the bottom of a cliff when we were holidaying in Cornwall. It was soon after his diagnosis and he was just a learner. The feeling of uselessness I got as a parent will stay with me forever. In the end two of my other children literally ran up the cliff and returned with some glucose just in time. So please remember that when you refer to feeling a bit dizzy or even fainting as a "hypo".[/quote]


I completely understand as a T1, if it were my child that was T1 I would be even more passionate. I thank god every day that it is me not him. I have a friend with 2 T1 children ( she found out the eldest one was T1 just as the youngest was going on a pump ) She manages it well ( I suppose she has to.)
What makes me even more empathetic and fired up is when I hear of Mums and Dads up in the night constantly testing their child terrified that they wont wake up! It must be very difficult. Its one thing managing your own diabetes another to be responsible for your child's.

There is a difference I agree. Also I used to faint as a child/ young adult so I can say from experience, there is also a big difference between the two.

Lucy.

 

[xyzzy]

It's pointless, sorry.

I'll go take my insulin now, it's dinner time.

I'm sorry for faking a hypo and pretending to be disorientated and not be able to stand even before starting insulin. I will refrain from this in the future as now I realize some people have real problems.

Your argument is no different to Mep's so I'm afraid it get's the same answer at least to begin with.

How do you know EXACTLY the same thing wouldn't have happened if you hadn't been diagnosed diabetic? No one is disputing with you that what you said happened what we are disputing is that having the label "T2 diabetic" was the cause.

Lot's of people go dizzy, get nauseous or even pass out who don't have that label. Encouraging diet only or diet only plus Met diabetics to be more concerned about hypo's than the general non diabetic population is complete nonsense. It fact I would argue it can cause a newly diagnosed diet only T2 a load of issues if they get told "Now you are diabetic expect to hypo" Doing so can stop them getting their levels under control through a belief that they are now "different" to everyone else in the general population and that for some reason run higher risks and should therefore keep their levels high.

Did they have a smaller risk of a hypo the day before they were diagnosed? What about a month before or a year before? Did most even know about hypos before they were diagnosed or have even recognised one if they had one in their previous non diabetic life?

Why is a diet only T2 any more likely to hypo than a non diabetic? Where is your evidence?


You are right. If you get those symptoms you should treat them whether you are diabetic or not and what ever blood level they emerge at. No one is disputing that and no one is accusing you of faking what you felt so please don't imply they are. If you are in a dangerous environment immediate treatment of the symptoms is obvious.

The difference is that if you were alone in a safe environment and not an insulin user then when those symptoms occurred unless you were very very unluckly your liver would dump and you would recover. It did it to me a few weeks ago and I reported it on a thread for discussion but I never once claimed the fact that I fainted for a few seconds or felt very sick for a while afterwards equated in seriousness to a full blown life threatening insulin induced hypo. That is all I'm saying.

Someone alone in a similar same safe environment who overdoses on insulin purely by mistake may not be so lucky. Apparently as a diet only or Met using diabetic the research suggests you have at most a 3 in 1000 chance of being unlucky and end up needing medical attention. I wonder what the comparative death rate caused by hypos is between diet only or diet + Met users and insulin using diabetics.

 

[Grazer]

I wonder what the comparative death rate caused by hypos is between diet only or diet + Met users and insulin using diabetics.

A bit like the England world cup footie results.....