How often do you have "a low incident"

[EnduroDiabetic]

I guess this is a T1DM question. How often do you guys go low? and what do you consider to be "low"?

So I was having a conversation the other day with some non-diabetic friends, they were asking me how often I go "low", for me I hit the low 3's probably once every couple of days, sometimes more, sometimes less, and they asked "is that good"? to which I have no idea, I don't know if its "normal" to have those episodes or not.

I get that 4-6 is the optimum range, however, I don't get any physical symptoms until I hit about 3, so I'm not overly aware of, or concerned until I hit that point. Thankfully I have never passes out or had "a low incident", however, that leaves drawing a blank when I think about where that line actually is... So at what point is one actually in "danger"? and how often do people generally get it completely wrong and need serious help?

And is hitting the low 3's every couple of days "normal"?

 

[Antje77]

I guess this is a T1DM question. How often do you guys go low? and what do you consider to be "low"?

I can only tell you the way I approach it, and I really have no clue what is 'normal' or usual.

- I think I dip just below 4mmol 5 or 6 times a week, some weeks more often, some weeks less, not concerned about those.
- 3.4 - 3.6 happens maybe once or twice a week, usually with mild symptoms. I see those as 'whoops, should have paid more attention'.
- Seeing a number lower than that is always a bit of a shock. Happens about once a month I think, give or take a bit. My reaction is something like 'that shouldn't have happened, too close to danger zone'. Besides, it makes me feel yuck, not only physically but usually accompanied by feelings of doom and gloom.
- A 2.something is very rare, once or twice a year. Scares me into running higher than I like for a few days to give myself some time off from worrying about it happening again until the memory has faded a bit.

I get that 4-6 is the optimum range, however, I don't get any physical symptoms until I hit about 3, so I'm not overly aware of, or concerned until I hit that point. Thankfully I have never passes out or had "a low incident", however, that leaves drawing a blank when I think about where that line actually is... So at what point is one actually in "danger"? and how often do people generally get it completely wrong and need serious help?

The danger of not noticing a hypo until lower numbers is there being less room to react before actually passing out. Some people never notice a hypo until they pass out. As far as I understand, the level at which people aren't able to help themselves anymore varies, I don't think there is a set number for that.
I've passed out from a hypo once, but that was due to a situation that will never happen again. I hope I'll never find out at what exact number I lose consciousness.

 

[Grant_Vicat]

I can only tell you the way I approach it, and I really have no clue what is 'normal' or usual.

- I think I dip just below 4mmol 5 or 6 times a week, some weeks more often, some weeks less, not concerned about those.
- 3.4 - 3.6 happens maybe once or twice a week, usually with mild symptoms. I see those as 'whoops, should have paid more attention'.
- Seeing a number lower than that is always a bit of a shock. Happens about once a month I think, give or take a bit. My reaction is something like 'that shouldn't have happened, too close to danger zone'. Besides, it makes me feel yuck, not only physically but usually accompanied by feelings of doom and gloom.
- A 2.something is very rare, once or twice a year. Scares me into running higher than I like for a few days to give myself some time off from worrying about it happening again until the memory has faded a bit.


The danger of not noticing a hypo until lower numbers is there being less room to react before actually passing out. Some people never notice a hypo until they pass out. As far as I understand, the level at which people aren't able to help themselves anymore varies, I don't think there is a set number for that.
I've passed out from a hypo once, but that was due to a situation that will never happen again. I hope I'll never find out at what exact number I lose consciousness.

I think it varies according to what is happening with glucose tolerance levels. When I had an HbA1c of 12 (many years ago, I would need assistance around 3.4. As my HbA came right down to 5.8. I had been known to be in control (just) at 1.3. This happened when I was alone, putting up a very large remake of the square in Verona and pondering the best way to fix a balcony 8 feet up. I remember walking round and round in circles, just unable to get my head in gear. I went to the back of the vast hall to go up to the main school building to find food. Miraculously there was a plate of cakes and biscuits left from a meeting ten hours earlier. I wolfed the lot down, shook violently, sat on a bench and did a test, while auras appeared in my eyes on and off. It said 1.3. I was so startled I repeated the test. No different. So yes, at that stage I could be dangerously close, but so wrapped up in whatever that on occasions outside help was necessary. That is why I have never wanted to live alone!

 

[sgm14]

You might like to watch a FreeStyle Webinar at

This mentions a study in Scotland which showed the average number of lows to be 42 per year for Type 1 diabetics and an average of just over 1 serious events. (Serious being where they were not able to correct the problem by themselves).

I'm not an expert and not even Type 1, but I am on insulin, which means I know a bit about lows. (Plus I have a few type 1 relatives).

> Is that good?

In my opinion - No, it is not good.

A more difficult question would be : Is that bad?

Honest answer is I don't know. It seems to me that everybody is different. For some people a low of 3 is not really noticeable and for other people their brains are affected at much higher figure. If you start to get confused around 3, then hitting that level regularly would be bad. There is also the issue about what happens if you go low when you are asleep.

> What is a low?

My FreeStyle Libre tracks the number of 'low glucose events' which it defines as levels lower than 3.9 for longer than 15 minutes.

Going on that definition, my figures started off slightly worse than yours, but I quickly discovered that my symptoms were mostly physical and I never seemed to get confused or had any issues recognising what the problem was and fixing it. Also if I went low during the night, it always seemed to wake me up. Hence I never considered it really bad. But I wasn't happy with it and have been working to get them lower. They are much lower now, but 14 in 90 days means I am still below average.

As well as recording low events, the FreeStyle libre records the Time in Range and the AGP report from the libreview states that the target is to be lower than 3.9 for less than 4% of time and lower than 3.0 less than 1% of the time, and by that definition, my figures are good.

> So at what point is one actually in "danger"?

When your brain function starts to malfunction. This seems to be different for different people, but I think 1.5 is the normally quoted figure. Interestingly, the FreeStyle libre just shows LO when the figures are below 2.

 

[Ushthetaff]

I’ve been type 1 for coming up to 40 years and I’ve lost count of the number of hypos I’ve had. But one thing I will say there is no number for a low incident in my opinion , I know the hypo number is below 4 but to me it’s when I feel in need sugar and I know when I need sugar, the number has varied for me over the years , it use to be as high as 6 but my Hb1ac was over 90 in those days now my HB1ac is around 53 so I feel hypo ar below 4 sometimes 3. Hypos are totally an individual thing even down to symptoms. As stated her awareness is key , I tend to run my sugars between 5-8 as I canny drive at below 5 plus I think controlling a around 4 is too close to the “” infamous “ hypo number.

 

[JohnEGreen]

Well I'm not T1 or Lada or on insulin or blood sugar lowering meds but I have been down to 2.2 that did not feel good.

 

[MarkMunday]

The problem with going below 4 is that hypo awareness is eroded. If it happens often enough, we become hypo unaware, or unable to sense low blood glucose. It is not good because hypo unawareness can mean we allow blood glucose to drop to the level we pass out or lose control. Dangerous if driving or operating machinery. If my blood glucose goes below 4 I try to understand what caused it and I try figure out how to stop it happening again.

 

[kev-w]

I've sat and shook my head at a 1.7 a few times over the years before treating it so I don't fret when in the high 3's too much, something I saw on Twitter recently was a non D dietician wearing a libre and dropping to the high 3's a few times on a night which I found interesting as hypoglycemia is classed as starting at 3.9.