HYPO Experiment - QED

[Grazer]

There have been many discussions on this forum, some quite heated, about whether or not a Type II on diet only (with or without metformin) can have a hypo.
The issue here concerns the definition of a hypo. Hypo is simply short for hypoglycaemia which means low blood sugar. Anyone, diabetic or not, can have low blood sugar but it is normally only those diabetics injecting insulin or insulin stimulating drugs that suffer the sort of dangerous hypo that requires intervention and sometimes hospitalisation. Other diabetics would normally see their own metabolism correct any low blood sugar episode.
SO, I decided to put this to the test. I play golf, which is a more energetic form of exercise than some may realise. During a round of 18 holes, I will walk about 5 to 6 miles dragging a heavy trolley behind me and swinging energetically at a ridiculously small white ball, frequently missing. As I'm not in my first flush of youth, I often have a brief respite after nine holes and on occasion have used this to test my blood sugar levels. At that stage, they are nearly always in the threes and I have recorded 3.2 with no ill effect. I don't test after 18 holes, because by then I'm normally celebrating (my low blood sugar, not my normally quite dire golf) with a couple of pints and a bacon Sarney with brown sauce!
Yesterday, I played 18 holes with a very light lunch in advance so my fuel reserves (blood glucose level) would have been quite low. After nine holes, I tested my blood sugar level which was 3.5. I didn't rest, but continued on to complete my 18 holes. I know that my blood sugar level continued to drop, and I drank only water during this time (no energy drinks) which spanned a total of four hours. I definitely had low blood sugar towards the end of the round, as I felt somewhat lightheaded and dizzy on a couple of occasions as I addressed the ball. Non-golfers should note that addressing the ball is not a matter of calling it Sir, I frequently call it many things but never Sir. Addressing the ball simply means standing in front of it with the forlorn expectation of hitting it well.
At the end of my golf, there was no beer and no bacon Sarney. I packed up and went home, and then tested my blood sugar level thinking I might see a record low. My reading was 6.0.
This means that at some time during my golf, (probably about the time I had a couple of dizzy spells), the alpha cells in my pancreas decided enough was enough, and they released glucagon. This told my liver to release glycogen which produced a surge of glucose into my blood. In other words, I had a liver dump.
It is probably likely that any insulin user who did not correct their dosage for this level of exercise and who did not take on any form of extra fuel during the round, could have had a potentially dangerous hypo. As a Type II on diet only taking 500mgs of metformin twice a day I simply experienced low blood sugar followed by a liver dump.
Hopefully my experiment upon myself helps to illustrate the discussions we frequently have, and the assertion that a Type II on diet only/metformin is unlikely to have a dangerous hypo unless they have some other medical complaint. Diabetes itself and metformin alone do not cause dangerous hypos.

 

[borofergie]

I've said this a few times before but, every Saturday morning I run in a 5k race - which is pretty full on, my Heart Rate is usually 90-93% of my maximum.

1. Before I start running my BG is always 5-6mmol/l (my usual fasting level)
2. When I finish running my BG is usuall 8-11mmol/l
3. I assume that at some time during my 3 mile race my BG drops below my "hypo" level, causing my liver to dump
4. I manage this without slowing down, feeling giddy, going into a coma or dying
5. I eat less than 30g of carbs per day

 

[Scardoc]

I've said this a few times before but, every Saturday morning I run in a 5k race - which is pretty full on, my Heart Rate is usually 90-93% of my maximum.

1. Before I start running my BG is always 5-6mmol/l (my usual fasting level)
2. When I finish running my BG is usuall 8-11mmol/l
3. I assume that at some time during my 3 mile race my BG drops below my "hypo" level, causing my liver to dump
4. I manage this without slowing down, feeling giddy, going into a coma or dying
5. I eat less than 30g of carbs per day

I think we should up the stakes here Gents. How about doing your next 5K with Grazer's golf bag over your shoulder?

As a T1 I am very jealous. I have a 10K on Sunday and without a starting level of 6 or above and around 6/7 Jelly Babies during the run I would almost certainly drop after 3K. No experimenting for me, one bad hypo running and my Wife will ban it!!!

 

[xyzzy]

I don't disagree Grazer BUT I do think the symptoms of low blood sugars can vary on such things as the time of day and from person to person. Like yourself a few months ago I did a very similar experiment just to get confidence that my systems do actually work as the are intended to . Like you I have found one of the great benefits of walking is that it does effectively reduce BG's just as well as any kind of structured exercise in my opinion (as long as you walk far enough). On my normal walk there is a hill which I occasionally decide to run up. I have measured at the top of the hill and been 3.2. I've then continued running without feeling any effects and measured again 5 minutes later and been over 7. So to that extent I completely agree.

On another occasion things have been different though. One morning I woke up went for a pee and felt really strange and fainted. Came to a few seconds later and felt absolutely c**p, nauseaous, dizzy etc. This passed after about 5 mins but I felt really quite unwell for hours. Tested my levels just after the initial recovery and again they were again over 7. I know all about DP in the mornings but this was different as my normal DP level is low 5's.

What I'm getting at is in both cases I undoubtedly had low levels and my systems responded with a liver dump to get things sorted however on the first occasion there were no noticeable symptoms but on the second there certainly were and they were not pleasant.

Like yourself I still wouldn't classify them as a true hypo as there was no risk of ending up in a diabetic coma as in both cases my bodies normal liver dump worked as it should. I also agree that none of what happens has anything inherently to do with being diabetic.

The large UKPDS study divided reported hypo's into 4 strengths.

(1) transitory symptoms not affecting normal activity
(2) temporarily incapacitated but patient able to control symptoms without help
(3) incapacitated and required assistance to control symptoms
(4) required medical attention or glucagon injection

For diet only diabetics

1 in 1000 report an episode where they actually needed to do something about it i.e level 2 to 4

For Metformin only diabetics

3 in 1000 report an episode where they actually needed to do something about it. i.e level 2 to 4

So based on that large study Metformin does triple the risk of someone reporting an episode BUT the risk is still remote so only 3 people in every 1000 people end up reporting an episode of note. To me this completely explains why for example the DVLA is quite content to conclude that Metformin users are no more of a risk to drivers than diet only diabetics who undoubtedly have no additional risk than a non diabetic.

 

[borofergie]

I think we should up the stakes here Gents. How about doing your next 5K with Grazer's golf bag over your shoulder?

As a T1 I am very jealous. I have a 10K on Sunday and without a starting level of 6 or above and around 6/7 Jelly Babies during the run I would almost certainly drop after 3K. No experimenting for me, one bad hypo running and my Wife will ban it!!!

Here's the rub though Scardoc - you probably run 10k in the same time as I run 5k - so I'll forgive you the jelly babies.

I happily run up to 10miles without any food (I've never been further than that).

It's obviously different for T1s.

 

[lucylocket61]

this is all very interesting.

Since I started low-carbing, my lows have not resulted in fainting. I will sit the next one out rather than administering something like fresh orange juice, and see what happens. I was afraid to try this, but, after reading the above posts, am happy to give it a go at home.

 

[Robinredbreast]

That was a very intersting read Grazer, and a thought provoking one as well. A very good experiment :thumbup: RRB

 

[hanadr]

I haven't experienced ANY hypo symptoms since Idropped using Gliclazide seeral years ago and went low carb.
All this [admittedly anecdotal evidence] does suggest that Bernstein has the right of it in his doctrine of small numbers. ie. Small doses of insulin[for those that use it] are much safer. Bernstein is talking about figures like 7 units.
Very few, if any, British T1s use so little. I have even met people using U500 insulin
this is 5 x the strength of the normal U100 and suggests mammoth doses.
Hana

 

[catherinecherub]

I think what people are forgetting is that there are three types of hypo.
1. Mild.
2. Moderate
3. Severe.

A good definition here from http://www.Hypodiab.com. There are a trusted source and you can see who their editorial team comprises of. http://www.Hypodiab.com/generic.aspx?id=4 You can subscribe to their newsletter and read some interesting studies. I did send them an email and this was their reply,

"The guidelines define an episode of hypoglycaemia as being mild, moderate or severe. Mild or moderate is defined as an event that the patient can self treat irrespective of symptoms, severity or an asymptomatic blood sugar of below 3.9. With mild hypoglycaemia, only autonomic symptoms are present whereas autonomic and neuroglycopenic symptoms are present with a moderate event. Severe hypoglycaemia is defined as an event that requires third party assistance to treat".

 

[lovinglife]

It may not be "dangerous" for a T2 not on meds but liver dumping can reallly mess up those numbers,

personally if I feel not right and test and I am at 4 or below I always have a 5g casrb snack - takes me back up to around 4.5 - I much rather that than a liver dump which can take me into the high 7's and stay there for quite a while- it's usually just before a mealtime too which means if I didn't have a small snack I would be in the 7's and not the 4's before my meal. - I always feel quite yucky for a while after a liver dump too (granted I am on glic so can get real lows if not careful but have only had a very rare 2 a couple of times)

For me I don't like to be in the 7's 2 hrs after a meal so I certainly don't want to be there without eating! - I love my grub too much for that and it would really cheese me off! :lol:

 

[Grazer]

It may not be "dangerous" for a T2 not on meds but liver dumping can reallly mess up those numbers,

personally if I feel not right and test and I am at 4 or below I always have a 5g casrb snack - takes me back up to around 4.5 - I much rather that than a liver dump which can take me into the high 7's and stay there for quite a while- it's usually just before a mealtime too which means if I didn't have a small snack I would be in the 7's and not the 4's before my meal. - I always feel quite yucky for a while after a liver dump too (granted I am on glic so can get real lows if not careful but have only had a very rare 2 a couple of times)

For me I don't like to be in the 7's 2 hrs after a meal so I certainly don't want to be there without eating! - I love my grub too much for that and it would really cheese me off! :lol:

Hi! As you're on Glic, one of the insulin stimulating drugs I mentioned in my first post, I can see why you take your snack. For me, the long period I have in the 3s and 4s more than makes up for what seems a very temporary rise by way of liver dump to compensate for the lows. I wasn't trying to suggest people should try and starve to cause a dump by the way! :lol: I was just trying to show the results of my experiment, and the fact that for us on diet only/met our body does compensate for lows so we don't need to worry overly. You're right though; it is annoying after all that exercise to see a reading higher than when you started! I normally have an apple half way round, and that seems enough for me.

 

[smidge]

I haven't experienced ANY hypo symptoms since Idropped using Gliclazide seeral years ago and went low carb.
All this [admittedly anecdotal evidence] does suggest that Bernstein has the right of it in his doctrine of small numbers. ie. Small doses of insulin[for those that use it] are much safer. Bernstein is talking about figures like 7 units.
Very few, if any, British T1s use so little. I have even met people using U500 insulin
this is 5 x the strength of the normal U100 and suggests mammoth doses.
Hana

Bernstein is exactly right Hana. I use 7 units of basal split 4 at night, 3 in morning - so no more than 4 active at a time. I then use rapid acting with meals. I rarely have more than 25g carb at a meal, so my Apidra doses are usually 3 units or less. An average day would mean 5 to 7 units Apidara for the whole day. Because my doses are small, it doesn't drag my body down I.e. my body will correct lows just as Grazer described in his opening post. Mid-morning is my only real hypo danger time when the effects do my Insuman basal and Apidra reach a combined peak. Even then, a single jelly baby or one finger of a dark chocolate kit kat sorts it out. Not sure if I count as Type 1 in this case as I am LADA and still have well-functioning pancreatic alpha cells as far as I can tell.

Smidge

 

[Sid Bonkers]

Having suffered a few hypos when I was on insulin I would not make light of one, ever. Whilst it is not common for diet only or diet/meds T2's to suffer hypos it can still occur and there have been numerous accounts of these over the last 3 or 4 years here on the forum that will testify to it.

An interesting web page to read that Catherine posted here back in 2009.

Extract:

The risk of hypoglycemia unawareness is far lower in people who have Type 2 diabetes because hypoglycemia occurs less often. A study using tight control in Type 2 diabetes done by the Veterans Administration showed that severe lows occurred only four percent as often in Type 2 compared to Type 1.

http://www.diabetesnet.com/diabetes-con ... nawareness

The link that Catherine made her post to was titled Hypo's and long term brain damage now it may be that any brain damage caused by hypos is temporary and not permanent as suggested back in 2009 but I wont be playing Russian roulette with my health by knowingly going below 4 mmol/L thats for sure.

IMHO hypos should always be treated, swiftly :thumbup:

 

[Grazer]

I think what people are forgetting is that there are three types of hypo.
1. Mild.
2. Moderate
3. Severe.

Hi Catherine! I certainly wasn't forgetting this, in fact i suppose I referred to it in my original post by pointing out that both non-diabetics and diabetics on diet/Metformin can get low blood sugar episodes, which is affectively a "mild" hypo in your list. Indeed, i provoked one in myself when i got a "bit light headed and dizzy" Point of my experiment was to show that going below 4 isn't an issue for T2s on diet/metformin any more than for a non-diabetic as we correct our own blood sugar level ultimately (i had my measured levcel of 6) after reaching a low level, UNLESS there is something else wrong with us.
This is no different to non-diabetics who after all spend a fair amount of time in the threes and don't worry about it or eat "corrective" food. My wife (non-diabetic) sometimes feels a bit weak and dizzy after a lot of golf - we both eat something we've taken in the golf bag. Most golfers take a banana in their bag for mid-round, I take an apple. If you expend a lot of energy with not much fuel in the tank you'll get low blood sugar potentially!