'going lower' trend worries

[jopar]

HOWEVER. I have never been able to find any verified instance of someone's actually dying from hypo. It only happens in novels.

I've know 2 people to die from untreated Hypo's..(both T1's)

There's really is two definitions to 'Hypo's' one which is based on the likely hood of the individual actually dying if intervention isn't give... Then there's the definition of what a 'hypo' is...

With T2's who are diet only, or take medication such as metformin, that don't simulate the pancreas to produce an higher amount of insulin, are classed as having the same risk as a non-diabetic suffering low blood glucose levels, they are going to suffer a horrible experience but the lack of intervention isn't going to kill them...

However T2's who take medication such as insulin or Glitz type tablets.... Will if low blood glucose if intervention provided could die from said hypo..

MY MIL, suffers low blood glucose levels, (she doesn't eat enough) if left untreated she's likely to pass out, but saying that this might happen next to a busy road, so she sustains injury etc falling in front of a car, doesn't mean that her hypo's are as dangerous as mine, just means it happened at the wrong time and wrong place, which can actually happen to a T1 or T2 diabetic's who fit the 'dangerous' group!

Going back to the original post, about concerns at the 'going lower' trend...

I would say it's a concern...

The guideline targets are set partly for an initial goal to achieve get to this point you've lowered the risks or limit the impact of long term complications.. It at this point that further goal posts are individualised to the individual... Because what might be a realistic target for one, isn't for another there are many reasons for this, age, lifestyle, environmental and personal preference etc.

So what's achievable for one, may put another individual in a state of constant fear of their future because they can't do or achieve what the next person along can...

 

[shop]

HOWEVER. I have never been able to find any verified instance of someone's actually dying from hypo. It only happens in novels.

I've know 2 people to die from untreated Hypo's..(both T1's)

I am aware of 1 sadly ( T1 ) It was reported not long after my diagnosis. He was on his way home from a night out, on a train. Had a hypo and people thought he was drunk! Very sad.

 

[Grazer]

HOWEVER. I have never been able to find any verified instance of someone's actually dying from hypo. It only happens in novels.

I've know 2 people to die from untreated Hypo's..(both T1's)

I am aware of 1 sadly ( T1 ) It was reported not long after my diagnosis. He was on his way home from a night out, on a train. Had a hypo and people thought he was drunk! Very sad.

I think the general public could have some general "training" about type !s and dangerous hypos. Things like they do for strokes, or heart attacks, that you see on the TV as public interest ads. I saw a report of a young T1 lad at a train station collapsing, and people just walking round him. He survived thankfully. Trouble is, people nowadays are afraid to get involved; "is the person drunk or on drugs?" "Is it a set up and I'll be mugged as I try to help?" and so on. But a few simple ads with "ring for help if you see this" wouldn't go amiss.

 

[Defren]

I've had BG's in the 3's, very rarely I admit, but I have had them. I have never suffered a single hypo symptom ever, and considering that people can die from them, I hope I never do!!

 

[noblehead]

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

Surprising figures :shock:

 

[lucylocket61]

MY MIL, suffers low blood glucose levels, (she doesn't eat enough) if left untreated she's likely to pass out, but saying that this might happen next to a busy road, so she sustains injury etc falling in front of a car, doesn't mean that her hypo's are as dangerous as mine, just means it happened at the wrong time and wrong place,

Exactly Jopar

I think we need to keep in mind that there are low sugar incidents (like i have) , which are horrid but not dangerous

and there are Hypo's

Unfortunately they are given the same name, but are very different. But they seem to be being viewed as the same thing, which they are not.

 

[smidge]

Hey again!

Personally, I think the official figures are just too high. There is nothing wrong with BGs in the 4s - they are good! The serious hypo problem only applies to those of us on insulin and we lower the risk by knowing our bodies and how we react to food insulin etc. I'm not belittling the dangers of hypos and am accutely aware of them, but insulin is much better and more controllable these days and it's about time the medical world came to terms with that and stopped treating us all like idiots and reviewed the hypo level and the correction advice.

Smidge

 

[Pneu]

I will just have to agree with the majority in this thread...

If you are not on insulin inducing medication or insulin then yes you can suffer from 'low' blood glucose and get the same response as the general population.. i.e. hunger, nausea, dizziness, etc... if you have blood glucose below 4 and you want to use that as your base line then by all means take on board some glucose.. those pre-hypo symptoms are certainly not pleasant and there is certainly no reason to suffer from them if you have generally good glucose control..

If you are on insulin or a pancreas inducing medication then certainly you need to be much more aware of going below 4 mmol/l.. Modern insulins especially can rapidly change blood glucose.. as in drops of 1 or 2 mmol/l in a matter of minutes (when active.. ie. after there onset time) and therefore you need to be much more aware of what you have eaten and where you are in the profile curve of the insulin you have taken.. That said personally if I am 3.8 or 3.9 pre meal then I am not about to madly stuff glucose I'll just drop 1 unit off my injection and end up somewhere in the mid-high 4's.

In regards to the OP's question...

If I were type II and diet / met controlled then I would aim for as tight control as possible.. the chance of a dangerous hypo is slim to none and I think in type II's especially lower blood glucose is going to help maintain beta cell function... 7.8 mmol/l is the level at which beta cells generally die off... although levels over 5.5 mmol/l have been shown to damage them.. I am not suggesting 5.5 mmol/l as a +1 or +2 hour target.. but if you can get lower than 7.8 mmol/l without drastically effecting quality of life then I think you should..

For type II on insulin or other insulin inducing drugs or type I or type 1.5... then you need to add hypo awareness to the mix... You should be aiming for levels that give you the best control without losing hypo awareness or inducing excessive hypo episodes.. That is going to be a balancing act and the tightness of your control I would suggest depends on how much time and effort you want to put in to controlling your diabetes and how much you want to test, inject and adjust..

Mod Edit (Pneu): I should probably point out these are my personal opinions and from my HbA1c's you can see I don't personally follow the NICE or diabetes.co.uk guidelines re blood glucose.

 

[Pneu]

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.

Those are interesting...

I would say that I suffer from level 1's maybe once a month.. the odd drop into the 3.6 - 3.9 range pre-meal or if I am late eating or do unexpected activity.. I would not really consider this to be an issue..

I have a level 2 perhaps once a year (just checked my spreadsheet! I have had two readings of between 3.0 and 3.5 mmol/l in the last 36 months)... and I have had 2 level 3's since diagnoses probably both at the serious end of level 3.. i.e. passed out.. both in the first 18 months of being diagnosed. never had nor never want a level 4..

 

[wiflib]

Pneu, that's the way I see it. I'm 51, my mum is still very much alive and kicking at 91 and the only reason Dad died last November at 88 is because he placed blind faith in his doctors. It still took him 30 years though.

I figure I probably have, avoiding buses, at least another 40 years to live and I want to make sure I treat my pancreas as gently as possible. I could very easily run my levels in the 5-6 mark but that means my beta cells will die faster. Instead, my levels are 3-4, rarely hitting a 5 unless I've done something strenuous.

For me, keeping as low as I possibly can is my target but I'm lucky, my diabetes was diagnosed through sheer chance. I didn't have to wait for symptoms.

wiflib

 

[Mileana]

Okay. So if someone has hypo symptoms interfering with their ability to think, coordinate movements etc, this is not dangerous and they should just get on with whatever they were doing and hope they were not in the wrong place at the wrong time, such as at the wheel... Surely not?

I can appreciate like I said 10 posts ago that a t2 or non-diabetic hypo will not progress into coma and death, but it still doesn't mean that it is 'not dangerous'.

I am all for loads of information to the general public about t1 hypo's as they're deadly on their own, regardless where the person might be if not treated.

I am sorry, but it's fairly pointless to say that because someone has had or has a risk of getting a 4 on above list, then the 2 and 3 does not present a danger to self or others in the same or a different person.

All I'm saying if someone has hypo symptoms they shouldn't pretend to be a full capacity - hence the 'incapacitated' in the description above. Anything else than taking the symptoms seriously while driving etc etc would be madness.

 

[Anonymous]

Okay. So if someone has hypo symptoms interfering with their ability to think, coordinate movements etc, this is not dangerous and they should just get on with whatever they were doing and hope they were not in the wrong place at the wrong time, such as at the wheel... Surely not?

I can appreciate like I said 10 posts ago that a t2 or non-diabetic hypo will not progress into coma and death, but it still doesn't mean that it is 'not dangerous'.

I am all for loads of information to the general public about t1 hypo's as they're deadly on their own, regardless where the person might be if not treated.

I am sorry, but it's fairly pointless to say that because someone has had or has a risk of getting a 4 on above list, then the 2 and 3 does not present a danger to self or others in the same or a different person.

All I'm saying if someone has hypo symptoms they shouldn't pretend to be a full capacity - hence the 'incapacitated' in the description above. Anything else than taking the symptoms seriously while driving etc etc would be madness.

:thumbup: exactly Mileana.

I think quite a few on this thread are missing the point that going low is bad for you regardless of whether you will drop dead from it or not.... and if you have symptoms at all it is dangerous!

If you're not going to think of yourself, then think of others.... treat your hypo! A hypo is a hypo, no disguising it or pretending it isn't.

My endocrinologist has made it perfectly clear that if you have symptoms your judgment has ALREADY gone.... that means you can't be doing anything that can be risky to you or someone else.

Bottom line... know your 'safe' level and treat your hypo. Whether or not it's going to kill you is hardly the point. Hypos are dangerous for both T1 and T2 diabetics. Hopefully you never have to learn this the hard way if one day your liver happens to fail on you and not dump that glucose.

Keeping yourself in safe levels is important.
Interesting medical article on Type 2 diabetes and Liver Disease: http://care.diabetesjournals.org/content/30/3/734.full

 

[wiflib]

And those type two's who are not allowed to have meters and may be suffering a false hypo? Would it be a good idea for them to treat it?

wiflib

 

[Grazer]

All I'm saying if someone has hypo symptoms they shouldn't pretend to be a full capacity - hence the 'incapacitated' in the description above. Anything else than taking the symptoms seriously while driving etc etc would be madness.[/quo

Without wishing to go round in circles again, the point is that a type 2 on diet only or metformin is no more likely to suffer a hypo at the wheel than a non diabetic. So you might as well tell the entire population to be careful while driving in case they have a hypo. Would you tell everyone at weight watchers to be careful about Hypos when driving as they are
On a diet? Should the DVLA tell drivers to notify them if they skip meals then exercise before driving? Because this is what can give the general population low blood sugar, INCLUDING diabetics on diet only/metformin. People get low blood sugar, as Pneu said and as many of us have said, but people includes diabetics and non diabetics. The only people likely to have hypos at the wheel MORE than a non diabetic, are diabetics on insulin or insulin promoting drugs. Thi Is why the DVLA only want to hear from them. If anyone, diabetic or not, had any medical condition affecting driving they should tell the DVLA. So if they had regular hypos affecting them because if some medical condition they should speak up. But diabetes in itself doesn't do that, where the diabetic is controlling it on diet or metformin. So if your diabetes, controlled by diet means you haven't eaten enough and you get low blood sugar, by all means have a bite to eat before you drive. But that's the extent of it. You're not gonna suddenly collapse at the wheel unless there something else wrong with you medically.

 

[Defren]

All I'm saying if someone has hypo symptoms they shouldn't pretend to be a full capacity - hence the 'incapacitated' in the description above. Anything else than taking the symptoms seriously while driving etc etc would be madness.[/quo

Without wishing to go round in circles again, the point is that a type 2 on diet only or metformin is no more likely to suffer a hypo at the wheel than a non diabetic. So you might as well tell the entire population to be careful while driving in case they have a hypo. Would you tell everyone at weight watchers to be careful about Hypos when driving as they are
On a diet? Should the DVLA tell drivers to notify them if they skip meals then exercise before driving? Because this is what can give the general population low blood sugar, INCLUDING diabetics on diet only/metformin. People get low blood sugar, as Pneu said and as many of us have said, but people includes diabetics and non diabetics. The only people likely to have hypos at the wheel MORE than a non diabetic, are diabetics on insulin or insulin promoting drugs. Thi Is why the DVLA only want to hear from them. If anyone, diabetic or not, had any medical condition affecting driving they should tell the DVLA. So if they had regular hypos affecting them because if some medical condition they should speak up. But diabetes in itself doesn't do that, where the diabetic is controlling it on diet or metformin. So if your diabetes, controlled by diet means you haven't eaten enough and you get low blood sugar, by all means have a bite to eat before you drive. But that's the extent of it. You're not gonna suddenly collapse at the wheel unless there something else wrong with you medically.

+1

Metformin and diet are not causes or will they increase the chances of hypo's. The DVLC would soon have something to say if they did!!

 

[Mileana]

I am from a country where we can have meters. Limited strips for non-insulin users, but we do have them.

False hypo's often happen at the start when levels are coming down but your body interprets it as if glucose is missing, or it is a real but not lethal hypo induced by too much insulin being sent out to deal with a meal with the insulin still present when the meal is gone, or after something very stenous over a longer period of time, or just for no reason if you're prone to it.

I would certainly say treat, but don't overtreat. False or real hypo's in normal and type2 people will respond the same as a type1 (milder than 4) hypo to treatment. You can treat it normally with much less glucose or for that matter, you could choose to wait.

I would wait well out of harms way, though, or I would treat it with a small amount of something and a bit of bread afterwards.

Our nurses say that half a slice of bread with a bit of jam or the like will make you feel much better when your blood sugar starts to go back up. Of course, you want to be in a position where a few months down the road your body will have adjusted to normal or near normal levels so you don't have the symptoms at high levels.

The symptoms are what interferes with your ability to make a sound decision though so you need the symptoms to go away before driving etc. Then you need to think about what the heck you can do to get your body used to normal ish blood sugars so you don't have the swings and the perceived lows.

That's my view at least.

 

[Mileana]

DVLA about Type 2, on meds that don't induce hypo's.

Drivers will be licensed unless they develop relevant disabilities e.g. diabetic eye problem affecting visual acuity or visual fields, in which case either refusal, revocation or short period licence.
Drivers are advised to monitor their blood glucose regularly and at times relevant to driving. They must be under regular medical review.

Now, it is not my fault that the UK is inconsistent in that it 'requires'/strongly encourages you to measure, but doesn't give you the kit. It does however say you are 'advised to'.

From the At a Glance Medical Standards thingamy that is on their page.

 

[Defren]

DVLA about Type 2, on meds that don't induce hypo's.

Drivers will be licensed unless they develop relevant disabilities e.g. diabetic eye problem affecting visual acuity or visual fields, in which case either refusal, revocation or short period licence.
Drivers are advised to monitor their blood glucose regularly and at times relevant to driving. They must be under regular medical review.

Now, it is not my fault that the UK is inconsistent in that it requires you to measure, but doesn't give you the kit. It does however say you are 'advised to'.

From the At a Glance Medical Standards thingamy that is on their page.

It isn't anyone's fault, but the point is, if you are on Metformin and diet alone, you are as likely to hypo as a non diabetic, hence why the DVLA don't require any special measures put in place, to allow you to continue to drive.

 

[Grazer]

If every time a new T2 felt a bit rough because their BGs were getting a bit better they had half a jam Sarni, they'd never get in control. That's the sort of advice I followed from my dietician and nurse and I regularly got BGs at 14 . it's only when I ignored them that I got down to decent levels, on diet only. By the way, if you're gonna have a Sarnie, have a decent one and put bacon
In it!
Re your DVLA info, that's a general statement issued to any diabetics of interest to them. I've spoken with them; they don't even want to hear from you if you're on diet only or metformin. It's insulin dependants who are of interest to them.

 

[Mileana]

Okay. Fine. Drive on then. Get blurred vision and lacking coordination and run a kid over. Then let's talk.

DO NOT DRIVE WHEN AFFECTED BY SYMPTOMS OF HYPO, RARE OR NOT.

That's not so hard.

Get used to the lower level in your sofa, that's cool. Or in the office. Or in the bedroom. Or walking down the street where you'll bump your head, not some toddler.

Thank you.