How much time do you spend having low blood sugar (<4mmol/L)?

[EllieM]

I definitely start to lose hypo awareness if I have too many true hypos (ie glucometer under 4s not sensor ones, my sensors also read low). I'm not sure a blood sugar in the mid to high 3s actually does physical damage (non diabetics can go down to 3.5 quite easily), but losing hypo awareness is very bad news. (I regained mine by running above 6 for a while, but it's better not to lose it in the first place.)

 

[Tony337]

Hi
I love this thread.
Whilst i have utmost regard for the NHS its view on diabetes is one size fits all.....

it thinks we don't know how to manage our condition.
it thinks a hypo means hospitalization and the cost of an ambulance and a hospital bed.
i can function quite normally between 2.5 and 3.5 but my neighbour who has the same condition cannot.
It fails to take that fact into consideration and considers me lucky i have never been hospitalized in my 50 years of being type 1.

I'm 93% in range and 5% below and i'm not bothered about the 5% at all............

I have a libre that has an alarm!
Its a magnificent piece of tech and i adore it and cherish it.
Before that i ran my levels higher at night and blow me if i went low i woke up!

Please don't think i'm disrespecting the NHS or being smug i just am what i am and i can feel a song coming on.....

Good luck everybody

Tony

 

[Nicola M]

My 3 monthly average hovers around 1-2% and that’s even with the sensor sometimes lagging behind for a long time or saying I’m low when I’m not. Each to their own and everyone is different but I personally would want to get that number down from 10% but if you’re okay with that then don’t worry about it too much.

 

[RD02]

Hey,

I try to maintain a very tight control of my blood sugar, and this results in my libre 2 reporting that i spend 10% of time below 4mmol.

Now, generally that time will be in the high 3s. Rarely do I have a blood sugar that needs more than ~4g of fast acting carbs to correct. I also check my blood sugar regularly and don't inject within 3hrs of sleeping.

I also think that my libre2 can on occasion report a blood sugar far lower then it actually is (confirmed with finger prick), and that can skew my time in range.

However, when I see my diabetic nurse, they will tell me that i have too many hypos. I personally would prefer having a fairly regular minor hypo to having a high a1c. My last a1c was 5%.

I know there is some research suggesting that hypos can contribute to dementia. And a bad hypos can kill you. I appreciate that, that is why i don't inject before sleeping and check my levels regularly.

Is 10% of time below 4mmol very bad? Overall my TIR is ~90% because im basically never above 9mmol.

(I saw recently there was a thread around a1cs that are too low, but my question is more around whether my TIR is bad).

Thanks

I like you tread the path of tight control , I too have been pulled up about hypo’s / time in range. I’ve now swapped to dexcom.

For me personally i now ignore the low readings and go on what my glucose metre says. I do believe the software is flawed in that you only have to have some rouge readings below the threshold and it’s recording it as a hypo. It should work on the basis of at least a few consecutive low readings to report it in the data.

Only my opinion.

 

[jaywak]

48 years type 1 and on more than one occasion I have woken at night and thought oh I feel a bit low, gone downstairs done a test oh it's 1.8 I better have some glucose powder gone back to bed woken in the morning with a normal blood sugar and felt completely normal but have spoken to other type 1 s who have collapsed after going into the 3 s , I think we must accept we are all different .

 

[Just-a-little-prick]

What a good question!

I think (but I'm no scientist) it's a very hard question to answer though.
There are lows so severe that they lead to immediate brain damage (and death), but I think those are not the lows you're wondering about.

I've read that it's thought that multiple episodes of low BG throughout the years can cause some brain damage. I'm pretty sure it's not the mid to high 3's doing this, considering non diabetics tend to go this low occasionally.
Now lower 3's and high 2's? Who knows?

Mild brain damage due to hypos seems very hard to measure if you ask me. Tiny alterations in the brain aren't easily found, and lots of things outside diabetes can cause them too.
Even if you had a huge cohort of diabetics and non diabetics to compare over decades, you'd still need CGM data over decades as well to even find a correlation to hypos. And we don't have CGM data for that long, let alone a huge cohort of people regularly doing tests to see how their brain function changes over the years.

For myself, I don't worry too much about the higher 3's, although I treat when under 4 to nudge me up a little, but I very seriously try to avoid getting close to 3.0.

What a good reply, Antjie!
I recall having this discusssion a while ago with my specialist. He had noticed that we were nowadays reading a lot of death notices for military men in WW2 - many of whom were pow's imprisoned in concentration camps for years.They had little food, very poor diet, and were forced often to do manual labour. Consequently their sugars were permanently low. Yet, these men lived into their late eighties and nineties. It appears that - far from harming them - their forced regime had ensured longevity!
I think that the OP is worrying over the wrong thing - it is hypers that damage you; and, if you ever get into the extreme experience of going into a coma, may even result in death.

 

[Captain_Sensible]

before Libre I was regularly below 4 , nowadays I am lucky ( or unlucky depending on your point of view) if I’m below 4 once a month This down to the alarms on the Libre system , I set my low alarm at 4.1 as soon as it alarms I take some quick acting sugar ( wee can of “ full fat” Cola )

Good thinking! My Libre 2 reads low all the time tbh in comparison to a finger prick. My low is set at 3.2 mmols. I use the Libre reader all the time cos I'm not too au fait with smartphone stuff. I've had T1 for 64 years so in comparison to Wee testing and test tubes and finger pricks- this Libre 2 thing is marvellous. In that time of 64 years I've had horrendous hypos over the years- unconscious many times at night - I guess I'm lucky to be still here

 

[MuttNJeff]

As with most other people, I find that the libre2 on android often underreads (or overreads if high) compared to my AccuCheck test strips. Sometimes I take 3 dextrosol tablets and see the level rising even before I've finished chewing the first of them, other times the level stays down. I've also noticed in the last few weeks that (particularly after the sensor has lost contact ot I've been away from the phone) the readings and trend arrow can change a lot more than I was led to believe in the tutorial - a level arrow but an change of plus or minus 2mmol within 5 minutes. But then, where I have scanned to ensure there is a reading I can often go back and see that readings from scans are above (if high) or below (if low) the graph line and not connected to it.

 

[Zinadane]

Libre definitely reads lower at the below 5mmol range. I would think this is deliberate from abbotts point of view. A tolerance with this stuff and they are on the safe side. If the other way then danger of hypo and people not knowing. Imagine the court cases.
Too many low's hypos pretty bad for your brain cells as far as I know. This is why they encourage below 5%.
Lows kill your brain, highs kill your organs. Basically it's a tightrope!
50+years of T1d and still going so don't worry too much

 

[holdem]

Libre definitely reads lower at the below 5mmol range. I would think this is deliberate from abbotts point of view. A tolerance with this stuff and they are on the safe side. If the other way then danger of hypo and people not knowing. Imagine the court cases.
Too many low's hypos pretty bad for your brain cells as far as I know. This is why they encourage below 5%.
Lows kill your brain, highs kill your organs. Basically it's a tightrope!
50+years of T1d and still going so don't worry too much

Hey mate when you say too many lows bad for your brain is this true? My memory is shocking and ive never put it down to my diabetes. Also when you say low do you mean sort of below 3 or what?

cheers

 

[Nicola M]

Hey mate when you say too many lows bad for your brain is this true? My memory is shocking and ive never put it down to my diabetes. Also when you say low do you mean sort of below 3 or what?

cheers

I’m not sure how true it is but I know that when I was diagnosed with Epilepsy they said the cause was due to the lows I had as a child scarring my brain. Make of it what you will though!

 

[holdem]

Interesting i had never heard this. cheers

 

[Zinadane]

I only really became aware of this a few years ago. After my reports were showing 8% below 4mmol.
And the endo bought it to my attention and highlighted the dangers to me.
Had a few hypos in my time, so yes, you start worrying about how many brain cells you've killed off etc
Getting older etc, so difficult to actually pinpoint it, but I certainly don't feel as sharp as I used to.
Also, I started to think about how many brain cells I've killed with alcohol hangovers. Not sure if this is similar damage you'd get from a hypo.
I certainly now try to keep my levels below 4mmol at less than 5%.
Im sure you can Google all sorts of good and bad info on this. Probably a grey area and you'll never know for sure the detrimental effects you've done.
So don't worry and do you're best moving forward on I say.

 

[sgm14]

However, when I see my diabetic nurse, they will tell me that i have too many hypos. I personally would prefer having a fairly regular minor hypo to having a high a1c. My last a1c was 5%.

I remember reading a story of a computer programmer who added this silly feature (flying ducks) to the chess game he was making because he knew his project manager would always find something to complain about and he didn't want to have to remove or change any of the features he liked. Sure enough his manager told him to "get rid of the ducks".

Some people are never happy and I'm beginning to think the same applies to some doctors/nurses.
My A1c was not as low as that when one endo was uncomfortable with it being so low.

The time below 3.9 is less than 1% which I am happy about (the LibreView AGP report says the target is "less than 4%"), but was still told I had too many hypos. (Mind you I would probably agree).

Also this was based on the libre "Low Glucose Events" which are lows which last at least 15 minutes. I have probably as many lows that aren't counted as LGE's. (Unlike Antje77 and others, my libre responds quite quickly). I don't know whether other people agree, but I basically ignore them as, since the libre has to be deliberately excluding them, I am assuming the view is that they are not really dangerous.

I had a nurse (not a diabetic nurse) who was unhappy that I did not eat anything before going to bed despite my average blood sugar being about 7 at that time. (I don't know if it is a thing, but I have want I call 'Foot off the floor" syndrome where my BS can sometimes jump up a few minutes after I get into bed!) I didn't think it was a good idea to mention to the nurse the novorapid correction dosages I sometimes took at night.

I'm not sure I would like your percentage time below 3.9% (even knowing that it isn't accurate), but I am rather envious of your A1c and your Time in Range.

 

[newjourney]

I have found this thread fascinating and helpful. I spoke to a nurse yesterday who looked at my phone app for the Libre. I am 97% in target and she said the 2 % lows, mainly 3,.8 would cause me permanent memory loss. I mentioned that non diabetics don't get memory loss from 3.8 and she said well you are different. I asked for the research so will see what she finds. She asked me to do better. I felt so good with my results and found her rather annoying! Oh well.

 

[becca59]

I have found this thread fascinating and helpful. I spoke to a nurse yesterday who looked at my phone app for the Libre. I am 97% in target and she said the 2 % lows, mainly 3,.8 would cause me permanent memory loss. I mentioned that non diabetics don't get memory loss from 3.8 and she said well you are different. I asked for the research so will see what she finds. She asked me to do better. I felt so good with my results and found her rather annoying! Oh well.

Frankly I feel that she didn’t congratulate you on the 97% was outrageous.

 

[jaywak]

I remember reading a story of a computer programmer who added this silly feature (flying ducks) to the chess game he was making because he knew his project manager would always find something to complain about and he didn't want to have to remove or change any of the features he liked. Sure enough his manager told him to "get rid of the ducks".

Some people are never happy and I'm beginning to think the same applies to some doctors/nurses.
My A1c was not as low as that when one endo was uncomfortable with it being so low.

The time below 3.9 is less than 1% which I am happy about (the LibreView AGP report says the target is "less than 4%"), but was still told I had too many hypos. (Mind you I would probably agree).

Also this was based on the libre "Low Glucose Events" which are lows which last at least 15 minutes. I have probably as many lows that aren't counted as LGE's. (Unlike Antje77 and others, my libre responds quite quickly). I don't know whether other people agree, but I basically ignore them as, since the libre has to be deliberately excluding them, I am assuming the view is that they are not really dangerous.

I had a nurse (not a diabetic nurse) who was unhappy that I did not eat anything before going to bed despite my average blood sugar being about 7 at that time. (I don't know if it is a thing, but I have want I call 'Foot off the floor" syndrome where my BS can sometimes jump up a few minutes after I get into bed!) I didn't think it was a good idea to mention to the nurse the novorapid correction dosages I sometimes took at night.

I'm not sure I would like your percentage time below 3.9% (even knowing that it isn't accurate), but I am rather envious of your A1c and your Time in Range.

At my last visit to my hospital diabetic clinic the consultant there , himself a type 1 for as long as me , ( 49 yrs ) when I said that since using the Libre for the last 6 months I had noticed the dawn phenomenon sending my morning bg through the roof said that he had the same problem and had rectified it by setting his high bg alarm to 8 during the night and if it goes off injects 1 unit of bolus , I did say that I was always told not to inject at night , he said it works for him so give it a go , I did and it is working and strangely the wake ups are getting less and less as if my body is learning not to do it , the wake ups can be annoying but you have to weigh up the pros and cons and like he said you don't have to worry as much as we used to about the lows with the Libre alarms .

 

[sgm14]

by setting his high bg alarm to 8 during the night and if it goes off injects 1 unit of bolus

When you do this, roughly what time does your alarm go off?

I was warned to avoid stacking, i.e. not to take two injections close together.
Looking at my figures today, I would guess they starting rising at half-five and if I had the alarm set to 8 it would have triggered around six which is just an hour before I usually get up and take my breakfast and hence a full dose, so I probably wouldn't have taken an injection at 6.

the wake ups can be annoying

That doesn't worry me as I usually wake up several times during the night anyway.

 

[holdem]

I have found this thread fascinating and helpful. I spoke to a nurse yesterday who looked at my phone app for the Libre. I am 97% in target and she said the 2 % lows, mainly 3,.8 would cause me permanent memory loss. I mentioned that non diabetics don't get memory loss from 3.8 and she said well you are different. I asked for the research so will see what she finds. She asked me to do better. I felt so good with my results and found her rather annoying! Oh well.

Bless you. This seems like dream control to me. Well done.

 

[jaywak]

When you do this, roughly what time does your alarm go off?

I was warned to avoid stacking, i.e. not to take two injections close together.
Looking at my figures today, I would guess they starting rising at half-five and if I had the alarm set to 8 it would have triggered around six which is just an hour before I usually get up and take my breakfast and hence a full dose, so I probably wouldn't have taken an injection at 6.



That doesn't worry me as I usually wake up several times during the night anyway.

The dawn phenomenon was kicking in at about 3 - 4 am and would go above 8 at about 5 am , when I get up at about 7 -30 am my bg was in the green so I delayed my bolus until i'de showered and reduced my bolus by 2 units sometimes more depending on where my bg started , it seems to be working most days and am not seeing the terrible highs I used to see first thing in the morning .