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It's the medication that's dangerous

wallycorker said:
Maybe so Fujifilm - but what a coincidence that the number they come up with is the nice and convenient whole number of 4!

Why should it be such a nice convenient whole number? Wouldn't you have expected something more precise like a number of 3.76 or 4.24?

Maybe you got it right and perhaps it was a number arrived at by some sort of a committee "over a pint and a packet of crisps"- and perhaps then someone wrote the number down on the back of a fag packet. :lol:

Best wishes - John
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John

I would really expect a little more maturity coming from someone like yourself, who I regard as someone who is well schooled on subject matters regarding diabetes.

As you know, there is a slight time delay in the true level of a persons blood glucose level when testing, therefore someone with a reading of 4 may be much lower, for example below 3.5, which I know from many years of experience is hypo territory. Consistently falling below 4 can have serious consequences in many people with diabetes, loss of hypo awareness can be a life threatening condition, which is why we are advised against pursuing such low numbers. '4 is the floor' is easy to remember, and has no doubt prevented countless people from falling into a hypoglycemic state.

I think it is worth bearing in mind that many new and newly diagnosed people read this forum, who have little knowledge or experience of diabetes in general, and therefore members should be careful of the advice and information that is given out.

Regards

Nigel
 
None of us are experts on diabetes. Some think that they know more than the experts and this seems to be the problem.
The best we can hope for, unless we want to retrain as an Endocrinologist, is to be able to manage our own condition and pass on tips and strategies that have worked for us. This does not mean that they are the universal answer for every diabetic.
If you decide that hypo territory is for you then so be it but please do not suggest that it is O.K. for everyone else. It isn't.
Feeling that you are O.K. is subjective as someone else may view your demeanour/attitude/behaviour as abnormal. Nearest and dearest may have seen it all before and be accepting of it. They may just put it down to your diabetes. The DVLA and Police have a different attitude towards it.
Bad advice abounds on the internet and we really do not want to add to that do we?
Hypo awareness seems to me a better place to be than hypo unawareness.
 
catherinecherub said:
Feeling that you are O.K. is subjective as someone else may view your demeanour/attitude/behaviour as abnormal. Nearest and dearest may have seen it all before and be accepting of it. They may just put it down to your diabetes. The DVLA and Police have a different attitude towards it.
Bad advice abounds on the internet and we really do not want to add to that do we?
Hypo awareness seems to me a better place to be than hypo unawareness.
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So just what are you saying Catherine that all type 2s even those that are not on medications are at risk. If you are suggesting that, how does it equate to those who are told they don't need to test BGs and are also drivers should they not drive.

I have had BGs below 4.0 but only through testing do I know, I definitely don't have any symptoms of a disabling hypo. As I drive a lot are you saying I should not be driving .

Interpretation
Glucose thresholds for counter-regulatory hormone secretion are altered in well controlled type-2 diabetic patients, so that both symptoms and counter-regulatory hormone release can take place at normal glucose values. This effect might protect type-2 diabetic patients against episodes of profound hypoglycaemia and make the achievement of normoglycaemia more challenging in clinical practice.
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http://www.thelancet.com/journals/lance ... 40-6736(00)03322-5/fulltext

Graham
 
I have learned to be extremely cautious when a medical professional tells me information that has been "accepted or proven" for many years. Remember Dr J Lister back in the 1860's? He found from his experience and study that germs were the cause of high death rates in surgical procedures. He was castigated by his peers in the medical field when he suggested that they needed to wash their hands in a solution that would erradicate germs from one patient before they attended the next.

My GP was concerned that I would have hypos when she learned that I was eating a low carb diet and not taking any medications. I had discontinued Metformin as I was achieving fasting BGs in the low fours and now 8 months later with diet alone am in the low 5s and occasionally in the top 4s. I am not going to hypo if I am not taking meds and never have had a hypo in my 57+ years.

Then my non-diabetic husband has been getting fasting BGLs between 5.5-6.0. His 2 hourly result from two GTT were 3.4 and 2.7. His doctor thought that this was a FANTASTIC figure, so low! Was he concerned that he might hypo? Not at all. Was the doctor concerned that his FBGs were a tad high? No, because his were around 5.8, they were a similar age and in the doctor's opinion there was nothing abnormal with his figures.

For non-medicated diabetics I have to agree with Hanadr.
Can I ask if there are any non-medicated diabetics on this forum who have had actual full on hypos, black-outs, convulsions not related to an infection?
 
clearviews said:
I am not going to hypo if I am not taking meds and never have had a hypo in my 57+ years.
Really.....I doubt very much that you would have known anything about it. Mild Hypoglycaemia can be worked through very easily. Have you NEVER found yourself sweating, felt faint, gone pale, had a headache, had tingling lips, felt your heart pounding, been anxious, had blurred vision, felt hungry, been irritable or confused, found your concentration lacking, felt like your personality has changed (shouting at the kids, ranting at the telly, newspapers, life in general,) found it difficult to get up in the morning, or shaking..... :?: Just some of the symptoms that you might get, not all of course. One I could add to the list is a blocked nose....very annoying, all rectified with two or three Glucotabs and a snack.

Well, I'm 61 and I have had ALL of those things happen to me over the years. Many of them were when I was NOT a Diabetic, many years before diagnosis. Now I know more about the subject I am sure a lot were probably down to low blood sugar levels, I used to skip meals, snatch tiny snacks, exercise hard, had a very stressful job, stayed out in the Sun too long. All possible causes for low blood sugar levels. Most of the symptoms used to disappear after I had some food.

Then my non-diabetic husband has been getting fasting BGLs between 5.5-6.0. His 2 hourly result from two GTT were 3.4 and 2.7. His doctor thought that this was a FANTASTIC figure, so low! Was he concerned that he might hypo? Not at all. Was the doctor concerned that his FBGs were a tad high? No, because his were around 5.8, they were a similar age and in the doctor's opinion there was nothing abnormal with his figures.

I don't know what your non Diabetic husband has to do with it.....as you say he is not a Diabetic and yes, his numbers at the test are great. His metabolism was obviously dealing well with the GTT. As any non Diabetic would be expected to. Nothing to do with Hypoglycaemia. The Dr was quite rightly not concerned.In a non Diabetic they wouild only be concerned if the numbers were consistently below around 2.5 mmol/l and certain other criteria were met. So, we should really stick to Diabetic's and their numbers which is what this forum is all about. Non Diabetic's can start their own forum and tell us how great their numbers are..... :wink:

For non-medicated diabetics I have to agree with Hanadr.
Can I ask if there are any non-medicated diabetics on this forum who have had actual full on hypos, black-outs, convulsions not related to an infection?
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Hypoglycaemia has been explained on this forum many times before, ad infinitum. It can and does happen to ANYBODY. Some people seem to thnk that it doesn't exist in their case ....just because they have, in their words, never felt any symptoms. They are either very lucky or just simply Hypo unaware because they have run blood glucose levels too low for too long. That is how unawareness begins. You cannot divorce one from the other, they exist. No left turn's, no going back. It is a medical fact however hard some try to prove otherwise. Endocrinologist or Diabetologists have never changed their opinions about this. If they ever did then I'm sure we would be the first to know.

As for your request for non medicated diabetic's to respond here, I hope they do and truthfully answer the list I gave you previously. The symptoms. I know of some personally that have had the symptoms and know it for what it is. None of them ever made out that it didn't exist in a non medicated Diabetic.....they knew different.

You don't have to have had a blackout or convulsions to have had a hypo. Those are when you are in severe hypo territory, there are many stages of a hypo, some mild and some not so mild, none of which are particularly pleasant....I can assure you. If it looks like a hypo, feels like a hypo, and even sounds like a hypo.....then I think we can safely assume that it might just be a.....Hypo...... :D

So, I don't agree with you or Hana. That's life I suppose.....So all bet's are off !
(Hi CC & SS) :wink:
 
I think I might answer this one. More my line of experience I think.

graham64 said:
So just what are you saying Catherine that all type 2s even those that are not on medications are at risk. If you are suggesting that, how does it equate to those who are told they don't need to test BGs and are also drivers should they not drive.

What Catherine has said is correct. The Law requires ALL drivers of Motor Vehicles on a road to be in proper control of their vehicles at ALL times, that includes ALL types of Diabetic's. A simple Road Safety measure.

There is no exemption because you didn't know you were hypoglycaemic, however there are certain specific defences to the offence committed which all depends on the circumstances. As a driver you should be able to test prior to a journey and also during that journey if required.

How you do that is entirely your responsibility. Nobody elses. If your GP doesn't give you test strips then you will have to buy your own. You can't blame your GP or the PCT for not giving you a meter and test strips.

As for not driving, well, if you think you are not fit to drive then you should not drive, in the same way as drink impairs ability, so does a hypo. Have an accident whilst in that condition and you could find some very searching questions being asked, and your Insurance cover may be invalidated as you would have broken the terms of your agreement, however some companies are sympathetic to things like this. The Police, I can assure you are not !

I have had BGs below 4.0 but only through testing do I know, I definitely don't have any symptoms of a disabling hypo. As I drive a lot are you saying I should not be driving .

If you ever have a hypo then you SHOULD feel the symptoms, (back to unawareness again). If as you say, you drive a lot it is incumbent on YOU to make the decision as to whether you drive or not.....it is solely YOUR responsibility. If you get it wrong, then the consequences can be severe. I suffer from hypo's sometimes, and test before a journey, during the journey and frequently have to stop at Services to either top up BG levels with some food or just rest while hyper levels subside. That is my choice and my responsibility. I am the driver. I am in control of the vehicle.

Hope that helps. ?
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Sorry to be pedantic Clearviews.
It was Ignaz Semmelweiss in Vienna, who insisted that his colleagues wash their hands in Chlorinated lime and ultimately gave his own life for his beliefs and researches. Lister used a carbolic spray to prevent post-operative infections. Both believed in the "Germ theory" and were ridiculed for it.
However their opponents did come to accept that fewer patients died. Even if it took a LONG time and MANY deaths.
Perhaps our dieticians will see it eventually too.
Hana
 
As stated earlier, I sound to be exactly the same as Hana, Graham and Clearviews inasmuch that I am a non-insulin dependent Type 2 with very good blood glucose control. My blood glucose levels spend a lot of time in the 4s and quite often go below and as low as 3.4 at the lowest that I've ever recorded. When my levels are below 4, I feel absolutely no symptoms whatsoever and feel no different to when the figures have been in double figures.

My GP tells me that this isn't anything that I need to be concerned about. He quite simply tells me if I feel strange in anyway then all I should do is "eat something" - he doesn't specify anything in particular. Several dietary-aware non-diabetics that I know tell me that is what they do the same too. Now that I'm testing - against all the advice given by my health professionals - that is what I do too - i.e. if I find myself below 4 then I take a small piece of fruit. Moreover, I snack on fruit at regular intervals between meals to try to minimise any such situations - however, I still do record levels below 4 even when doing that. In particular, I snack on fruit whenever I am driving both before starting and during the journey.

Certainly, in my own particular situation, I am very pleased to be what people have called hypo' unaware and be free of what sound to be very unpleasant diabetic symptoms indeed. I consider this to be something good rather than to be bad as at least one forum member seems to think it to be.

As a non-insulin dependent Type 2 on metformin only, I have never felt at any risk whatsoever in such situations. Moreover, There isn't anything that I have read in this thread that convinces me that I ought to think otherwise.

I do realise that things are very different for insulin-dependent diabetics - both Type 1s and Type 2s - and also for certain other Type 2s on some other medications. Moreover, I do understand that the very unfortunate people who suffer from the extremely nasty sounding symptoms of hypos ought to be doing their absolute best to avoid such situations.
 
Yes Hana, I had a full blown hypo one night about 3 in the morning, ended up lying on the bathroom floor sweating, shaking and could not move for about 15 minutes.Not something I want to repeat in a hurry especially on a freezing cold night !!
In the past, before I was diagnosed a diabetic, I used to take cadets to summer camp. If we missed a meal, which we often did, I very often went hypo. I recognised this even back then and had to get something to eat quickly.I have known many others, not diabetics, who suffer the same 'low' symptoms, especially if they do not eat and have seen a few pass out simply because they are 'low'.

As stated before by Cugila, ANYONE can hypo. This argument could run on and on, rather like the diet threads but WE will continue to give out the proper information until the medical profession decide to redefine the definition. What the experienced members decide is their personal level is up to them. We are advising new members. There will be no left turn on this issue from the moderators !

John,, you may think being hypo unaware is a good thing :shock: :shock: but like the unfortunate people who do not feel pain it carries its own particular risks!!! I feel terrible below 4 and hope that I always will to warn me of the risks!!
 
sugarless sue said:
Probably because I am very hypo aware, and thank goodness for that !
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Yes Sue - but there must be some other explanation as to why that is the case?

It would seem that most well-controlled non-insulin dependent Type 2s do not have that severity of hypo' awarenes - it all sounds remarkably unpleasant to me. Haven't you ever thought that maybe would be better off understanding why you are so badly affected? What do your healthacre professionals say about your particular situation?

Best wishes - John
 
There seems to be a pattern emerging here. When the non-believers see my posts they feel they have to dissect and discredit them. No left turns, no right turns but straight for the jugular. :lol:

I suggest those that believe that because they feel alright, and hypo unawareness does not affect them, write to the DVLA and explain that they are the exception to the rule. No prizes for guessing the reply.
Frequent episodes of hypo's (even mild ones) force the brain to become accustomed to low glucose. This causes suppressed levels of adrenaline. The glucose transporters in the brain cells are damaged from frequent episodes of hypoglycaemia.
The usual method to try and gain hypo awareness is to run levels a bit higher and see if this re-establishes it.
I am well aware that this is more a problem for insulin users but to say that is something that you do not see as a problem amazes me.
As for the question of driving and test strips, your conscience has to be your guide on this one.

Wally, this Dr. who tells you not to be concerned about this. Is he the same one who told you to eat gigantic portions of starchy carbs to control your diabetes? Hypo unawareness is not a term that was made up for this thread, it is a medical term, not a forum based idea.
 
John.

Have a read of the symptoms and causes of Hypoglycaemia - very enlightening. It relates to ALL Dibetics not a narrow band of them.

As for Sue, she has an excellent comprehension of the subject and excellent hypo awareness. She probably knows more about Diabetes than most GP's. Your suggestion that she has a problem is WAY short of the mark !

This is really something that YOU should be aware of, perhaps you need to do some further reading and brush up on the subject. Have a nice day. :D

Hypoglycaemia.
http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/

Reversing Hypoglycaemia Unawareness.
http://www.diabetes1.org/news/Reversing ... nawareness
 
catherinecherub said:
.......Wally, this Dr. who tells you not to be concerned about this. Is he the same one who told you to eat gigantic portions of starchy carbs to control your diabetes? Hypo unawareness is not a term that was made up for this thread, it is a medical term, not a forum based idea........
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Hi Catherine,

Yes - he is! However, he is a well-respected-in-diabetes-circles doctor. He chairs at least on are diabetes groups within the local PCT and I do know that he used to chair another. Moreover, he is a doctor that I admire and the only one that I've ever gone to for about nine years now. If he's not available - I wait - or attend another of his clinics in neighbouring town. I certainly, don't expect him to be perfect quite simply because he's no different to the rest of us in that respect.

The entire "do not test" advice given to so many non-insulin Type 2s must be based on something. I had always thought the reason to be that this category of Type 2s were not expected to "suffer disabling hypoglycaemia" as the DVLA call it. As described earlier, certainly I seem to fall exactly into that category.

Best wishes - John
 
"wallycorker"The entire "do not test" advice given to so many non-insulin Type 2s must be based on something.
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It is....it's extremely simple.....it is all down to COST.

I had always thought the reason to be that this category of Type 2s were not expected to "suffer disabling hypoglycaemia" as the DVLA call it.
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We are not talking about the DVLA definition of 'disabling' Hypoglycaemia or who or what it relates to. We are talking about the medical terminology of hypoglycaemia and it's causes and effects on anyone, particularly a Diabetic. The related problem of hypo unawareness in anyone, but mainly in a Diabetic. Those are the issues.

Quite rightly the DVLA concentrate on people who are taking oral meds or are on hypo inducing drugs such as Insulin etc. They do not discuss hypo's in either non Diabetic's or Diabetic's on diet only. That doesn't mean it does not/will not happen, doesn't exist. They cannot cover every eventuality. It is about driving matters, not Endocrinology.

Anyway off for my lunch now.....a nice joint of roast beef, roast potato, roast parsnips, chantenay carrots, cabbage and swede.......delicious. All washed down with a Chateau Highland Spring....still water. Nectar. :D :wink:
 
From what I have read it would seem to be unusual for a diet only diabetic to suffer a hypo, but that does not mean it can't happen.

For my own part i thought I had my numbers under what I considered really good control especially after my last HB A1c of 5.1%, but my diabetes nurse told me that although I had done really well I should try to avoid getting the low 4's I often recorded along with the occasional highish 3 and that I should reduce my insulin slightly to achieve this.

I had already been reducing my insulin however as I have been coming off steroids over the last 5 months and the last 6 weeks have made quite a difference, anyway I have been keeping my numbers slightly higher for the last 6 weeks or so and have not had any 3's at all and only a couple of 4.5's and my last 14 day average is 5.7%.

All things considered I do actually feel happier with marginally higher numbers, I am not constantly worried about hypos and have been a lot more relaxed, I fully expect my next HB A1c to be .5 to 1% higher than the last one but I have not had a hypo now for about 4 or 5 months and I sincerely hope that trend continues :D

If you are diet only and never feel hypo then great, but I now believe from my T2 on insulin viewpoint that it is better to be safe than sorry. Not really relevant to this thread perhaps but thats my 2 pennyworth anyway :P
 
Just another thought
If a diabetic is used to high BG over a long period. It's perfectly possible to have quite severe hypo symptoms at a normal BG, such as 5 or even a high such as 7. What then does this say about driving?
I looked on the DVLa's website and found the following:

>>The Lead Clinician pointed out that a level of 3-mmol/l blood glucose reading is recognised as producing cognitive impairment. <<
In the debate about allowing T2s on insulin to extend their driving licenses.

I could find NOTHING about unmedicated T2s and I've really searched everywhere
So I'll stand by my assertion that it's the medicine that causes the trouble.
Hana
 
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