Type 2 Hypos with blood glucose at 5.5 mmol/L?

We propose that brain energy deficit is an important pre-symptomatic feature of Alzheimer’s disease (AD) that requires closer attention in the development of AD therapeutics. Our rationale is fourfold:
(i) Glucose uptake is lower in the frontal cortex of people >65 years-old despite cognitive scores that are normal for age.
(ii) The regional deficit in brain glucose uptake is present in adults <40 years-old who have genetic or lifestyle risk factors for AD but in whom cognitive decline has not yet started. Examples include young adult carriers of presenilin-1 or apolipoprotein E4, and young adults with mild insulin resistance or with a maternal family history of AD.
(iii) Regional brain glucose uptake is impaired in AD and mild cognitive impairment (MCI), but brain uptake of ketones (beta-hydroxybutyrate and acetoacetate), remains the same in AD and MCI as in cognitively healthy age-matched controls. These observations point to a brain fuel deficit which appears to be specific to glucose, precedes cognitive decline associated with AD, and becomes more severe as MCI progresses toward AD. Since glucose is the brain’s main fuel, we suggest that gradual brain glucose exhaustion is contributing significantly to the onset or progression of AD.
(iv) Interventions that raise ketone availability to the brain improve cognitive outcomes in both MCI and AD as well as in acute experimental hypoglycemia.

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We conclude that ingestion of medium-chain triglycerides improves cognitive function without affecting the adrenergic hormonal or symptomatic responses to acute hypoglycemia in intensively controlled type 1 diabetic patients. These findings suggest that medium-chain triglycerides could be used as prophylactic therapy for such patients with the goal of preserving brain function during hypoglycemic episodes, such as when driving or sleeping, without producing hyperglycemia.

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Al44 said:

Ten years ago I was diagnosed T2, now been 7 years on Metformin.
The last few 6-monthly checks my doctors & nurses said "Your HbA1c is 47 mmol/mo1Hb and shows your diabetes control is quite good, especially considering you're 73 years old."
My fasting blood glucose usually ranges 7 to 8 mmol/L and is NEVER less than 6.5 even after a 24-hour fast.
So I'm not sure it really is "quite good", but that's the background, not the point of my question, which is:
Can anyone here suggest why if my blood glucose falls below about 5.5 mmol/L during the day, I feel ghastly - shaky, spaced-out, trembling, the usual signs of a hypo. Yet my impression is this shouldn't happen until it falls below 4.
I've checked it with 2 other meters that give broadly similar readings.
Obviously we are all different, so is it possible my body just runs "sweeter" than most, or, if that's wishful thinking, what else might be going on?

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Al44 said:

Thank you Leslie, makes a lot of sense.

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