how low can you go?

HYPOGLYCAEMIA UNAWARENESS

One of the more distressing problems in diabetes is hypoglycemia unawareness. Normally, a person will feel warning symptoms when their blood sugar goes low, such as shaking and sweating caused by release of stress hormones. However, those with hypoglycemia unawareness have reduced warning signals and do not recognize they are low. Even if they happen to do a blood sugar test they may not realize what they need to do to treat the low. Luckily, stress hormone release is usually adequate to eventually raise the glucose level, although this may take several hours to work.

That hypoglycemia unawareness could occur during sleep is not surprising since people wake up for less than half of the lows that occur at night, but it happens with equal frequency when people are awake. Unless recognized and treated by someone else, serious problems, such as grand mal seizures, can occur. If you have witnessed seizure activity or bizarre behavior, you have some idea of the danger that hypoglycemia unawareness can present. Fortunately, research and clinical experience has shown that this condition can be reversed.

Here is a link to the full article.
http://www.diabetesnet.com/diabetes_con ... reness.php

cugila said:

HYPOGLYCAEMIA UNAWARENESS

One of the more distressing problems in diabetes is hypoglycemia unawareness. Normally, a person will feel warning symptoms when their blood sugar goes low, such as shaking and sweating caused by release of stress hormones. However, those with hypoglycemia unawareness have reduced warning signals and do not recognize they are low. Even if they happen to do a blood sugar test they may not realize what they need to do to treat the low. Luckily, stress hormone release is usually adequate to eventually raise the glucose level, although this may take several hours to work.

That hypoglycemia unawareness could occur during sleep is not surprising since people wake up for less than half of the lows that occur at night, but it happens with equal frequency when people are awake. Unless recognized and treated by someone else, serious problems, such as grand mal seizures, can occur. If you have witnessed seizure activity or bizarre behavior, you have some idea of the danger that hypoglycemia unawareness can present. Fortunately, research and clinical experience has shown that this condition can be reversed.

Here is a link to the full article.
http://www.diabetesnet.com/diabetes_control_tips/hypoglycemia_unawareness.php

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If you search the internet you can find evidence to support virtually any position you decided to take. Sometimes the evidence is difficult to refute, but when it comes to hypoglycaemia I can only comment on my own experience, which is as per my post. Maybe things will change, but for now 12 years of no issues, so I’m not inclined to start worrying. But please don't think that I don't care, normal non diabetic ranges for BS is what I strive for, it just difficult to reconcile what I know from experience with recommendations that seem not to apply to me.

Steve. I am not having a go at you.

This forum is read by many newly diagnosed and inexperienced Diabetics. I haven't trawled the net for my information, I have talked to Endocrinologists, and others who are far better qualified than either of us to determine what is a safe level and what is not.

You seem to be happy with what you are doing, no problem. The information is there for the new members, not the ones like us old hands. I too have been a Diabetic for 12 years, I'm still learning things even now and I don't profess to know it all. We just like to make sure a new Diabetic doesn't make the same mistakes we might have.

Have you ever seen the result of a Diabetic Coma....first hand, not in a film or on TV ? I have.
Some years ago I was out in an area of Birmingham when I and a colleague came across a parked car in a side street with a male slumped behind the wheel. First thought he was drunk, we couldn't rouse him and he was as cold as ice, hardly any pulse and little or no breath.

An ambulance was called and this man was whisked off to one of the best A & E Dept's in the country.
They did all they could for this guy, worked on him for nearly an hour. Then finally they decided that was it. They could do no more. He was dead. Aged 43, a type 1 Diabetic on Insulin obviously. At the inquest the verdict was death due to a Diabetic Coma. Apparently his family knew he was always running very low numbers, bragging about how low he could go. Didn't do him any good in this instance - a Diabetic Coma can hit so suddenly you would not even know it was coming. Fine one minute....dead the next.

I went to his funeral, they asked me to be there because I was the last person to help him. Very poignant seeing his wife, family. All devastated because he was gone so young. So forgive me if I don't agree with your thinking, I don't want anybody to go through that sort of thing.....ever.

Thanks for that Phoenix. Understand it a little better now and reduced fear of some spikes somewhat. Also should give some understanding to those who report intolerance to cereal in the morning but can take them later. Lost it a little in the middle but will listen a few more times to try and get it.

Totally understand your reasoning cugila.

I'm not suggesting that low bs is a good thing or that you should ignore it. In a perfect world my BS would never go lower than 4 or higher than 6, but I balance this with the impact to my life style in trying to achieve this 100% of the time. So in practice I’m happy with 3 to 7 and the occasional low or high outside that range doesn't bother me too much....

The risk with low BS is definitely real and can be catastrophic as you point out, but I'm not sure how we can really way this up in the general population. For example: What risk do I run when my BS is 2.0? A one in a thousand chance of a diabetic coma, one in ten thousand, one in a million or possibly never?

My feeling is that some people do not tolerate low BS very well at all and others seem to do a lot better.

A very crude example is reading the warnings on most medications which would put me off taking them if I didn't take a more pragmatic approach of what's the risk? For me 12 years of no issues leads me to believe my risk of complications from the 'occasional' low bs is not worth worrying about.

All said though, my only point is that it’s not as simple as some people make it appear.

Hi Steve.

I too appeciate your point, however if you are Ok as you say at 2 mmol/l. Good luck to you. Perhaps you will never experience what I described. Personally, if the odds were I in 10 billion I wouldn't be prepared to take that chance. That's after my 12 years of experience.

There is another thread on here where T1's with over twenty/thirty years experience take a different view to you and agree with what I have posted. I Hope some of these 'some people ' you talk about have gained something from our little discussion.

I know this forum routinely goes against some of the dietary advice on here, but I wouldn't argue with an acknowledged medical fact.

Cheers and good luck.

I guess we agree to disagree.

To some extent it's not that I actually disagree with you :wink: More that I've not experienced anything bad, so it's hard to reconcile the 'facts' with what I know to be true for me.

Anyway lets move on....

To Cugila: yeah well?
thanks for the info sorry I could not get back to reply, I have a lot of problems (medical type)
at the moment so?
to your question did I get a warning with the 1.7 Hypo yes at 1.759357 strange?
I do have Secondary Hypos most nights, and some VERY VERY Bad ones once or twice a week?
Have been like it for 33 years many Docs, Consultants (good ones) and Bad and a Prof
"BUT" NO answers!
On doing 4am Tests 3.4 to 4.2 this is from:
Midnight 17.4mmol down to 3.2 4am up to (goes Vertical) 18.7 at 9am
to which some (dr) say increase the BedTime Insulin (death wish "mine" )
15 years ago I could walk away from a Bad Hypo now I can't (Had to many) Max is 6 one Day
Its called THE.....SOMOGYI........EFFECT But does it exist??????

So how low can you go 1.7mmol to 5.1mmol I try very hard to stay above 6 .0!!!!!

and yeah I read his Books 50 years ago (Robotic Laws)

B

Hi insulinman.

Yeah well ? Medical problems.....me to. No worries. you must have a pretty snazzy meter to get a 6 decimal places result....cool ! 33 yrs, I take it you are happy with that then. Bit more practice and you will get there.

As for the Somogyi effect there is a discussion on here about this subject.
The Somogyi effect is a phenomenon where hypoglycaemia is followed by hyperglycaemia as a result of an over-reaction to the low sugar. It is usually seen in children with insulin dependent diabetes mellitus, especially where an insulin with a long acting component is being used.
ALSO
Somogyi effect
The Somogyi effect can occur when a person takes long-acting insulin for diabetes. If the blood sugar level drops too low in the early morning hours, hormones (such as growth hormone, cortisol, and catecholamines) are released. These help reverse the low blood sugar level but may lead to blood sugar levels that are higher than normal in the morning. An example of the Somogyi effect is:

A person who takes insulin doesn't eat a regular bedtime snack, and the person's blood sugar level drops during the night.
A person's body responds to the low blood sugar in the same way as in the dawn phenomenon, by causing a high blood sugar level in the early morning.
How can you tell the difference?
The Somogyi effect can occur any time you or your child has extra insulin in the body. To sort out whether an early morning high blood sugar level is caused by the dawn phenomenon or Somogyi effect, check blood sugar levels around 2 a.m. to 3 a.m. for several nights.

If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect.
If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon.


Back to Asimov, got nearly all his books and the early short stories. Fabulous writer.

Our daughter was 3.6 at 10pm last night it took 45 minutes to get her b/s above 4.They dropped to 3.1 after the first 15 minutes why did this happen.
she said i hate feeling this way when i have a hypo ,i wish it was me and not her with diabetes

Hi sophsmam.

What exactly did you use to try and raise the Bg levels last night ? I can understand how she feels having a hypo is not a nice feeling for anybody, me included !

Hypo unawareness can present if you repeatedly run bg levels below 4, so that's why every diabetic needs to be aware of it. It may seem you can function acceptably at the time, but you're just storing up problems for the future. Also can present if you've had years of poor control (one of the features of autonomic neuropathy). With me I suspect it's a bit of both, and I wouldn't wish it on my worst enemy:

Last night I had a terrible hypo, completely unwarned and not caught by my CGM system. I woke up this afternoon with a bg level of 31.2 - that's a classic example of the Somogyi effect, not to be confused with Dawn Phenomenon which is quite different. I don't use a long acting insulin, I did have a snack before bed and nothing else unusual, remarkable or untoward. Nasty.

sophsmam said:

Our daughter was 3.6 at 10pm last night it took 45 minutes to get her b/s above 4.They dropped to 3.1 after the first 15 minutes why did this happen.
she said i hate feeling this way when i have a hypo ,i wish it was me and not her with diabetes

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Ah, bless her, she must bave been scared, as I'm sure you were! This has happened to me, tested, treated, re-tested and BG has dropped again. It could be (one theory!) that her fast acting insulin was still working? So, she had dropped too low but the insulin was peaking and continuing to work on the BG? Examples like this just highlight the necessity to check 15 mins after you have treated a hypo, so at the risk of sounding condescending, well done for doing that Hope your daughter is doing ok now

glitterzoe said:

my goodness how this has ranged, glad to see so meny different oppinions and some like myself who seem to still be able to fuction in the low 1-2. just gose to show how different we all are

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Nothing to do with being different. It's a bit like the drunks on the roads who after a 'skinful' get in their car and drive........they too always maintain they are perfectly safe, they can function well ? Doesn't affect me at all guv ! You see they are always the last to know....... Ah well.

cugila said:

glitterzoe said:

my goodness how this has ranged, glad to see so meny different oppinions and some like myself who seem to still be able to fuction in the low 1-2. just gose to show how different we all are

Click to expand...

Nothing to do with being different. It's a bit like the drunks on the roads who after a 'skinful' get in their car and drive........they too always maintain they are perfectly safe, they can function well ? Doesn't affect me at all guv ! You see they are always the last to know....... Ah well.

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Diabetes has got everything to do with being different! We are all individuals and insulin (as Glitterzoe is Type 1, I will use that medication as my reference) affects us all in different ways. I don't believe Zoe is claiming that she is safe to drive a car when 1-2 but perhaps she feels she is, who knows! I wouldn't be, but we are all different. Hang on, haven't I said that already?! :wink: I will quote that Dr chap who wrote that book 'How to think like a pancreas' (apologies, can't remember his name as I type!)

'It amazes me how I didn't ever drive butt-naked into a tree on the way to work!'

He was referring to a time before he stabilised his BG in his 20's when he would wake in the morning, get dressed, drive to work and carry on as normal with a BG under 3. I doubt he was proud of it, but he did it, never the less! When confusion is a symptom of a Hypo, I doubt I could have told you my name at certain times in the past, but get myself dressed and get to work? you betcha!! and before I get lots of 'how dangerous!' comments let me say this - I know!! I didn't choose to do it, my body just 'functioned' and my brain dealt with the low BG. It's a tricky business, this type 1 lark! :lol:

This thread could run on and on in this theme BUT... for the benefit of new type 1's it has to be stated that under 4 is hypo territory!!
There may well be experienced type 1's who can function,or think they can function, at lower levels but that is their choice..it does not make it ok for new type 1's to think that is is the norm.

sugarless sue said:

This thread could run on and on in this theme BUT... for the benefit of new type 1's it has to be stated that under 4 is hypo territory!!
There may well be experienced type 1's who can function,or think they can function, at lower levels but that is their choice..it does not make it ok for new type 1's to think that is is the norm.

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Well said Sue. Functioning "normally" at lower levels is also called hypo unawareness...

i totally agree sue, i am a type 1 and once under 4 even if feeling fine i do treat it

sugarless sue said:

This thread could run on and on in this theme BUT... for the benefit of new type 1's it has to be stated that under 4 is hypo territory!!
There may well be experienced type 1's who can function,or think they can function, at lower levels but that is their choice..it does not make it ok for new type 1's to think that is is the norm.

Click to expand...

But no one is saying that being under 4 isn't hypo territory?! Experienced and newbie type 1's know what they are dealing with and (hopefully!) know how to fix problems when they happen - we are all on a learning curve, because we are all different - that's what makes us all so fabulous hence this forum, to share and compare - great for newbies in my opinion as the only certain thing I can tell them is when you are using insulin, your body will throw up the odd curve ball from time to time forewarned , etc etc :lol: