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How Many Hypo's Is Too Many?
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<blockquote data-quote="kitedoc" data-source="post: 1905991" data-attributes="member: 468714"><p>Hi [USER=214632]@James_Donnelly[/USER], Thank you for posing this question, particularly when diabetes complications from high BSLs are emphasised so much. Based on my experience as a T!D for 52 years, not as professional advice or opinion:</p><p>Each hypo has the potential to do harm. And whilst my brain seems to have adapted to low BSLS so that I am less affected by a hypo than I used to be (all in subjective terms, of course)!! a hypo still matters.</p><p>And there is a difference I find between <em>the 'sneaky' hypo</em> where my BSL drops slowly and I may not pick it up until the 3.2 mmol/l mark, whereas a <em>more rapid drop in BSL</em> might trip my senses at the 4 mmol/l mark. The advent of CGM, Libre etc has of course made things easier - at least when such technology is accurate and active.</p><p>However <em>it is the severity of some hypos which scares me</em>. I have had one episode of going hypo and needing mouth to mouth resuscitation and 2 shots of glucagon given to get me through it. The cause was embarrassingly simple: I was tired, woke up for breakfast, had my insulin and fell asleep before having breakfast. My wife thinks I have not been affected by this episode (but she thinks I have the inferior intelligence of a male anyway)!!! This episode happened at the 45 year mark on insulin, at a time when I was having to take 6 + short-acting shots of insulin (plus 2 of long-acting) per day to try to get BSL under control but still suffering from night-time hypos in particular. <em> Going onto an insulin pump </em>was the best thing I have ever done and hypos are now mild and infrequent.</p><p>Interestingly from that episode it was also discovered that I had<em> Obstructive Sleep Apnoea (OSA)</em>. I was not overweight but apparently had the type of airway (shape and structure of mouth, palate, throat) that predisposes to this condition). I was told that OSA and hypoglycaemia formed the double whammy which threatened my life.</p><p>I have never got hypo when I used to imbibe<em> alcohol </em>many years ago but I have heard enough horror stories of diabetics being thrown into jail as drunks when they were really hypo only, and of the fact that glucagon does not work when alcohol is present in the blood stream to steer well away from the stuff.</p><p>Some pundits think hypos over time might contribute to mental difficulties later in life.</p><p>Except for the one or two cases I have heard about where persons overdosed intentionally on insulin and suffered brain damage I have no real belief one way or the other about hypos and dementia being related.</p><p>My hypo awareness did improve after I was started on the pump. Hypo awareness is a term open to interpretation. If you have the 'adrenaline symptoms' of sweating, rapid heart beat, shakes as your first warning symptoms at a certain BSL level and over time that changes so that at about the same BSL your first noticeable symptoms are of confusion, clumsiness etc then is that a change in awareness or not? My point would be that hypo awareness has important situational and practical considerations.</p><p>If you are able to recognise the onset of a hypo in the latter case of confusion etc in the absence of the adrenaline caused symptoms and manage it that is all very well but will you be able to manage well enough if driving, up a ladder, crossing a busy street on foot etc? Hypos, my specialist reminds me have the potential to cause immediate harm, unlike high BSLs.</p></blockquote><p></p>
[QUOTE="kitedoc, post: 1905991, member: 468714"] Hi [USER=214632]@James_Donnelly[/USER], Thank you for posing this question, particularly when diabetes complications from high BSLs are emphasised so much. Based on my experience as a T!D for 52 years, not as professional advice or opinion: Each hypo has the potential to do harm. And whilst my brain seems to have adapted to low BSLS so that I am less affected by a hypo than I used to be (all in subjective terms, of course)!! a hypo still matters. And there is a difference I find between [I]the 'sneaky' hypo[/I] where my BSL drops slowly and I may not pick it up until the 3.2 mmol/l mark, whereas a [I]more rapid drop in BSL[/I] might trip my senses at the 4 mmol/l mark. The advent of CGM, Libre etc has of course made things easier - at least when such technology is accurate and active. However [I]it is the severity of some hypos which scares me[/I]. I have had one episode of going hypo and needing mouth to mouth resuscitation and 2 shots of glucagon given to get me through it. The cause was embarrassingly simple: I was tired, woke up for breakfast, had my insulin and fell asleep before having breakfast. My wife thinks I have not been affected by this episode (but she thinks I have the inferior intelligence of a male anyway)!!! This episode happened at the 45 year mark on insulin, at a time when I was having to take 6 + short-acting shots of insulin (plus 2 of long-acting) per day to try to get BSL under control but still suffering from night-time hypos in particular. [I] Going onto an insulin pump [/I]was the best thing I have ever done and hypos are now mild and infrequent. Interestingly from that episode it was also discovered that I had[I] Obstructive Sleep Apnoea (OSA)[/I]. I was not overweight but apparently had the type of airway (shape and structure of mouth, palate, throat) that predisposes to this condition). I was told that OSA and hypoglycaemia formed the double whammy which threatened my life. I have never got hypo when I used to imbibe[I] alcohol [/I]many years ago but I have heard enough horror stories of diabetics being thrown into jail as drunks when they were really hypo only, and of the fact that glucagon does not work when alcohol is present in the blood stream to steer well away from the stuff. Some pundits think hypos over time might contribute to mental difficulties later in life. Except for the one or two cases I have heard about where persons overdosed intentionally on insulin and suffered brain damage I have no real belief one way or the other about hypos and dementia being related. My hypo awareness did improve after I was started on the pump. Hypo awareness is a term open to interpretation. If you have the 'adrenaline symptoms' of sweating, rapid heart beat, shakes as your first warning symptoms at a certain BSL level and over time that changes so that at about the same BSL your first noticeable symptoms are of confusion, clumsiness etc then is that a change in awareness or not? My point would be that hypo awareness has important situational and practical considerations. If you are able to recognise the onset of a hypo in the latter case of confusion etc in the absence of the adrenaline caused symptoms and manage it that is all very well but will you be able to manage well enough if driving, up a ladder, crossing a busy street on foot etc? Hypos, my specialist reminds me have the potential to cause immediate harm, unlike high BSLs. [/QUOTE]
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