Hi Alison
The general rule is if you are a T2 on no meds or just Metformin you will be no different to a non diabetic and non diabetics can get low sugars just like a T2. The level that low starts to effect you varies from person to person and from situation to situation so I've recorded well below 4 mmol/l and felt fine but on other occasions have got your symptoms at slightly higher levels as well. The speed your levels are falling also has an effect.
If you get them the best approach is normally to eat but as a T2 on just Metformin its probably best to eat something like a slice of bread, or some nuts or some crackers and cheese rather than a load of sugar or glucose as would be found in most fruit juices and sweets as these may "spike" your blood sugar levels too high. In any event eating something healthy is always the wiser choice in my opinion.
In the end a no or minimal meds T2's body should self correct. The body has a mechanism for doing this called a liver dump. At some point your brain will go "had enough of this" and tell your liver to dump a load of glucose at which point your levels will rise quite considerably. Normally a liver dump is caused by doing stuff like strenuous exercise which will lower levels. Alternatively it can and does just happen if you slowly fall to a very low level. If you hadn't eaten anything since lunchtime then you would likely be approaching the days lowest sugar level anyway which is normally early evening before dinner.
As a pretty newly diagnosed T2 your levels will be a bit all over the place anyway especially if you have reduced to amount of sugar and carbohydrate in your diet which of course all us T2's need to do to get safe blood sugar levels. Even though we do self correct it doesn't alter the fact that sometimes you get the sickness dizziness thing before the liver dump would occur. If you are lucky like I was after running the liver dump occurs before you get any symptoms but sometimes you get the symptoms first. What you have to remember is that throughout your life this liver dump mechanism has probably cut in loads of times without you ever realising it or remembering it.
In a T1 or insulin injecting diabetic or occasionally a diabetic who is on insulin stimulating drugs (Metformin isn't) a true hypo can occur. In this case the normal cause is an over injection of insulin. This causes a rapid fall in levels that can simplistically override the bodies normal liver dump responses. In these cases nothing apart from orally taking on board extra glucose will stop the decline and is therefore very dangerous as under around 2.5mmol most people start to run the risk of falling unconscious. Even then the body has its own defences. It will try and keep important bits like the brain at a higher levels than non critical bits. Some T1's on the forum have been happily conscious and alert with readings in the high 1's.
The ADA (American Diabetes Association) says for an insulin injecting diabetic the hypo range begins under 4mmol but does not become dangerous until levels fall below 2.5. The key thing in that statement is
insulin injecting.
Another way of looking at it is to realise
being diabetic doesn't cause hypos. True hypos are caused by insulin injections or powerful diabetic drugs not the diabetic themselves.
Something a newly diagnosed T2 needs to be aware of is that those dizziness and sickness symptoms can occur at levels far higher than people think. These are called false hypos and happen simply because that diabetics body has got use to running at very high sugar levels so their bodies object to having the sugar taken away. This is actually quite dangerous as it can act as a big disincentive to a T2 who is trying to get to normal levels as the level the false hypos can occur can be well above the recognised max safe blood sugar level of 8. If the person doesn't realise what's happening then its quite likely they think their levels are too low and that they are "hypoing". They then eat a load of sugar and their body goes "thanks" and then continues to damage itself by having too high levels. If these occur you should try to bring your levels down slower but don't give up trying.
Here's what one of the forum moderators said a few weeks ago about the same thing
Pneu said:
Right... there needs to be a clear definition here... many non-diabetics regularly have blood glucose of below 4 mmol/l... if the mean fasting blood glucose of the general non-diabetic population is in the very low 4's then by definition some people are going to have fasting blood glucose in the mid - high 3's... (3.3 mmol/l is commonly citied as the 'lower level' of normal blood glucose). What you don't see is them regularly falling over or collapsing from hypo's because this is 'normal' blood glucose.
Anyone controlling their diabetes that doesn't use pancreas stimulating drugs or insulin is as likely as a non-diabetic to suffer from a hypo... i.e. yes you can still have them but you are going to have to have done something pretty daft to suffer from one... i.e. drink a lot... do a lot of exercise without eating... etc... This is exactly the reason why for instance the DVLA does not require these types of people to undergo the same level of scrutiny as insulin taking diabetics.. the risk to them is no greater than a normal member of the public.
If you take insulin then ofcourse you need to be much more aware of what your blood glucose are doing... as a type I diabetic of many years the danger from hypo's comes from the rapid change in blood glucose that insulin can produce.. Along with the fact that your body is not in control of the amount of insulin in effect... in a non-insulin controlled diabetic as your blood glucose drops lower your body stops producing insulin, your liver dumps glucose and all is well... in an insulin controlled diabetic that insulin keeps acting if there is too much insulin in your system them your livers glucose dump is not enough and your blood glucose continues to drop..
Therefore it is advised that you keep your blood glucose above 4 mmol/l... this ensures that you have some buffer to dangerously low blood glucose and also ensures that you maintain a hypo awareness (for most people)...
The point at which low blood glucose becomes dangerous is when it starts to effect brain function this is known as Neuroglycopenia.. Neuroglycopenia causes the majority of the symptoms that we associate with hypos... mood swings, fatigue, weakness, apathy, lethargy, confusion, amnesia, dizziness, delirium, etc... these symptoms typically present at between 2.0 - 2.4 mmol/l...
So in summary: If you are a diabetic who does not take pancreas stimulating drugs or insulin then a reading of between 3.3 - 4.0 mmol/l is nothing to be overly concerned about (you aren't about to drop into diabetic coma!.. indeed this may even be 'normal' for you). If you plan on exercising or drinking or any sort of activity that may effect your blood glucose or you have recently undertaken any of these activities then you may want to eat some carbs...
If on the other hand you are taking insulin or pancreas stimulating drugs and you get a reading that is sub 4 mmol/l then you should take it seriously and actively correct.