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'going lower' trend worries

xyzzy said:
Grazer said:
And let's remember that the biggest challenge we have with most new type 2's is in STOPPING them from eating bread, sugar, bakery products and so on. Let's not give them an excuse to eat those things everytime they THINK their blood sugar is going too low, because maybe they're not used to lower more normal BGs, when for the vast majority getting out of double figures is the first challenge.
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Yes I agree Grazer, apart from the distinction that an insulin induced hypo is life threatening and normally having "low blood sugars" isn't that's the other thing that makes me angry in all of this, the damage it can do to the newly diagnosed.
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I completely agree. There is never an excuse for a jelly baby to pass a non-insulin-dependant diabetic's lips :lol:

The other thing that really makes me angry is the advice that insulin-users get on correcting 'hypos'. The medical world builds in a huge margin of error to 4. New insulin users quite naturally build in their own margin (not knowing that a huge margin has already been built in) and often start correcting the moment they fall into the high 4s or low 5s. The advice is then to take 10g quick acting carb e.g. orange juice, coca cola etc, followed by 15g slow-acting carb e.g a sandwich. By the time you've eaten 25g or more of carb with no insulin, your BG is sky high and you spend the day on a high/low roller coaster. The advice should be tailored to the individual and based on their body weight. Smaller people need less carb to raise blood sugars. At the very least, we should be advised to take very small amounts of carb and test frequently. 1 jelly baby will raise my BG by 2.5 or 3 (sometimes more) within less than 10 minutes. It contains 6g pure glucose.

Sorry if that's a bit ranty, but I get so frustrated with this issue!

Smidge
 
mep73 said:
Here in Australia we must advise if we have a medical condition and it is noted on our licence. [/quote

This is simply incorrect. I am a type 2 driver with a NSW truck (Medium Rigid) licence and diabetes is NOT noted on my licence anywhere!!!! Each State is different I believe. I did enquire when I was diagnosed as to the requirements with the RTA but was told that I am only required to inform them. If I were on insulin I believe I have to get a letter from my doctor every two years stating I am well controlled. I may not drive if I have above the legal limit of alcohol in my system and my eyesight has to be better than the holder of a car licence and if I need glasses for the eyesight test, that is noted on my licence and I must wear glasses when driving.

Please do not give incorrect information mep73.
Alison
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4mmol/l IS NOT a DANGER level to people not using Insulin or insulin promoting drugs. In fact it's not even low enough for endocrinologists to diagnose Reactive Hypoglycaemia.
People who habitually run blood glucose around 10 [of which there are Many] may feel very hypo and ill/faint/dizzy at a bg of 7. I'e met 1 long tem T2 who claims to feel all this if ever his Bg hits single figures. [He is an insulin user!]
the "4's the floor" mantra was designed for insulin users to warn them to the dangers of a bg which might still be dropping.
It came from a DUK volunteer NOT qa n HCP, but was adopted, because it's very memorable. it's not based on science.
I can and do often function at well below 4 and even below 3. I don't feel hypo [and yes I do know the feeling] until just above 2.
I'm unlikely to be simply hypo unaware, because I've not used insulin promoters for years and habitually run Bg at about 5.
for the first couple of years after diagnosis, I followed HCP guidelines, ran a BG of 7 - 10 and experienced hypo symptoms as a result of using Gliclazide, at about 4
Incidentally all the familiar hypo symptoms are well known to strict low calorie dieters.
Hana
 
My BG's are always 3-4 and have been for a long time. Am I in a permanent state of hypoglycemia?

wiflib
 
[quote="smidgeThe other thing that really makes me angry is the advice that insulin-users get on correcting 'hypos'. The medical world builds in a huge margin of error to 4. New insulin users quite naturally build in their own margin (not knowing that a huge margin has already been built in) and often start correcting the moment they fall into the high 4s or low 5s. The advice is then to take 10g quick acting carb e.g. orange juice, coca cola etc, followed by 15g slow-acting carb e.g a sandwich. By the time you've eaten 25g or more of carb with no insulin, your BG is sky high and you spend the day on a high/low roller coaster. The advice should be tailored to the individual and based on their body weight. Smaller people need less carb to raise blood sugars. At the very least, we should be advised to take very small amounts of carb and test frequently. 1 jelly baby will raise my BG by 2.5 or 3 (sometimes more) within less than 10 minutes. It contains 6g pure glucose.

Sorry if that's a bit ranty, but I get so frustrated with this issue!

Smidge[/quote]

When newly diagnosed I would feel the symptons of a hypo from the high 3's and below, the advice on some fast acting sugar followed by more carbs worked well then and still does now although I now feel hypo symptons at 3.5 and below. When I had the hypo, in relation to my last meal or when I expected my next meal to be, would determine how many carbs I took on board after the intial hit of fast acting. It is purely dependant on the individual and I don't think the medical world should be held to blame as they can't cater for individuals when publishing guidelines etc.

What the medical world has always told me is that controlling diabetes involves a huge amount of trial and error. Hence, you know how a jelly baby will effect you. I can predict what my blood sugars at the end of a run will be to probably +/-0.3 if I know my starting level, how many JB's I ate during the run and whether my levels were falling or rising before the start. Trial and error.
 
Hey Scardoc!

Scardoc said:
When newly diagnosed I would feel the symptons of a hypo from the high 3's and below, the advice on some fast acting sugar followed by more carbs worked well then and still does now although I now feel hypo symptons at 3.5 and below. When I had the hypo, in relation to my last meal or when I expected my next meal to be, would determine how many carbs I took on board after the intial hit of fast acting. It is purely dependant on the individual and I don't think the medical world should be held to blame as they can't cater for individuals when publishing guidelines etc.

What the medical world has always told me is that controlling diabetes involves a huge amount of trial and error. Hence, you know how a jelly baby will effect you. I can predict what my blood sugars at the end of a run will be to probably +/-0.3 if I know my starting level, how many JB's I ate during the run and whether my levels were falling or rising before the start. Trial and error.
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I don't really disagree with what you say there. My point is that the medical world tell you about correcting BG of 4 with 10g + 15g carb as though it's the law and is absolutely essential for everyone. It isn't. I actually got told off last week for having an HbA1c of 6.1 - the nurse honestly believes I might die of a hypo if I run an HbA1c at that level - I think it's too high. They absolutely put the fear of God in insulin-using diabetics. The end result is that many Type 1/1.5s run their BGs too high and suffer the complications. I really do hold the medical world to blame for that. Their advice might have been appropriate back in the day when the only insulin available was the twice daily mixes, but it needs revising for the bolus/basal regime where you have much better control over when an how much insulin is active.

Smidge

Smidge
 
Phoenix
I'm aware that some people are thinking that "dead in Bed" syndrome in diabetics might be caused by hypoglycaemia. However if you follow the references, you'll find it's not proven and that other explanations account for most of these deaths. Many have remained unexplained. Post mortem, it's difficult to determine that hypoglycaemia happened.
I know of a couple of examples of hypoglycaemic drivers causing deaths on the road, but not of any PROVEN deaths from hypoglycaemia.
Even if insulin caused a few of the deaths mentioned, It was essentially an overdose which did it. Not simply a low bg.Since a very severe hypo causes fitting, I'm surprised that no evidence of this is qupoted in the "dead in bed" literature.
Please don't get the idea that I would ever make light of any unexpected death, specially that of a child. I understand very well how devastating an occurence it can be.[a close friend lost her non-diabetic son to a sudden death in bed. His father was the one who found him. 10 years later, there's still a HUGE hole in this family]
I'm just analysing evidence scientifically. My husband is a long term T1 as I've written before, and I've dealt with a few hypos, a couple bad enough to cause fitting and frothing at the mouth.
Hana
 
I have to admit Smidge that my last HbA1c was 6.7% and my highest ever, previous being 6.1% and lowest being 5.8%. The doc was happy and said 6.5% was ideal as anything lower probably indicated I was running too low at times. I was very surprised that my level shot up to 6.7% but I did have a bad spell around xmas where I couldn't keep my levels down and it turned out I had an infection.

Now, I keep a letter in my drawer at work as it has phone numbers of the diabetes team. It's from Oct '08, 6 months after diagnosis. I quote:

"your HbA1c is fairly tight at 5.9%. Hopefully the carbohydrate counting advise that you are due to get later this month will help stabilise your blood tests, but I would suggest that you cut back your insulin doses if you are finding that your tests are less than 4 regularly"

Now, I don't regularly have readings less than four and never really have. My current meter average for the last 180 days is 6.5%. In my experience my HbA1c will come back less than the meter so I'm anticipating 5.9/6.0%. The fear they have put into me is not that I will die of a hypo but that I will stop to feel the effects of hypos until it's too late. That does worry me a bit but at the same time I know my body and I know to test before driving, before and during exercise etc so........ I've learned to listen to their advice but factor "me" in when I do. Also, any GP/nurse I have seen always goes "Oh, your diabetic", looks at my HbA1c results and says they're excellent!!
 
Hana,
It is hardly possible to initiate a clinical trial. Until now very few people have worn CGMs.
However, there was in those references one report of CGMS recording very low blood glucose levels prior to death and' no other major abnormalities that could have contributed.'
http://www.ncbi.nlm.nih.gov/pubmed/19833577

It was essentially an overdose which did it
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.
You are right that the hypoglycaemia would be caused by too much insulin.All my hypos are caused by too much insulin relative to what I'm doing, occasionally to what I have eaten. I don't think anyone said anything different. The problem is that in some people, particularly children their insulin needs and activity patterns vary so making insulin requirements more difficult.
I've had extremely low glucose levels and been able to treat them myself.
I've also had a CGM show that my glucose levels to fall and rise to safety. I was only waking up after the event. I'm lucky in that I still seem to have a good counter regulatory system. That isn't the case for every T1 (and it may change for me).
 
phoenix said:
Hana,
However, there was in those references one report of CGMS recording very low blood glucose levels prior to death and' no other major abnormalities that could have contributed.'
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So, isn't 1 person in a report, er anecdotal?

The point is most people reading this will be Type 2's many of whom are newly diagnosed and have been given hardly any information, other than 'eat a balanced diet' and include starchy carbs in every meal. Posting links showing that low blood sugars are associated with death is not going to help those people get to grips with the key thing in their and all of our lives; getting our blood sugars as low as safely possible.

Dillinger
 
Dillinger.
This was in direct response to a disucssion with Hana about T1 I specifically used that each time.
I trust you read the other posts and the link.
Yes,It was a one off case for the reasons cited. it was however documented and as it was reported as a case report subject to peer review and part of other evidence which at the very least points to risk.
Perhaps you now think that we can tell people that overnight hypos are always benign and not to worry about testing and knowing what their basal does overnight.
correction I used the phrase caused by insulin.
 
My original post and all subsequent ones have been aimed at Type 2's like myself. Primarily those on diet only, or diet and metformin only.

Should I put, in the heading of my future questions and threads, that I am talking about type 2's in order to clarify and avoid misunderstandings?

It didnt ocurr to me that type 1's would think that my question could be addressed to their situation. Indeed, I would consider it impertinent of me to presume to know what their requirements are, and their blood sugar parameters would be for safety. :(

Maybe the mods could sub-divide this section of the board into Type 1 discussions and Type 2 discussion to avoid any confusion in the future.
 
Lucy beat me to the gun! I was typing this when she posted. I( think the T1 hypo issue is well worth a discussion obviously, but lucy, the op, did ask a question of the newly diagnosed which then mutated into "can T2's on diet only/metformin have hypos", and has now mutated again. I'm a bit concerned that some involved in the original thread, particularly the new T2s, might not spot that most of the recent threads discussing hypos are from T1s, and might start thinking "so I can get them, i must test before I drive on diet only" etc when we've just got rid of all that. So maybe a separate thread for REAL hypos for insulin dependants , acceptable levels etc might help? Not trying to be difficult, and I know threads do develop, but this one could get confusing in my view.
 
The problem is that on this forum T2 is so often taken to mean T2 on diet/metformin only.

I understand how important it is for T2s on metformin not to dupe themselves into thinking they must keep BG levels high to avoid hypos. But for those of us non-T1s on pancreas-stimulating meds, ‘false hypos’ (if you want to call them that) are a big deal. There are an awful lot of stages in between the ‘feeling a bit dizzy’/disorientated and ‘full-on insulin-induced life-threatening hypo’. The UKPDS figures on 4 strengths of hypo make no sense to me: ‘ate some jelly babies then got on with life’ for everything except ‘required medical attention or glucagon injection’ doesn’t reflect my experience at all. For many of us it is not a case of you feel a bit dizzy and disorientated, you take a jelly baby and you are happy again. In my case you don’t just feel faint – you shake uncontrollably, you start gasping for breath, you feel bruised all over, you hardly have the energy to move. And of course you can collapse in front of traffic while crossing a busy street (as I did the day after I was diagnosed and put on glipizide and the stupid nurse was so intent on telling me not to eat grapes that she didn’t warn about hypos – nearly finished me off altogether) – but that sort of disorientation isn’t the only danger. I first joined the forum more than a year after diagnosis, asking advice about my problems post-hypo, because even when my sugars rose again I was absolutely shattered, still gasping for breath, still unable to move for more than 24 hours afterwards. This was not over-acting from feeling a little dizzy. I had never had any symptoms like this before in my life, and for a while it made my life hell. If the sugars drop unexpectedly low the body can go into shock, the hormones go haywire, and you can feel seriously ill and have sudden waves of deep depression. My GP, who knows his stuff on diabetes (I’m lucky), is emphatic that these sort of hypos may not cause comas but they are doing serious damage, more so than spikes in BG (I’m not convinced on the latter point – obviously the key is to avoid both). I strongly applaud the emphasis in this forum on dietary control, but downplaying the danger of hypos (and suggesting that they don't really 'count' if they don't require immediate medical attention) for those not taking the diet/metformin-only route is irresponsible.
 
Hi Lucylocket!

No, I think your post was perfectly right and in the right place. The question of lowering BGs safetly is equally relevant to Type1/1.5s - we just have a few more things to take into account. If you really only want a Type 2 perspective on something, there is a Type 2 area to have that discussion, but I think that would be a shame. This thread has covered a number of areas and hopefully, people will take away from it that there is no elevated risk of serious hypos for those not on insulin (or insulin-producing medication) and that lowering their BGs should be their priority. Also, that insulin-dependant diabetics can safely lower our BGs too with a bit of extra care - in my posts, I was just trying to point out that minor hypos in insulin-dependant diabetics can be corrected easily and although we should be respectful of hypos, we should not be so scared of them that we keep our BGs high.

Sorry if you found any of my posts intrusive on your post :D

Smidge
 
desidiabulum said:
‘ate some jelly babies then got on with life’
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Oops :oops: sorry desidiabulum. The second parts of those sentences are my "tongue-in-cheek" interpretations of what the first part of the sentence actually does say in the research. I should have made that clear. It was an attempt to show that levels 1, 2 and some of the 3's could be interpreted as "low sugars" as opposed to others of the 3's and the 4's which are most definitely dangerous and probably mostly insulin induced hypos.

Again apologies to anyone I've misled. Was not my intention ....
 
desidiabulum said:
but downplaying the danger of hypos (and suggesting that they don't really 'count' if they don't require immediate medical attention) for those not taking the diet/metformin-only route is irresponsible.
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But that's the point. We're saying they DO count if you're on insulin-stimulating drugs like you are, and shouldn't be downplayed. The discussion about the difference between real hypos and low blood sugar has been about those on diet only/metformin, compared to insulin users or those on insulin stimulating drugs. So DEFINITELY not playing down the real hypo situation.
 
Thanks grazer and xyzzy for clarifying -- you are my favourite posters, really you are! I just detected an edge creeping into discussion of hypos that seemed a bit out of character...
 
OK, I have now replied to the wrong post (sorry desiabulum) and upset smidge (sorry smidge)

So I'm off for a cup of tea and some cheese. Anyone fancy a cuppa???

You do all know i never intend to offend, dont you? Its just that my brain/mouth connection is not always switched on..........and often my fingers have a mind of their own. What i think I have typed, and even read on the screen, is not always what I actually typed :lol:
 
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