How many hypos do you have a week?

[Eldorado]

I've just had a weird telephone conversation with a diabetes specialist nurse who contacted me at the request of the diabetes nurse at my local surgery. I'd asked her about the new fast acting insulin, Fiasp. Neither of them are specialists in type 1. Neither of them know about the new insulin.
We got into a conversation about levels and hypos. My latest hba1c results have been 38, 45 and 46. They're so so much better since I've been using the Aviva Expert, although I don't quite believe the 38 result. I said I try to run my BG at around 5-7. How many hypos do I have on average in a week? I said maybe 2-3, but I get good warning signs (at around 3).She seemed to think this was outrageous and that I needed to run my BG higher to raise the level of my hypo awareness to around 5. She kept talking about 'all these hypos'. I said I wasn't concerned about it and it was something I can live with. After all it's easy to correct with a few jelly babies. No big deal! I have to admit I started to get a but ticked off and said I wasn't prepared to start messing about running my BG higher on the basis of 'if it ain't broke, don't fix it'. I've started to wonder though if I'm wrong and if 2-3 hypos a week is too many. What do you all think? How many hypos might you get in a week and how many is too many? Both my GP and the consultant I see at the hospital annually have been really pleased with my lower hba1c results.

 

[tim2000s]

Hi @Eldorado - that's a difficult one to answer. If you aren't feeling your hypos until 3, then you are starting to get into the too low zone. Ideally you should be feeling them above 3.5 mmol/l. If you are having 2-3 per week and they are getting below three then you should be concerned. I'm pinging @catapillar who can discuss hypo unawareness and the issues it causes.

If you still had hypo awareness between 3.8 and 4.0 then there would be no issues. What your nurse says about 5 is just a load of old codswallop though. It's probably worth taking a look at what's causing your hypos and where you're getting to and trying to work out how to improve how low you go. I don't think 2-3 per week between 3.5 and 4.0 is too extreme (especially given that non-Ds get to that range regularly), however, 2-3 at 3.0 is too many.

 

[TheBigNewt]

I probably average at least 5/week. I feel it about 3.0 but I'm perfectly normal acting. I'm pretty normal at 2.5 too but I feel it more. What I am really careful with is going to sleep. I've mentioned what I do but I'm not supposed to mention it any more. I think the nurse's yelling at you for so many lows is a bit of drama to be honest with you. It goes with the territory. As long as you can tell and correct you should be OK. Just be careful at night. That's when the serious problems usually happen.

 

[fletchweb]

I've just had a weird telephone conversation with a diabetes specialist nurse who contacted me at the request of the diabetes nurse at my local surgery. I'd asked her about the new fast acting insulin, Fiasp. Neither of them are specialists in type 1. Neither of them know about the new insulin.
We got into a conversation about levels and hypos. My latest hba1c results have been 38, 45 and 46. They're so so much better since I've been using the Aviva Expert, although I don't quite believe the 38 result. I said I try to run my BG at around 5-7. How many hypos do I have on average in a week? I said maybe 2-3, but I get good warning signs (at around 3).She seemed to think this was outrageous and that I needed to run my BG higher to raise the level of my hypo awareness to around 5. She kept talking about 'all these hypos'. I said I wasn't concerned about it and it was something I can live with. After all it's easy to correct with a few jelly babies. No big deal! I have to admit I started to get a but ticked off and said I wasn't prepared to start messing about running my BG higher on the basis of 'if it ain't broke, don't fix it'. I've started to wonder though if I'm wrong and if 2-3 hypos a week is too many. What do you all think? How many hypos might you get in a week and how many is too many? Both my GP and the consultant I see at the hospital annually have been really pleased with my lower hba1c results.

That seems like a lot - with me I may hit the low 3s 2 - 3 times per month at most, but it's usually associated with unplanned physical activity. If your hypos happen at around the same time of day and you're awake - you may want to try a snack of some kind 30 mins before those times you're low - that's assuming you have been able to spot a trend on when you get low BGs. Secondly - and this took me years - try not to over compensate if you're treating a hypo. I remember when I was younger I'd test in the high 2s - feel absolutely terrible and then over compensate with what I was eating resulting in a BG level of 20 an hour later - making me feel even worse - that doesn't happen anymore but it's easy to do and it happens to a lot of us.

.

 

[DiabeticDadUK]

I think there are no perfect number of hypos per week. Everybody being different, leading different lives etc. So the nurse having a hissy fit over 2-3 per week really needs to wind her neck in, especially if you're managing well and your consultant has indicated as such.

I might have 1 a week, sometimes less, sometimes more. I feel hypo at 4 and under. Under 3 I'll feel pretty bad.

 

[TheBigNewt]

I agree with fletchweb, hold back on the sugary treats if you're hypo else you end up way high. Because we don't get to eat that stuff very often it's tempting to eat a whole box of Cracker Jacks right/?

 

[catapillar]

There are two types of hypo symptoms:

1. Warning symptoms when adrenaline is released because your body is panicked by the low blood sugar and it's telling you to do something about it. That's things like shakes, sweats, hunger.
2. Cognitive symptoms, your brain needs glucose to work, when you get these symptoms the low blood sugar is impairing brain function & realistically you are already too late treating the hypo. Things like confusion, balance issues, numbness (cos that's just your brain not working to process sensation from your nerves), and personality changes.

If your body gets used to being low it won't panic and release adrenaline to give you symptoms to warn you when you are low. It'll also slow down on getting your bodys response to release glucagon and trigger a liver dump to fix a hypo.

Hypo unawareness means no driving licence.

If you've had a discussion with your DSN about increasing target levels for a while in order to protect hypo awareness I would seriously consider it. I'm unconvinced by the idea you should be getting warnings a 5, but certainly at 4 in an ideal world you should be getting warnings. You wouldn't have to raise things or change things much, just give a bit of thought to what might be causing your hypos and do what you can to avoid them, just aim to stay above 5 for a couple of weeks and that should ramp up your body's panic at 4 and under.

 

[TheBigNewt]

Like I said, for me it's about 3-3.3. One thing that can help are the CGMs. I know the Dexcom will ring your phone when you go below about 4.0 so you can check and correct. Does your NHS provide for those? I would think they would if you met certain criteria.

 

[Juicyj]

I agree with the hypo warnings at 4, any lower and you could start losing your hypo awareness, as we need to be above 5 from a DVLA perspective to drive a car this makes it even more important, maybe this is where your DSN has got confused possibly. Personally I have about 2 hypo's a week, which I consider to be 'normal' if there's such a thing, and feel hypo's around the 4 mark. I always analyse each hypo event to understand the cause, so excess exercise, bolus timing etc, there should be a tangible reason for each one

 

[donnellysdogs]

I think alerts before a level of 3.0 are important but 5 no. 3.8 would be my desired level of being alert to hypo's.

I think the general criteria for hypo's within hospitals are ranging from 2 to 3 hypo's a week maximum.
I've changed hospitals a lot due to moving and one that could not help me and recognised that I needed tertiary care. All the consultants have mentioned to me as a maximum of 2-3 per week and ideally no lower than 3.8.

Never forget if you drive anything even if it is a pushbike etc you really need to be 5.0.

Years ago I had a CGM because I worked with what was deemed as dangerous equipment in my workplace.. strimmers, chainsaws etc..
i have a funded CGM now but that was due to exceptional circumstances and not wholly linked to hypo or hypers..

 

[noblehead]

I've started to wonder though if I'm wrong and if 2-3 hypos a week is too many. What do you all think?

If that's every week then it is too many @Eldorado so I tend to agree with your DSN. Also by not recognising the hypo's until you are 3mmol/l is prove that your hypo awareness symptoms are suffering as a result.

Why not look for a pattern when the hypo's occur and try and address it, appreciate hypo's can occur for no rhyme or reason but more often than enough there is a reason behind them.

 

[Kristin251]

None per week. Maybe once a month I dip under 70 but that's usually fasting depending on if I ate enough for dinner OR an extended stay at the local place.

This is where bernsteins laws of small numbers works for me. Small low carb meals, small insulin doses, smaller room for error.

Previously at time of DX and eating carefully weighed carbs I was having lots of hypos. Down into the forties. Backed off carbs and lowered doses of course and those about stopped completely.

I feel it when I go below 70.

 

[TheBigNewt]

I used to be bad, my secret motto was "in diabetes it's bad to be high, and the only way you know you're not high is when you're low". Bad advice!

 

[DaftThoughts]

I have recorded 1 hypo since around February. I've had a few times of toeing the line around 4.5, but nothing lower than that usually. I recognize hypos very early when I start heading towards 4, and I fix them before they happen. Including my adjustment period and some hormonal issues that raise my glucose for no reason, I have an average of 7.4mmol/L with a deviation of +-1.5mmol/L across the past 3 months - not the tightest control, but all things considered I'm doing great.

I avoid hypos like the plague where possible, it would be totally unacceptable for me to have them 2-3 times a week. I am on the road too often, vulnerable as a cyclist, and a hypo could be a quick end to my life as I live on my own as well. No job due to disability so it can be days before anyone misses me - not risking that whatsoever. I don't feel bad when I'm between 5-9 and I like to stay in that range even if some consider it too high. The risk just isn't worth it.

To be honest, I'm kind of seeing this at the same level as an eating disorder. "I'm fainting 2-3 times a week because I'm on this extreme diet, but my doctors are really pleased with my weight loss results so it's no big deal." Just because your HbA1c is lower now, doesn't mean you're getting there in a healthy way. The numbers alone aren't so important, the whole picture is though. Your body goes through tremendous stress when your blood sugar crashes, a low A1C isn't going to do anything for your long-term health when you're constantly dealing with adrenaline cocktails that keep your stress levels consistently high.

As others have said, your long-term hypo awareness also takes a great hit from such frequent crashes, and before you know it, you no longer have the luxury of calling it 'no big deal'. I'm sure we'd all rather you don't go through that because it really sucks and makes life more difficult.

Edit: I want to clarify that I don't think everyone who has hypos every now and then is not handling their health well. They happen, it's part of it. What I'm getting at is that the idea of "Well my A1C is great and the docs are pleased, so the hypos aren't that important" raises big red flags for me. In my opinion, hypos are always important, and we should always strive to prevent them. It doesn't always work, but we need to try at least.

 

[Eldorado]

Hi everyone. Thanks for taking the time to reply. There are some interesting comments here.
The first thing is maybe we are talking about different things when we refer to a hypo. I never 'crash' or need help to sort myself out. All that happens is I think 'maybe I need a bit of topping up' and 2 or 3 jelly babies does the trick. So I'm not talking about bad hypos - the dizziness, blurred vision and the shakes. It's more of an 'uh oh' type of feeling. And in the bad old days I would never have had awareness of this sort of thing on a BG of 5. The level at which I get awareness hasn't changed over the years. I think it's an individual thing. Our bodies are all different and we all have different lifestyles. It's doing what suits.
As for driving, I never ever drive off without checking my BG first and would never set off below 7.
I do try and work out what has caused the low and it's usually down to extra exercise. Or just getting the insulin dose wrong. I would guess we all do that sometimes.
I've tried really hard to improve my hba1c and for the first time in over 30 years I'm not ashamed of it! So it was a bit galling to be told by a nurse, who admitted she's not a specialist in Type 1, that I'm running too low and need to up things. I thought afterwards her advice was reckless and could have been really confusing and demotivating, especially for someone who was newly diagnosed.
Thanks again for all the comments. It's not easy being type 1, although it's something we all have to get used to. It's good to get some feedback.

 

[Claire007]

Im trying to word this carefully so I don't sound like I'm lecturing you, but I think you've missed the point.
The fact you're not having full on hypo symptoms until you reach a BG of 3 is a bad thing, not a good thing.
@caterpiller explains it well up thread. The lack of symptoms doesn't mean you're safe, or it's not a 'bad hypo' quite the opposite.
Run a little higher for a while and you should regain hypo awareness from a BG of 4.
Maybe the nurse didn't word it well, but meant for you to run at above 5 to bring back your hypo awareness to 4ish.

 

[Amy993]

It all depends. I had none for a couple of weeks, then on Monday had 3. I was aware of 2 of them, but wasn't aware when it was at 2.8. The lowest i have been is 1.8 where i felt like i was going to pass out and my legs were in so much pain and numbness.

 

[TheBigNewt]

I finished 9 holes of golf one time years back and was 1.6. I parred the last hole too! I think the slower you come down the more normal it feels being low. And I was playing alone too, so I could have been pretty stupid but I could still play golf decent.

 

[Daibell]

Hi. I take the point about serious hypos versus just feeling a bit weird, but I think you are going too low too often. I don't try to keep my HBa1C that low and was told off by my DN when I was at 6%. I think your DN is giving good advice. I may go down to below 4mmol once or twice a month but that's all. I still have a little insulin production so those with none might find control a bit more difficult than me.

 

[steve_p6]

People are quoting some very specific values here 3.0, 3.5, 4.0.

Which are the meters that are so accurate?